1. CHAPTER 9:
VITAMINS
MEDICAL
BIOCHEMISTRY

2. THE WONDERFUL WORLD OF
VITAMINS/MINERALS/SUPPLEMEN
TS
Pill pushers claim that
supplements are necessary
to guard your health,
compensate for processed
foods, enhance your
athletic abilities, and
promote future “super
health”

3. WHAT ARE VITAMINS?
s VITAMINS are essential organic
substances needed in minute
amounts by the body to perform
specific metabolic functions
s When a vitamin is synthesized
from existing chemicals in the
body the ingredient to make the
conversion are called pro-
vitamins (ex: carotine--Vit A.)

4. THERE IS NO
DIFFERENCE OR
ADVANTAGE BETWEEN A
VITAMIN OBTAINED
NATURALLY FROM FOOD
AND A SYNTHETIC
VITAMIN
ONLY 13 LEGITIMATE VITAMINS EXIST
• ORGANIC SUBSTANCES
• REQUIRED FOR SPECIFIC METABOLIC
FUNCTION
• NEEDED IN SMALL AMOUNTS

5. NON-VITAMINS
s RUTIN (Lipoic Acid)
s Bioflavonoids (Vit P)
s Par-amino-benzoic acid
(PABA)
s Carnitine (Choline)

6. Where do Vitamins
Come From?
s All vitamins are found in
green leaves and roots of
plants except Vit B12 which
is found only in animals
s Man cannot synthesize Vit C
and most of the fat soluble
vitamins

7. VITAMIN
ABSORPTION

8. FUNCTIONS OF VITAMINS
s essential links and regulators in
metabolism
s tissue synthesis

9. TWO TYPES OF
VITAMINS
s FAT SOLUBLE
- A (Retinol); D (Cholecaciferol); E
(Tocopherol); K (Menadione)
s WATER SOLUBLE
- C (Ascorbic Acid); B-complex-
Thiamin, Riboflavin, Niacin,
B-6, Pantothenic Acid, Biotin,
Folacin, B-12

10. FAT SOLUBLE
VITAMINS
A, D, E, K
- Daily ingestion unnecessary,
as they are stored in the
liver, fat cells and
subcutaneously
- No mechanism to leave the
body
- Can be toxic in excess

11. FAT SOLUBLE
VITAMINS
VITAMIN DEFICIENCY
EXCESS
Vit A night blindness headach, vomiting,
anorexia swelling
Vit D rickets vomiting, diarrhea
Vit E possible anemia relatively nontoxic
Vit K severe bleeding relatively nontoxic,
jaundice

12. VITAMIN A
Carotenoids
s Functions
- Source of vitamin A
- Antioxidants
- Other health benefits
s Food Sources
- Yellow-orange vegetables
- Orange fruits
- Dark-green leafy vegetables

13. Three biologically active molecules:
retinol, retinal (retinaldehyde) and retinoic
acid.
R
Retinal Retinoic Acid
Retinol

14. ß-carotene is Converted to Vitamin A
ß-carotene
ß-carotene O2
Dioxygenase
Bile salts
H
C
Retinaldehyde
O
C O
H
Retinaldehyde

15. Retinal is Reduced to
Retinol
H
C
Retinaldehyde O
NADPH (NADH)
Retinaldehyde + H+
Reductase
NADP+ (NAD+)
CH2OH
Retinol

16. Retinal can be Oxidized to
Retinoic Acid
H
C
Retinaldehyde O
NAD,
FAD
OH
C
O
Retinoic acid
(all-trans)

17. Cells Dependent on Vitamin A
s Skin
s Cornea
s Trachea
s Immunocytes

18. Bitot’s Spots

19. Bitot’s Spots

20. Vitamin A in Food =
Carotene + Vitamin A Esters

21. Hypervitaminosis A
s Vitamin A
(not carotenoids)
s Liver damage
s Hemorrhage
s Coma
s Death

22. Vitamin A Teratogenesis
s Associated with > 20% rate
of spontaneous abortions
and birth defects
s 13-cis-retinoic acid
s During first trimester
s Accutane

23. Anti-carcinogenic Properties of
Vitamin A
s Epidemiologic studies
- Colon
- Skin, breast, liver, prostate, & lung
s Not replicated in basal diet
separately or in combination
s Other compounds in fruits & vegetables?
s Mechanism?
- Oxygen radical trap
- A complements properties of E

24. VITAMIN E
sA vitamin in search of a
disease!
“no known evidence of dietary
deficiency of vitamin E in
humans”
s Anti-oxidant effects
- protects polyunsaturated fats
and vitamin A from destruction
by oxygen

25. Vitamin E (TOCOPHEROLS)
-The α-tocopherol molecule is the most potent of
the tocopherols.
-is absorbed from the intestines packaged in
chylomicrons.
- is delivered to the tissues via chylomicron
transport and then to the liver through
chylomicron remnant uptake. The liver can
export vitamin E in VLDLs.
- Due to its lipophilic nature, vitamin E
accumulates in cellular membranes, fat deposits
and other circulating lipoproteins.
- - The major site of vitamin E storage is in
adipose tissue.

26. Vitamin E
Major Function:
-Act as a natural antioxidant by
scavenging free radicals and molecular
oxygen. In particular vitamin E is
important for preventing peroxidation of
polyunsaturated membrane fatty acids.
The vitamins E and C are interrelated in
their antioxidant capabilities.

27. Sources and Absorption of
Vitamin E
s Vegetable oils
s Bile salts
s Pancreatic secretions
s Mixed micelles
s Chylomicrons

28. Clinical Significances of
Vitamin E Deficiency
s No major disease states have been
found to be associated with vitamin E
deficiency due to adequate levels in the
average American diet. The major
symptom of vitamin E deficiency in
humans is an increase in red blood cell
fragility. Since vitamin E is absorbed from
the intestines in chylomicrons, any fat
malabsorption diseases can lead to
deficiencies in vitamin E intake.

29. s Neurological disorders have been associated
with vitamin E deficiencies associated with
fat malabsorptive disorders.
s Increased intake of vitamin E is
recommended in premature infants fed
formulas that are low in the vitamin as well
as in persons consuming a diet high in
polyunsaturated fatty acids.
s Polyunsaturated fatty acids tend to form free
radicals upon exposure to oxygen and this
may lead to an increased risk of certain
cancers.

30. Vitamin E

31. Progression of Neurologic Symptoms of
Vitamin E Deficiency
+ 19 - 25% of patients + 25 - 75% of patients
+ 75 - 100% of patients
Hypoflexia or Areflexia
Truncal Ataxia
Limb Ataxia
Peripheral Neuropathy
Ophthalmoplegia
0 2 4 6 8 10 12 14 16
Age intervals, Year

32. VITAMIN D
s Vitamin D is a steroid hormone
that functions to regulate specific
gene expression following
interaction with its intracellular
receptor.

33. VITAMIN D
s The biologically active form of the
hormone is 1,25-dihydroxy vitamin
D3 (1,25-(OH)2D3, also termed
calcitriol).
s Calcitriol functions primarily to
regulate calcium and phosphorous
homeostasis.

34. THE ROLE OF
VITAMIN D
s Maintains plasma calcium &
phosphorous concentrations
s Supports cellular processes,
neuromuscular function, & bone
ossification
s Enhances calcium & phosphorous
absorption from small intestine &
mobilization from bone

35. VITAMIN D
Exists as several lipids;
1) D3 - made in skin exposed to
sunlight.
2) D2 - additive in fortified milk

36. Ergocalciferol (vitamin D2)
Cholecalciferol (vitamin D3)

37. Vitamin D
Metabolism

38. Bone Mineral
Content in
Children w/
Cholestasis
Changes in
Bone Mineral
Content

39. Bowed Legs of
Rickets

40. Rachitic Rosary

41. TOXICITY OF VITAMIN
D
s War-time supplementation
- 2,000 IU + 50 - 100 % more
- Nutritional deprivation
- Lack of sunlight
s Epidemic of calcimia
s Some permanent brain damage
s Resultant laws in Europe

42. VITAMIN D
s Deficiency
- Rickets in children
- Osteomalacia and
osteoporosis in
adults
s Toxicity
- Hypercalcemia

43. VITAMIN K
s Functions
- Blood clotting
- Formation of bone
s Food sources
- Green vegetables, liver,
egg yolks

45. VITAMIN K
(P hylloquinone)

46. Hemorrhagic Disease of the
Newborn
s Intrauterine vitamin K deficiency
s Sterile intrauterine gut
s Why/how would Mother Nature let this
happen?

47. Water Soluble
Vitamins
s Transported throughout
the water medium of the
body
s Not stored in the body

48. Deficiency of Water
Soluble Vitamins
s Pathophysiology is result of
reduced enzyme activities.
s Multiple deficiencies are common.
s Diagnostic Challenge? To
recognize multiple findings.

49. Drugs may act as Vitamin
Analogs (Media Serv)

51. Toxicity of Water
Soluble Vitamins
s Toxicity recapitulates deficiency if
co-enzyme ≠ vitamin
s Enzyme inactivation
s Thiamin, Riboflavin, Niacin,
Niacin, Pyridoxine, Folic acid
s Not Biotin or Vitamin C

54. Causes of Water Soluble
Vitamin Deficiency
s Decreased intake
s Decreased absorption
- Enhanced loss during enterohepatic
circulation
s Requirement
- Pregnancy
s Decreased Precursor
- Inborn error of metabolism

55. B Vitamins
s B vitamins act
primarily as
coenzymes
s Work as catalysts
s Function in energy-
producing
metabolic reactions

56. VITAMIN B1
s
(THIAMIN)
Functions
- Coenzyme in energy metabolism
- Helps synthesize
neurotransmitters
s Food sources
- Whole and enriched grains
- Pork, legumes, nuts, liver
s Deficiency
- Beriberi

57. VITAMIN B1
(THIAMIN)

59. TPP-ATP
Phosphoryltransferase
ATP TPP
Thiamine TPP
Thiamine-ATP
Phosphoryl Transferase

61. Clinical Significances of Thiamin
Deficiency
s The earliest symptoms of thiamin deficiency
include constipation, appetite suppression, nausea
as well as mental depression, peripheral
neuropathy and fatigue.
s Chronic thiamin deficiency leads to more severe
neurological symptoms including ataxia, mental
confusion and loss of eye coordination.
s Other clinical symptoms of prolonged thiamin
deficiency are related to cardiovascular and
musculature defects.

62. The severe thiamin deficiency disease is known as
Beriberi, is the result of a diet that is carbohydrate rich
andt hiamindeficient.
An additional thiamin deficiency related disease is
known as Wernicke-Korsakoff syndrome. This disease
is most commonly found in chronic alcoholics due to
their poor dietetic lifestyles.
Wernicke-Korsakoff syndrome is characterized by
acute encephalopathy followed by chronic impairment
of short-term memory. Persons afflicted with Wernicke-
Korsakoff syndrome appear to have an inborn error of
metabolism that is clinically important only when the
diet is inadequate in thiamin.

63. Dry Beriberi

64. Wet Beriberi

65. VITAMIN B2
(RIBOFLAVIN)
s Functions
- Coenzyme in energy metabolism
- Supports antioxidants
s Food sources
- Milk and dairy products
- Whole and enriched grains
s Deficiency
- Ariboflavinosis

66. VITAMIN B2
(RIBOFLAVIN)
s Riboflavin is the precursor for the
coenzymes, flavin mononucleotide
(FMN) and flavin adenine dinucleotide
(FAD).
s The enzymes that require FMN or FAD
as cofactors are termed flavoproteins.

67. VITAMIN B2
(RIBOFLAVIN)

71. Clinical Significances of Flavin
Deficiency
s Riboflavin deficiency is often seen in chronic
alcoholics due to their poor dietetic habits.
s Symptoms associated with riboflavin deficiency
include itching and burning eyes, angular stomatitis
and cheilosis (cracks and sores in the mouth and lips),
bloodshot eyes, glossitis (inflammation of the tongue
leading to purplish discoloration), seborrhea (dandruff,
flaking skin on scalp and face), trembling,
sluggishness, and photophobia (excessive light
sensitivity).
s Riboflavin decomposes when exposed to visible light.

72. VITAMIN B3 (NIACIN)
s Functions
- Coenzyme in energy metabolism
- Supports fatty acid synthesis
s Food sources
- Whole and enriched grains
- Meat, poultry, fish, nuts, and peanuts
s Deficiency
- Pellagra
s Toxicity
- High doses used to treat high blood cholesterol
- Side effects: skin flushing, liver damage

73. VITAMIN B3 (NIACIN)
•Niacin (nicotinic acid and nicotinamide) is also known
as vitamin B3. Both nicotinic acid and nicotinamide
can serve as the dietary source of vitamin B3.
•Niacin is required for the synthesis of the active forms
of vitamin B3, nicotinamide adenine dinucleotide
(NAD+) and nicotinamide adenine dinucleotide
phosphate (NADP+). Both NAD+ and NADP+ function
as cofactors for numerous dehydrogenases, e.g.,
lactate dehydrogenase and malate dehydrogenase.

74. NICOTINAMIDE AND NICOTINIC
ACID

75. Clinical Significances of Niacin and
Nicotinic Acid
•A diet deficient in niacin (as well as tryptophan) leads to glossitis
of the tongue (inflammation of the tongue leading to purplish
discoloration), dermatitis, weight loss, diarrheAdepression and
dementia. The severe symptoms, depression, dermatitis and
diarrhea, are associated with the condition known as pellagra.
•Nicotinic acid (but not nicotinamide) when administered in
pharmacological doses of 2–4 g/day lowers plasma cholesterol
levels and has been shown to be a useful therapeutic for
hypercholesterolemia. The major action of nicotinic acid in this
capacity is a reduction in fatty acid mobilization from adipose
tissue. Although nicotinic acid therapy lowers blood cholesterol it
also causes a depletion of glycogen stores and fat reserves in
skeletal and cardiac muscle.

76. Pellagra’s Dermatitis- Hand

77. Pellagra’s Dermatitis- Foot

78. Casal’s Necklace &
Hyperpigmentation of
Hands:
Before & After Niacin
Therapy

79. Pellagra GI & CNS
GI symptoms
Vomiting
Diarrhea
CNS findings
Depression, insomnia, headaches, dizziness
Progression to limb rigidity, paresis, and fatal
encephalopathy

81. VITAMIN B-6
s Pyridoxal, pyridoxamine and pyridoxine are
collectively known as vitamin B6.
s All three compounds are efficiently converted to the
biologically active form of vitamin B6, pyridoxal
phosphate (PLP).
s This conversion is catalyzed by the ATP requiring
enzyme, pyridoxal kinase.

82. VITAMIN B-6
Pyridoxine Pyridoxal Pyridoxamine

83. VITAMIN B-6
Pyridoxal Phosphate

84. VITAMIN B-6
s Pyridoxal phosphate functions as a cofactor in
enzymes involved in transamination reactions required
for the synthesis and catabolism of the amino acids as
well as in glycogenolysis as a cofactor for glycogen
phosphorylase and as a co-factor for the synthesis of
the inhibitory neurotransmitter γ-aminobutyric acid
(GABA).
s The requirement for vitamin B6 in the diet is
proportional to the level of protein consumption
ranging from 1.4–2.0 mg/day for a normal adult.
During pregnancy and lactation the requirement for
vitamin B6 increases approximately 0.6 mg/day.

85. VITAMIN B-6
s Deficiencies of vitamin B6 are rare and usually are
related to an overall deficiency of all the B-complex
vitamins.
s Other symptoms that may appear with deficiency in
vitamin B6 include nervousness, insomnia, skin
eruptions, loss of muscular control, anemia, mouth
disorders, muscular weakness, dermatitis, arm and leg
cramps, loss of hair, slow learning, and water
retention.

86. VITAMIN B-6
s Functions
- Coenzyme in protein and amino
acid
metabolism
- Supports immune system
s Food sources
- Meat, fish, poultry, liver
- Potatoes, bananas,
sunflower seeds
s Deficiency
- Microcytic hypochromic anemia
s Toxicity
- Can cause permanent nerve
damage in high doses

87. VITAMIN B9 (FOLATE)
s Functions
- Coenzyme in DNA synthesis and cell
division
- Needed for normal red blood cell
synthesis
s Food sources
- Green leafy vegetables, orange juice,
legumes
- Fortified cereals, enriched grains

88. VITAMIN B9 (FOLATE)

89. FOLATE
s Deficiency
- Megaloblastic anemia
- Can contribute to neural
tube defects
- Women of childbearing age
need 400 micrograms/day
of folic acid
s Toxicity
- Can mask vitamin B12
deficiency

90. CLINICAL SIGNIFICANCE
OF FOLATE
Folate deficiency results in complications nearly
identical to those described for vitamin B12 deficiency.
The inability to synthesize DNA during erythrocyte
maturation leads to abnormally large erythrocytes
termed macrocytic anemia.
Certain drugs such as anticonvulsants and oral
contraceptives can impair the absorption of folate.

91. VITAMIN B-12
Cobalamin is more commonly known as
vitamin B12.
Vitamin B12 is composed of a complex
tetrapyrrol ring structure (corrin ring) and a
cobalt ion in the center.
Vitamin B12 is synthesized exclusively by
microorganisms and is found in the liver of
animals bound to protein as methycobalamin
or 5‘deoxyadenosylcobalamin.

92. VITAMIN B-12
s Functions
- Needed for normal folate function
• DNA and red blood cell synthesis
- Maintains myelin sheath around nerves
s Food sources
- Only animal foods: meats, liver, milk,
eggs
s Deficiency
- Pernicious anemia
• Megaloblastic anemia + nerve damage

93. STRUCTURE OF VITAMIN
B-12
Cobalamins
Corrin ring contains
central cobalt atom
Adenosylcobalamin
Methylcobalamin

94. VITAMIN B-12
VITAMIN C

95. VITAMIN B-12

96. VITAMIN B-12
Pernicious anemia
Megaloblastic anemia
Neuropathy: particularly degeneration of spinal
cord
Universally fatal
Extrinsic factor from liver
Patients were not producing enough
Gastric acid to denature R protein
Intrinsic factor

97. VITAMIN C
s Increases absorption of iron
s Influences serum cholesterol
s Affects immune system
s Affects synthesis of collagen
s Affects drug metabolism
s Protects DNA in sperm

98. VITAMIN C (cont)
s Megadoses
- 1970 Linus Pauling - Vit C &
common cold
• recover more quickly
s Possible
effects of
megadoses
- Gout
- Destruction of B vitamins
- Breakdown of RBC

99. VITAMIN C (cont)
Ascorbic Acid

100. VITAMIN C
s Deficiency in vitamin C leads to the disease
scurvy due to the role of the vitamin in the post-
translational modification of collagens. Scurvy is
characterized by easily bruised skin, muscle
fatigue, soft swollen gums, decreased wound
healing and hemorrhaging, osteoporosis, and
anemia.
s Vitamin C is readily absorbed and so the primary
cause of vitamin C deficiency is poor diet and/or an
increased requirement. The primary physiological
state leading to an increased requirement for
vitamin C is severe stress (or trauma). This is due
to a rapid depletion in the adrenal stores of the
vitamin.

101. VITAMIN C (cont)

109. CHAPTER 10
MINERALS
s 4%of the body’s mass is
composed of 22 metallic
minerals

110. Major and Minor
s Major
Minerals
Minor s
Minerals Minerals
(< 100 mg/day)
(>100 mg/day)
- iron
- sodium
- zinc
- potassium - copper
- calcium - selenium
- phosphorus - iodine
- magnesium - fluorine
- - chromium
sulfur
- molybdenum
- chlorine
- manganese
• 4% of body mass consists of minerals

111. Minerals
s BIOAVAILABILITY
- HOW MUCH IS ABSORBED
BY THE BODY
• VITAMIN/MINERAL
INTERACTION
• FIBER/MINERAL
INTERACTION

112. Where Do Minerals
Come From?
s Minerals occur freely in nature
(rivers, lakes, oceans, topsoil, under
earth’s surface
s Minerals are found in root systems
of plants and in the body structures
of animals that consume plants and
water
s Best sources of minerals are animal
products (because they are more
concentrated in animal tissues than
in plants)

113. Function
s of
Minerals

114. Recommended Intake
and Sources of Minerals
s Mineral supplements are generally
not needed because most
minerals are readily available in
foods and the water supply
s Exceptions include some
geographic regions where the soil
or water is deficient in a particular
mineral
- What regions are scarce in iodine?
- What is iodized salt?
- What is iron insufficiency?

115. IODINE
-is required for the synthesis of the
thyroid hormones
- plays an important role in the
regulation of energy metabolism via
thyroid hormone functions.

116. Iodine- A major Deficiency
Problem in the World
s Swelling of thyroid
gland known as
goiter (iodine
deficiency)
s Hypothyroidism
-lower metabolism,
Goiter metal retardation,
cretinism
s 20% of world pop is

117. Vitamin-Mineral
Interactions
s Thereis synergism in consuming
some minerals and vitamins
together
- Fe absorption is improved with
vitamin C
(drink glass orange juice with Fe
containing foods)
- Ca uptake is facilitated if Ca-rich
foods are consumed with foods
high in vitamin D

118. Fiber-Mineral
Interactions
s Consuming too much fiber (>35g
daily) decreases absorption of Ca,
Zn, Mg, and Fe
These minerals become bound to
dietary phytate and oxalate and are
excreted
in the urine and feces
s What are phytate and oxalate?
- fiberous compounds that bind minerals
• phytates found in coffee, grain fibers
• oxalates found in chocolate, tea, coffee

119. Calcium
s The body’s most abundant mineral
(1.5 to 2.0% of body mass; 1400 g)
s Ca combines with P to form
hydroxyapatite, the crystalline
structure of bones and teeth
s Ionized, Ca serves these
functions:
• muscle contraction
• transmission nerve impulses
• activation of enzymes
• blood clotting
• fluid movement across membranes

120. What is
Osteoporosis?
s When calcium is deficient, the
bones “give up” their Ca to try
and restore the deficit. The bones
literally become “hollow” or
porous, leading to breaks and
fractures
s The hormone estrogen is linked
to osteoporosis (because
estrogen enhances Ca
absorption; a decrease in
estrogen no longer offers a

121. Osteoporosis
Bone Disease of Epidemic
Proportions
s 1.2 million fractures yearly
s 500,000 spinal fractures
s 230,000 hip fractures
s each year, 1.3 million osteoporetic women
will fracture one or more of their bones
s About 1 of 6 older men & 1 of 3 older women
will sustain hip fractures (death will occur in
20%)
s Often, x-rays don’t detect the disease until
bone loss reaches 30 to 50% of its total
mineral content!

122. Progressive
Disease
s 30-50% bone loss by age
70 y
s Shrinkage of spinal
vertebrae

123. Who Gets the
Disease?
s By age 50, men lose about 0.4%
bone each year; in women, the loss
is about 0.8% starting at age 35
(double the loss 15 years sooner!)
s During menopause, bone loss
accelerates to between 1% to 3%
each year. Thus, by age 60, a
woman can lose about 15% of her
bone mass, and by age 70, bone
loss can be as much as 30%

124. Where Does The
Bone
s
Loss Occur?
Most occurs in the vertebrae (person
shrinks in stature by up to 6 inches
from age 45-50 to age 70).
s The “spongy” bone (trabecular bone)
loses its mineral content, causing the
bone to crumble. The inside of the
bone becomes honeycombed (like a
beehive) and porous

125. Why is Dietary Calcium
Crucial?
s Shockingly, about 30% of college-
age females consume only 400 to
500 mg of calcium daily (RDA =
1200 mg daily)
s Calcium rich foods (dairy products)
contain vitamin D and this increases
Ca absorption into the bones
s Adequate Ca intake, begun at an
early age (6-14 years old),
increases bone density

126. CALCIUM AND EXERCISE
HELPS
s 1200 to 1500 mg Ca
- sardines, pink salmon, ricotta
cheese, dried figs
• calcium carbonate and calcium citrate
can help
• meat, salt, coffee, alcohol inhibit Ca
absorption
s Exercise -weight bearing help
- weight training important for “bone
fitness”

127. Sodium: How Much is
Enough?
s isa key circulating electrolyte
s functions in the regulation of ATP-
dependent channels with potassium.
s These channels are referred to as
Na+/K+-ATPases and their primary
function is in the transmission of nerve
impulses in the brain.

128. Sodium: How Much is
Enough?
s Excessive sodium intake increases fluid
volume and peripheral vascular
resistance
- sodium-induced hypertension (occurs in 1/3 of
individuals with hypertension in U.S. and
Japan)
s Recommended level = 1100 to 3300
mg/day (average in U.S = 3000 to 7000
mg/day; amount actually needed = 500
mg/day)
s Sodium plentiful in table salt, MSG, soy
sauce, condiments, canned foods, baking
soda, baking powder

129. IRON
s although considered a trace element,
has a critical role in the transport of
oxygen.
IRON
s Iron is the functional center of the heme
moiety found in each of the protein
subunit of hemoglobin.
s The function of iron is to coordinate the
oxygen molecule into heme of
hemoglobin so that it can be transported
from the lungs to the tissues.

130. IRON
s 80% of Fe is heme (heme +
protein globin --->
hemoglobin
s Iron Deficiency Anemia -
iron isufficiency (low Hb -
sluggishness, loss of
appetite.
s Inadequate Fe intake
(30-50% of females Fe

131. Other Functions of
Iron
s Heme iron is an important
component of myoglobin, a storage
and transport compound of oxygen
within muscle cells (myoglobin
contains about 5% of the body’s
total iron stores)
s Heme iron a constituent of
cytochromes that aids energy
transfer within mitochondria
s Cytochromes transfer electrons
(H + ) during redox reactions in
cellular respiration

132. Iron Deficiency
s
Anemia provides only
Fact: Typical Western diet
6 mg iron per 1000 calories of food
intake
s Hemoglobin (Hb) reduced to low levels
and produces sluggishness, loss of
appetite, reduced exercise capacity
s Thus, a female who consumes 1700
kCal daily only consumes 10.2 mg iron
daily
s Recommended intake for females: 15
mg/d
s Recommended intake for males: 12 mg/

133. Sports Anemia?
s Clinical anemia (12 g/100 ml
blood)
s Fe loss is transient and
occurs in early phase of
training

134. Iron Status in
Females
s 30 to 50% of American women
(young children, teenagers, women
of child-bearing age, and “athletes”
are iron deficient
s Consuming an additional 5 mg iron
a day would would increase iron
intake by 150 mg in one month. If
15-17% of this iron is absorbed,
this would make an additional 15 to
25 mg available to help to counter
the 5 to 45 mg iron loss during
menstruation

135. Source of Iron
Important
s Iron absorption varies depending on the
source of the iron (i.e., bioavailability
depends on the source of the iron)
s Vegetable sources: 2-20% of iron absorbed
s Animal sources: 10-35% of iron absorbed
s Are vegetarian athletes at risk for iron
insufficiency?
s What can you do to increase iron absorption?
- add foods rich in vitamin C to iron rich
foods to increase their bioavailability.
- drink glass OJ with cereal; add sesame
seeds to salad; add wheat germ to cereal.
This produces

136. Minerals and
Exercise
s Sweat loss during exercise
(1-5 kg loss is common) - 1.5 -
8.0 g salt
- Heat cramps - involuntary muscle
spasms
- Heat exhaustion - weak rapid
pulse, low BP, headache,
dizziness, sweating reduced
- Heat Stroke - sweating ceases,
circulatory collapse, death

137. Water
sThe energy content of a food is inversely
related to it’s water content. What does this
mean?
Foods high in water content are low in
calories, and foods low in water content
are high in calories
cheese
hi
Example: (cheese v watermelon) water
melon
lo
calories

138. Foods High in Water
Content
(are low in calories)
%Water kCal
s Lettuce 95.8% 3.7
s Tomato, Squash, Pumpkin 93.7% 5.7
s Cabbage 92.2% 6.5
s Strawberries 91.5% 8.6
s Watermelon 91.2% 8.9
s Grapefruit 90.8% 9.1
s Chocolate fudge 8.1% 115

139. Soft Drink Consumption
in the United States
s The average American
consumes 1 gallon of soft
drinks each week (52 gallons
a year), or about 1 ton of soft
drinks between the ages of 20
and 50!
s One-third of soft drinks are
diet drinks

140. Hydration
s Terminology
Euhydration
- Normal daily water variation
s Hyperhydration
- Increased water content
s Hypohydration
- Decreased water content
s Dehydration
- Losing water
s Rehydration
- Gaining water

141. Body’s Water Compartments
s Intracellular fluid or ICF (62%)
s Extracellular fluid or ECF (38%)
- Blood plasma accounts for 20% of ECF (3 L)
• When you sweat, the water comes from the blood
plasma (i.e., the ECF)
• If you don’t replace the ECF volume by
consuming water on a regular basis, blood
viscosity increases, placing a strain on
cardiovascular function
• Other components of the ECF include lymph,
saliva, fluids in eyes and joints, fluids secreted by
glands, fluids in the intestines, fluids excreted by
kidneys and skin, and fluids bathing nerves and
spinal cord

142. Electrolytes and
Body Water
s ICF
- low concentrations of Na + and Cl-
- high concentrations of K+
s ECF
- high concentrations of Na + and Cl-
- low concentrations of K+

143. Water Absorption
s 2.0 Liters ingested daily
- Saliva, gastric secretions, bile and
pancreatic and intestinal secretions
contribute an additional 7 L each
day
s Of the 9 Liters ingested, not all is
absorbed
- Ingested solutions and foods (salt,
AA, sugar drinks) blunt water
absorption

144. Urine
s pH ranges between 4.5 to 8.0
s High protein diets produce acidic
urine
s CHO rich (vegetarian) diets produce
alkaline urine (is pH above or below
7.4?)
s Color of urine produced by pigment
urochrome, an end product of Hb
breakdown
s In disease states, smell of urine
changes; fruity smell (acetone) in
diabetes, and solutes in urine

145. Functions of Body
Water system
s Serves as body’s transport
s Gas transport and gas exchange takes
place across moist surfaces
s Nutrients and gases are transported in
aqueous solution
s Waste products exit via urine and feces
s Water has heat stabilizing qualities
(absorbs large amounts of heat with
minimal changes in Temp)
s Fluids lubricate joints; prevents bone
grinding
s Gives turgor to body tissues because

146. Water
Balance
- No
Exercise

147. Water
Balance
with
Exercise

148. Defend Against
Dehydration
s Don’t remove “soaked” clothing—
dry clothes hinder evaporative
cooling
- Evaporation major physiologic
defense
- Evaporative loss of 1 L of sweat =
600 kCal of heat energy loss
s Drink water regularly during
physical activity, especially during
events lasting 60 minutes or

149. What is the
Primary Aim
of Fluid
Replacement?

150. To maintain plasma
volume
so that circulation and
sweating progress at
optimal levels

151. Glucose Polymers
s What is a glucose polymer? (link
of 10-15 glucose molecules)
s Sports drinks are popular
because:
- low osmolarity (maltodextrins).
Polymerized glucose solutions
provide water and CHO at a faster
rate than a drink of similar CHO
content consisting of
monosaccharides Summary:
Generalized and disaccharides.
Drink Cool Solutions, Drink Often, Choose the Brand
Wisely

152. Gastric Emptying
s Fluids must be emptied from the
stomach before absorption in the
small intestine.
s Three factors influence gastric
emptying:
- Fluid temperature; cold water empties
fastest (41 degrees F)
- Fluid volume; 8.5 oz every 15 min. Too
much slows gastric emptying
- Fluid osmolarity; gastric emptying slowed
when fluid is concentrated >10%. Sugary
solutions (4 - 8% should be goal for CHO
concentration for exercise longer than 60

153. Water Intoxication
(Hyponatremia )
s Water intoxication refers to excessive
water intake of more than 10 quarts a
day
s Causes significant dilution of the
body’s normal sodium concentration
s Symptoms include head-ach, blurred
vision, excessive sweating, and
vomiting. In severe cases, there is
cerebral edema, convulsions,
comatose, and death

154. Exercise and Heat
s Prevention is the most
effective way to control heat
stress injuries
- Acclimatization
- Water
- Salt
- Know when to exercise

155. Heat Disorders
HEAT CRAMPS
Cause: Prolonged exer in heat; negative Na
Symptom: Tightening, cramps, low Na
Prevent: Salt, acclimatization
HEAT EXHAUSTION
Cause: Cumulative negative water loss
Symptom: Exhaustion, hypohydration, flushed skin
Prevent: Hydration before, during exercise
HEAT STROKE
Cause: extreme hyperthermia, circulation failure
Symptom: hyperpyrexia, lack of sweat, neurologic
failure
Prevent: Acclimatization, water, minerals, no exercise

156. Activity And Heat

159. ACSM Position Stand:
Exercise and Fluid Replacement
1. Primary objective for replacing body fluid loss
during exercise is to maintain normal hydration.
2. Important to consume adequate fluids during the
24-h period before an event and drink about 500
ml (about 17 0z) of fluid about 2 h before exercise
to promote adequate hydration and allow time for
excretion of excess ingested water.

160. 3. To minimize risk of thermal injury and impairment of
exercise performance during exercise, fluid replacement
should attempt to equal fluid loss.
4. At equal exercise intensity, the requirement for fluid
replacement becomes greater with increased sweating
during environmental thermal stress.
5. During exercise lasting longer than 1 h, it
is important to do the following:
a. add CHO to the fluid replacement solution to maintain blood
glucose concentration and delay the onset of fatigue

161. b. electrolytes (primarily NaCl; ) should be added to the
fluid replacement solution to enhance palatability and
reduce the probability for development of
hyponatremia.
c. During exercise fluid and CHO requirements can be
met simultaneously by ingesting 600-1200 ml/hr of
solutions containing 4% to 8% CHO.
d. During exercise greater than 1 h, approximately 0.5 to
0.7 g of sodium per liter of water would be appropriate
to replace that lost from sweating.

162. Water Loss
and
Temperatur
e

163. SUPPLEMENTS
&
ERGOGENIC AIDS

164. Ergogenic-“tending to increase work”
An ergogenic aid is defined as “.. A
physical, mechanical, nutritional,
psychological, or pharmacological
substance or treatment that either
directly improves physiological variables
associated with exercise performance or
removes subjective restraints which may
limit physiological capacity”

165. Examples of Ergogenic Aids
• Warm-up • Caffeine ingestion • Carbohydrate ingestion
• Liquid ingestion • Glycerol ingestion • Phosphate ingestion • •
• Creatine ingestion • Blood doping • NaHCO3- ingestion
• Erythropoietin • Growth hormone • Testosterone
Nutritional Ergogenic Aids
• Caffeine Glycerol • Carnitine Phosphate
• Sodium Bicarbonate • Dichloroacetate
• Creatine • Branched chain amino acids

166. Nutritional
Herbs/Supplements
During the last decade, the use of
herbs as nutritional supplements has
expanded significantly. Thus,
knowledge of herbs, their purported
beneficial effects, and possible
negative side effects takes on added
importance for athlete and others
contemplating their use.

167. HERBAL AGENTS
Commonly used herbal compounds
- Astragalus (Huang qi)
- Bilberry (Vaccinium myrtillus)
- Bee Pollen (Buckwheat pollen; Puhuang)
- Chamomile
- Echinacea (Echinacea purpurea)
- Ephedra
- Garlic (Allium sativum)
- Ginseng, Asian (Pannax)
- Ginseng, Siberian (Eleuthero Root)
- Ginkgo Biloba (Maindenhair tree)

168. HERBAL AGENTS
Commonly used herbal compounds (cont)
Guarna (Paullinia cupana)
Kava Kava (Piper methysticum)
Milk Thistle (Silbum marianum)
Glucosamine Sulfate
Grape Seed Extract
Saw Palmetto (Serenoa repens)
St. John’s Wort (Hypericum perforatum)
Witch Hazel (Hamamelis virginiana)
Yohimbe
Valerian

169. Anabolic
Steroids
s Structure and action
- Sterol structure similar to testosterone
- Promotes protein synthesis
s Stacking
- Combining multiple steroid
preparations in oral & injectable form
s Pyramiding
- Progressively increasing the dosage

170. Anabolic Steroids
s Drug with a considerable
following
- Its becoming increasingly
popular with more than just
strength athletes
s Effectiveness
- Dosage is an important factor
- Training volume accompanying
use

171. Changes from
baseline in average
FFM, muscle, fat,
and strength over
10-wks of
testosterone
treatment

172. Examples of oral and injectable anabolic steroids
Generic Name Commerical Form Retail $ Black
Name Market $
Oxymetholone Anadrol-50 Oral: 50 mg $115/100 tabs $200-500
Oxandrolone Oxandrin Oral; 2.5 mg $420/100 tabs $600-1600
Stanazolol Winstrol V Oral; 2 mg $100/100 tabs $200-500
Nandrolone Durabolin Inject; 25 mg/ml $275/ml vial $200-500
Deconate Deca-Durabolin Inject; 25 mg/ml $12/2 ml vial $400-750
Androlone-D200 Neo-durabolic Inject; 50 mg/ml $12/2 ml vial $450-750

173. Life-shortening Effects of Exogenous Steroids Use in Mice

174. Anabolic
s
Steroidsrisks
Side effects and medical
• Cystic acne, “road rage,” peliosis hepatis,
increased plasma lipoproteins
• In males: testicular atrophy & gynecomastia
• In females: clitoral enlargement, squaring of the
jaw, lowering of voice
• ACSM Position Statement on Anabolic Steroids

175. Growth Hormone
s Genetic engineering comes to sports
- Human growth hormone
• Produced in the Pituitary gland
• Stimulates bone & cartilage growth
• Enhances fatty acid oxidation
• Reduces glucose & amino acid breakdown
- Excess GH may result in:
• Gigantism
• Acromegaly
- No unanimity among researchers

176. DHEA: A Worrisome
Trend
s DHEA- Dehydroepiandersterone
- Steroid hormone produced by the adrenal glands
s Claims for DHEA
• Testosterone booster
• Bolsters immune system
• Preserves youth
• Decreases fatigue & joint pain
• Slows aging
• Invigorates sex life
- An unregulated compound with uncertain safety

178. Androstenedione
s Claims:
- Stimulates production of endogenous testoterone
- Enables one to train harder
- Increases muscle mass
- Aids healing/recovery process
s Research shows no effect of
supplementation on basal serum
testosterone or any training response in
terms of muscle size & strength

179. Amino Acid
Supplements for an
Anabolic Effect
Claims:
Boost body’s natural production of:
- Testosterone
- Growth hormone
- Insulin-like Growth Factor – 1
Resulting in an increase in muscle mass
and a reduction in fat mass

180. Creatine
s Supplement form - creatine monohydrate
- Important component of high-energy phosphates
- Documented benefits in humans
• Improved muscular strength and power
• Enables heavier lifting for greater overload
- Creatine loading
• 20 –25 g/day
- Some research shows no benefit

181. Amino Acid
Supplements
Stimulating an anabolic effect
Consuming carbohydrate and/or
protein immediately after resistance
training may augment hormonal
response to the training

182. Branched Chain Amino Acids
The main BCAA’s are leucine,
isoleucine, and valine. These
amino acids decrease the ability for
tryptophan to cross the blood brain
barrier, impeding the formation of
seratonin and the perception of
fatigue (central fatigue).

186. Caffeine
Improved exercise Stimulant to CNS
endurance
↑ Diuresis
↑ Lipolysis
↑ Incidence of ↓ Muscle glycogenolysis
cardiac arrythmias

187. Caffeine
• The most highly consumed drug in North America
and Europe
• IOC initially banned caffeine in 1962, then
removed from list in 1972
• Today, urinary caffeine > 12 mg/L is an IOC
infringement
• This urinary level requires > 13.5 mg/kg caffeine,
where 1 cup coffee provides 80 mg (Assume 75 kg BW)
IOC banned dosage Ergogenic benefit
1012 mg/80 = 12.7 cups 330 mg/80 = 4.1 cups

188. Warning About Caffeine
s Possible side effects:
• Nervous irritability
• Muscle twitching
• Psychomotor agitation
• Elevated HR & blood pressure
• Increased occurrence of PVCs
• Insomnia

189. Caffeine produced significantly faster split times
Effects of
caffeine on
high-
intensity
exercise
results from
facilitated
use of fat as
an exericse
fuel, thus
sparing
CHO
reserves