m2c spring 2026 / water soluble vitamins

The Rhythm Nearly Proved Fully Contagious

The: Thiamin (b1)

Rhythm: Riboflavin (b2)

Nearly: Niacin (b3)

Proved: Pantothenic acid (b5)

Fully: Pyridoxine (“F”ive; b6)

Contagious: Cobalamin (b12)

vitamin b1

THIAMIN (active form —> thiamin pyrophosphate)

found primarily in:

• skeletal muscles

• liver

• heart

• kidneys

• brain

vitamin b1 DEFICIENCY

common in:

• malnourished + homeless population

• individuals w alcoholism (wernicke-korsakoff)

long-term deficiency:

• beriberi

  • poor appetite

  • irritability

  • apathy

  • confusion

  • weight loss

WET beriberi

involves the cardiovascular system

• edema is present due to cardiovascular issues

  • diuretics are given to get rid of excess fluids

DRY beriberi

involves the nervous system

• muscle wasting occurs

• neurological disorders present

  • immediate high-dose thiamin supplementation for treatment

wernicke-korsakoff syndrome

SEVERE thiamin deficiency

• caused by chronic alcohol use, leading to reduced absorption of vitamin b1

2 stage disease

• wernicke’s encephalopathy - acute stage

  • confusion/delirium

  • ataxia

  • ophthalmoplegia

• korsakoff syndrome - chronic stage

  • severe amnesia

  • confabulation

  • hallucinations/behavioral changes

vitamin b2

RIBOFLAVIN (active form —> FAD / FMN)

a prosthetic group for many enzymes

• involved in redox reactions

  • oxidative phosphorylation

  • glutathione reductase (manage oxidative stress)

vitamin b2 DEFICIENCY + TOXICITY

• inflammation of membranes

  • sore throat

  • cheilosis

  • glossitis (inflammation of the tongue)

  • stomatitis (inflammation of the oral mucosa)

  • seborrheic dermatitis

• bloodshot eyes

  • photophobia

• toxicity - no adverse effects

vitamin b3

NIACIN

• can be made from tryptophan in our body

crucial for the production + breakdown of glucose, fats, amino acids, and dna'

vitamin b3 DEFICIENCY

a mild deficiency is present in ALCOHOLICS

also those who eat CORN-BASED diets

• pellagra (rough skin)

  • casal’s necklace

• THE 4 Ds

  • diarrhea, dermatitis, dementia, death

vitamin b3 TOXICITY

toxicity can occur through vitamin b3 supplementation

• can be used for lowering LDL by actually increasing HDL (not the good kind though)

niacin flush + itching

• can be treated with low dose aspirin or ibuprofen

vitamin b6

PYRIDOXINE (active form —> pyridoxal phosphate)

used in amino acid metabolism, urea metabolism, synthesis of heme

vitamin b6 DEFICIENCY

RARE

occurs in:

• newborn infants fed formulas low in b6

• women taking oral contraceptives

• alcoholics

• as a consequence of drug therapy

  • tuberculosis (taking isoniazid)

  • rheumatoid arthritis (taking penicillamine)

symptoms

• cheilosis

• glossitis

• pellagra-like dermatitis

• depression

• confusion

vitamin b6 TOXICITY

side effects of HIGH doses:

• irreversible nerve damage

  • severe sensory nerve damage

  • walking difficulties

  • numbness of hands and feet

vitamin b9

FOLATE

used for the synthesis of dna, rna, amino acids, methionine regeneration from homocynsteine

• critical for rapidly dividing cells

vitamin b9 DEFICIENCY

caused by:

• suboptimal intake

• increased utilization

  • pregnancy

• inadequate absorption

  • celiac disease

  • crohn’s disease

• alcoholics

• elderly w poor diet

• those taking antacids

symptoms:

• macrocytic anemia (megaloblastic anemia)

• high homocysteine level is a marker for increased risk of heart risk

  • weakness

  • fatigue

  • headache

  • palpitations

  • shortness of breath

IN THIS CASE, FOLATE SUPPLEMENTATION WILL REVERSE THE ANEMIA BUT NOT NEUROLOGICAL DAMAGE CAUSED BY B12 DEFICIENCY!!!! (this is how you differentiate between the two)

vitamin b9 TOXICITY

excessive consumption of folic acid supplements may mask a b12 deficiency

• this allows neurological problems to keep progressing in spite of the anemia being resolved

vitamin b12

COBALAMIN

stomach: HCl + pepsin release b12 bound to protein in food; free b12 binds to r protein; intrinsic factor is released by parietal cells

duodenum: pancreatic enzymes break down r protein; are b12 binds to IF

ileum: b21 + IF complex is absorbed into blood and bonds to transport protein ‘transcobalamin II’

• b12-transcobalamin II complex enters portal vein and is delivered to liver

liver: b12 can be stored for years

vitamin b12 DEFICIENCY

caused by:

• decreased intake from food

• malabsorption

  • decreased IF

  • decreased gastric acid

  • removal of terminal ileum

symptoms

• pernicious anemia

  • autoimmune inactivation os IF which means the body can’t absorb b12

• megaloblastic anemia

• nerve damage (this is the long-term effect)

• painful swollen tongue

vitamin b7

BIOTIN

co-enzyme that adds co2 to compunds

it’s required for metabolism of carbohydrates, fats and proteins

• ABC carboxylases

  • ATP, Biotin, CO2

    • acetyl coa carboxylase

    • pyruvate carboxylase

    • propionyl coa carboxylase

vitamin b7 DEFICIENCY

RARE

usually due to a biotinidase enzyme deficiency

• the body is unable to reuse and recycle biotin

• this is an inherited autosomal recessive disorder

  • hypotonia

  • seizures

  • alopecia

  • eczema

  • developmental delays

  • lactic aciduria

also excessive consumption of raw egg whites

• avidin is a protein that binds the biotin and doesn’t allow it to be used

vitamin b5

PANTOTHENIC ACID (form —> coenzyme a acyl carrier)

from milk, meat, and vegetables

used in the synthesis of fatty acids, triacylglycerol, cholesterol, and acetylcholine

also in the synthesis of cell membranes

vitamin b5 DEFICIENCY

RARE

caused by:

• severe malnutrition

• severe malabsorption

  • individuals w alcoholism

symptoms:

• burning feet

• fatigue

• headache

• gastrointestinal issues

  • nausea

  • vomiting

  • stomach cramps

  • diarrhea

vitamin c

ASCORBATE

used in the formation of collagen, synthesis of neurotransmitters, synthesis of carnitine

it’s a water soluble antioxidant

increases the bioavailability of iron from foods

vitamin c DEFICIENCY

occurs in:

• urban/poor older adults

• severe burns/fractures

• individuals w alcoholism (decreases absorption)

• individuals who smoke (depletes tissue levels)

symptoms:

• scurvy

  • muscle weakness

  • joint pain

  • impaired would healing

  • loose teeth

  • bleeding and swollen gums

  • bruised skin

  • fatigue

vitamin c TOXICITY

vitamin c is metabolized to oxalic acid

• patients with a history of forming oxalate kidney stones should avoid high doses of vitamin c