Vitamin c 18

Some simple tips
for making lifestyle choices
change your life for the better ...
2/24/2018 1TaufiqMufti

Come up with a reasonable plan.
Consider easy ways to change your diet.
Add some activity that you really enjoy.

Vitamins
Minerals
Water
Carbohydrates
Fats
Proteins

Deep Reds
(tomatoes, cherries and strawberries)
Lycopene
a powerful antioxidant
reduces risk of cancers
(carrots, mandarin oranges, sweet potatoes and mango)

If you do
you will eat at least 5 servings
of fruits and vegetables every
day.
Try putting something of every color on
your plate!

 BRIGHT ORANGES (carrots, mandarin
oranges, sweet potatoes and mango)
 DEEP REDS (tomatoes, cherries and
strawberries)
 DARK GREENS (broccoli, asparagus
and kale)

 Vitamin C and Vitamin E
 Beta Carotene, a natural
antioxidant that enhances your
immune system
 Folate, a B vitamin that may help
prevent some birth defects

DarkGreens
(broccoli, asparagus and kale)
 Lutein and zeanthin
 carotenoids that have antioxidant
properties that protect your eyes
 Green cruciferous vegetables
 (cabbage, brussel sprouts, cauliflower,
kale and turnips) reduce the risk of
cancerous tumors.

BRIGHT ORANGES (carrots,
mandarin oranges, sweet potatoes and
mango),
DEEP REDS (tomatoes, cherries and
strawberries)
DARK GREENS (broccoli, asparagus
and kale)
BEAUTIFUL BLUES & PURPLES
(blueberries, eggplant and plums)

Blues & Purples
 Anthocyanins
phytochemicals responsible for the
blue color in fruits and vegetables help
to defend against harmful carcinogens.
 Blueberries
 increase brain function.

BRIGHT ORANGES (carrots,
mandarin oranges, sweet potatoes and
mango),
DEEP REDS (tomatoes, cherries and
strawberries)
DARK GREENS (broccoli, asparagus
and kale)
BEAUTIFUL BLUES & PURPLES
 SUNSHINE YELLOW (squash,
pineapple and corn)

Sunshine Yellows
(squash, pineapple and corn)
High in essential
vitamins and carotenoids.
Pineapple
 rich in Vitamin C,
manganese, natural enzyme
bromelain that aids in
digestion.

 walking
 dancing
 running
 aerobics
 weight training
 yoga
*If you don’t think the activity is fun,
you will not do it enough to make a difference!

What’s for lunch?
Try to pick a colorful meal and
be sure to drink plenty of
water.

This afternoon,
find something you like to do and ...

Vitamin C
 one very important vitamin.
 staving off colds, much better than
this.
 actually saves lives.
2/24/2018 TaufiqMufti 18

Vitamin C
• Decreased absorption with high intakes
• Excess excreted

Vitamin -C
 Functions
 Collagen synthesis
 Strengthens blood vessel walls
forms scar tissue, matrix for bone growth
 Antioxidant
 Thyroxin synthesis- prevent goiter
 Amino acid metabolism
 Resistance to infection
 absorption of iron

• Reducing agent (antioxidant)
• Iron absorption
• Synthesis of collagen
• Immune functions
– Does not prevent colds, reduce duration of symptoms
• Wound healing
2/24/2018
21TaufiqMufti

Antioxidant
 Can donate and accept hydrogen atoms
 Needs are higher for smokers
 prevents
cancers esophageal, oral, stomach
cardiovascular disease
cataracts

Vitamin C

 Sources
 Citrus fruits
 Cabbage-type , dark green
vegetables (bell peppers and broccoli)
 Cantaloupe, strawberries
 Lettuce, tomatoes, potatoes
 Papayas, mangoes
 destroyed by heat and oxygen2/24/2018 26TaufiqMufti

Vitamin C
 Easily lost through
cooking
 Sensitive to heat
 Sensitive to iron,
copper, oxygen
2/24/2018 TaufiqMufti27

Vitamin C in Other Animals
 All Plants can synthesizeVitamin C
 Some animals can make their own except,
Humans, apes, Guinea pigs, fruit eating bat… lost this
ability
 lack: L-gulono-γ-lactone oxidase
2/24/2018TaufiqMufti 29

 Vitamin C
safest and most
effective nutrients.
 prickly pear.
2/24/2018TaufiqMufti 30://
This is a
prickly
pear.

2/24/201
8
31
a water soluble vitamin
…. neccesary for normal growth and development.
body absorbs water, you need some Vitamin C every single
day.
TaufiqMufti

Vitamin C supports the immune system by
enhancing white blood cell function.

How I Can Get Vitamin C
Citrus fruit like oranges, clementines, lemons,
limes, and grapefruit
2/24/2018
TaufiqMufti 33
http://3.bp.blogspot.com/_YPqwOZuEZ1o/TU9dg6ZMZ6I/AAAAAAAABn8/3KIyQei8vo4/s1600/2
5671745_grapefruit.jpg
http://liv28.files.wordpress.com/2010/12/clementines_2006_tap.jpg

Why Vitamin C is Important to Us
 so Healthy and good for you!
 food that contains Vitamin C is so Yummy!
 Supports a healthy immune system.
2/24/201834 TaufiqMufti

A Healthy Dinner
Seasoned Chicken
Ceaser Salad
AsparagusBiscuit
2/24/2018
35TaufiqMufti

Healthy Snacks
 Healthy Snack foods are low in Calories and Fat,
 not very processed, give lots of energy for the day.
Fruits
and
Veggies!
Fruit
Juice
Salsa+
Corn
Chips
Goldfish
Fat-free
Yogurt

Unhealthy Choices
 Stay away from foods
with trans fats or salts
2/24/2018 TaufiqMufti37
Too much
sugar is also
very bad

RDA
• 90 mg/day for male adults
• 75 mg/day for female adults
• +35 mg/day for smokers
• Average intake ~72 mg/day
• Daily Value is 60 mg
• Fairly nontoxic (at <1 gm)
• Body is saturated at intake of 200 mg/day
• Upper Level is 2 g/day

Ascorbic acid
 RDA -2000
 Men: 90 mg/day
 Women: 75 mg/day
 Smokers: + 35 mg
/day
 Upper level for adults:
2000 mg/day

Scurvy
 Anemia (small-cell type)
 Atherosclerotic plaques
 Pinpoint hemorrhages,
 Muscle degeneration and pain
 bone fragility, joint pain
 Poor wound healing, frequent infections
 bleeding gums, loosened teeth
 hysteria, depression,
 rough skin, bruises

ScurvyFigure 7-102/24/2018 43TaufiqMufti

Scurvy
 Ascorbic acid = “no-scurvy acid”
 Not seen in the U.S. except for:
 Alcoholics and addicts
 Infants fed only cow’s milk:
 breast milk and formulas are fortified
w/ vitamin C
 Elderly ( ≥ 65 yrs): don’t eat enough fruits/veggies;
poor appetite

History of Scurvy
 Sailors on long sea voyages suffered horribly from
scurvy
 Jacques Cartier and his exploring party suffered from
scurvy in Canada during the winter of 1535-6. Local
Indians showed them how to brew a tea from
evergreens
 On Vasco da Gama's voyage to the East Indies in
1497, 100 out of 160 men were lost from the disease.
 Scurvy was also seen in the Great Potato Famine, in
soldiers during the Civil War, and in California Gold
Rush communities
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TaufiqMufti

46
Vitamin C
The most recognized of all vitamins is Vitamin C (ascorbic
acid):
2/24/2018TaufiqMufti

47
Vitamin C

 Connective tissue contains collagen protein.
Collagen is a triple polypeptide helix that is
strengthened by a significant quantity of 4-
hydroxyproline.
 Vitamin C is required to synthesize this important
amino acid. Without it, connective tissues weaken,
a condition often manifested as bleeding gums and
other hemorrhagic tissues.

Vitamin C
48
Formation of 4-hydroxyproline:
•During this reaction, prolyl hydroxylase is assisted by an Fe2+
cofactor, which is converted to the oxidized Fe3+ form during the
reaction.
•The Fe3+ is reduced back to Fe2+ by ascorbic acid, which acts as the
reducing agent and is converted into dehydroascorbic acid during
the process.
•Hence “antioxidant.” 2/24/2018TaufiqMufti

 Scurvy on the St. Lawrence River:
“Some did lose all their strength, and
could not stand on their feet…
Others also had all their skins spotted
with spots of blood of a purple
colour:
then did it ascend up to their ankles,
knees, thighs, shoulders, arms, and
necks.
Their mouths became stinking, their
gums so rotten, that all the flesh did
fall off, even to the roots of the teeth,
which all fall out.
- Jacques Cartier,
1536 492/24/2018 TaufiqMufti

Scurvy in the British Royal Navy
 James Lind
published his
Treatise on the
Scurvy in 1754
 Lime juice was
made mandatory
on British Navy
sailing ships 40
years later

Scurvy
2/24/2018TaufiqMufti 51
Follicular Hemorrhages

o The acidic property of vitamin C is
due to the enolic hydroxyl group
o Vitamin C is strong reducing agent
o L – ascorbic acid undergoes
oxidation to form dehydro ascorbic
acid & it is reversible reaction

o Ascorbic acid & dehydro ascorbic
acid are biologically active
o D – ascorbic acid is biologically inactive
o Ascorbic acid is present in all tissue &
plasma as reduced form
o Oxidation of ascorbic acid is rapid in the
presence of copper

o readily absorbed from stomach & small intestine
o Storage
o small amounts of vitamin C are stored 1 gm
o present as ascorbic & dehydro ascorbic acid
o found in retina, adrenal gland, pituitary & thymus

o Ascorbate 2-sulfate is urinary excretary form of
ascorbic acid
o Oxalate is another metabolite & is excreted in
urine

o Coenzyme Forms
o Ascorbic acid ( reduced form)
o Dehydro ascorbic acid (oxidized form)
o Involves reversible oxidation – reduction reactions
o Interconversion of ascorbic acid to dehydro
ascorbic acid

o Proline hydroxylase:
o Proline hydroxylase catalyzes the hydroxylation of
proline on collagen
o Ascorbic acid & ferrous iron are cofactors
o Ascorbic acid is essential to keep the iron in
ferrous form
o It essential for maturation &cross-linking of
collagen

Proline
Hydroxy proline
Proline hydroxylase
Ascorbic acid
(Fe++)
O2
H2O
Succinate
α- Ketoglutarate

o Lysine hydroxylase
catalyzes the hydroxylation of lysine residues
present on collagen
oAscorbic acid & ferrous iron are cofactors
o Ascorbic acid is essential to keep the iron in ferrous
form
o It essential for maturation & cross-linking of
collagen

o It is administered after surgery to enhance wound
healing
Lysine
Lysine hydroxylase
Ascorbic acid
(Fe++)
O2
H2O
Succinate
α- Ketoglutarate
Hydroxy lysine
o Hydroxylation occurs after the peptide chain synthesis (post-
translational modifications)
o In vitamin C deficiency, collagen synthesis is defective, delayed
wound healing

o Tyrosine catabolism
o Parahydroxy phenylpyruvate hydroxylase
catalyzes the formation of homogentisic
acid
o Ascorbic acid is required
o Parahydroxyphenyl pyruvate
Homogentisic acid
Parahydroxy phenylpyruvate
hydroxylase
Ascorbic acid
(Cu ++)
O2

o Catecholamine synthesis
o Dopamine β oxidase catalyzes the formation of
norepinephrine from dopamine
o
o Adrenal medulla: rich in vitamin C
Dopamine
Norepinephrine
Dopamine β oxidaseAscorbic acid

o Ferrochelatase catalyzes the formation of heme
from protoporphyrin IX
o Vitamin C helps incorporation of Fe++ into
protoporphyrin IX
o Vitamin C keeps the iron in ferrous form
Protoporphyrin IX
Heme
FerrochelataseAscorbic acid , Fe++

o biosynthesis of bile acids
o Cholesterol 7 α hydroxylase catalyzes the
formation of 7α –hydroxycholesterol from
cholesterol
o vitamin C is a cofactor
o rate limiting step in bile acid synthesis
Cholesterol
Cholesterol 7 α
hydroxylase
NADPH + H+
NADP
7 α - hydroxy Cholesterol
Ascorbic acid

o Bone tissues possess an organic
matrix, collagen & inorganic calcium
& phosphate
o Vitamin C is required for bone formation
o

o
o Folic acid metabolism:
o Vitamin C needed for the formation of FH4
o In association with FH4, it is
involved in maturation of RBC

o Peptide hormone synthesis:
o Hydroxylation of glycine is carried out by
peptidyl glycine hydroxylase which requires
vitamin C

o Steroid synthesis
o Adrenal gland possesses high levels
of ascorbic acid
o Ascorbic acid is necessary for
hydroxylation reactions in the
synthesis of corticosteroid
hormones

o Sparing action of other vitamins:
o Ascorbic acid is a strong antioxidant
o It spares vitamin A, E and some B-complex
vitamins from oxidation

o Immunological function:
o Vitamin C increases the synthesis
of immunoglobulins & increases
the phagocytic action of
leucocytes

o Cataract:
o Vitamin C is concentrated in the lens
of eye
o Regular intake of ascorbic acid
reduces the risk of cataract formation

o Anti-oxidant property:
o Vitamin C is an antioxidant
o reduces the risk of
cancer, coronary heart
diseases
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o Inadequate intake mainly caused by dietary
deficiency
o Impaired absorption due to intestinal diseases
o Increased demand in pregnancy,
lactation, surgery and burns
o

o Infantile scurvy (Barlow’s disease)
o In infants between 6 to 12 months of age, diet
should be supplemented with vitamin C
o Hemorrhagic tendency:
o In deficiency, collagen is abnormal & the
intracellular cement substance is brittle
o capillaries are fragile, tendency to bleed
even under minor pressure

o Petechial hemorrhages:
o Due to rupture of capillaries, resulting from lack
of intracellular substances
o Ecchymoses
o hematoma in severe conditions
o Internal bleeding:
o In severe cases, hemorrhage may occur in the
conjunctiva & retina

o Oral cavity:
o gums becomes painful, swollen & spongy
o pulp is separated from the dentine
o finally teeth are lost
o Wound healing may be delayed

o Bones:
o failure of osteoblasts to form intracellular
substance, osteoid
o Without normal ground substance, the
deposition of bone is arrested
o bones become weak and fractures
o Hemorrhages into joint cavities
o Vitamin C & vitamin B are essential nutrients to maintain bone
density & bone quality

Anemia
o normochromic, normocytic (due to bleeding),
o megaloblastic ( due to reduced erythropoiesis)
o microcytic hypochromic anemia (impaired iron
absorption & impaired heme synthesis)
o Fatigue, depression, & susceptibility to
infections

o The beneficial effect of vitamin C is used in the
treatment of TB
o Clinical dose is 500 mg/day
o Vitamin C is recommended for treatment of ulcer,
trauma and burns

o Decreased plasma, platelet and leukocyte
ascorbic acid levels

COLLAGEN FORMATION
Vit- C Plays the role of a coenzyme in
hydroxylation of proline and lysine
hydroxylation reaction catalysed by
lysyl hydroxylase (for lysine)
and
propyl hydroxylase(for proline)
hydroxyproline and hydroxylysine are
essential for the collagen cross-linking
and the strength of the fibre.
82TaufiqMufti2/24/2018

Iron and hemoglobin
metabolism
:
Ascorbic acid enhances iron absorption by
keeping it in the ferrous form.
This is due to the reducing property of vit C.
83

Tryptophan metabolism
Vitamin C is essential for the hydroxylation of
Tryptophan to hydroxytryptophan in the
synthesis of serotonin by hydroxylase.

Folic acid metabolism
The active form of the vitamin folic acid is
tetrahydrofolate
Vitamin C is needed for the formation of
tetrahydrofolate.
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Adrenal gland possess high level of ascorbic
acid particularly in period of stress
It is believed that vit C Is necessary for hydroxylation
reaction.
.
Synthesis of corticosteroid hormones

immunological function
 : vitamin C Enhances the synthesis of
immunoglobins

Economically disadvantaged cannot purchase
foods high in vitamin C
 refugees
4

Cigarette smokers require increased intake of
vitamin C because of lower vitamin C absorption
Pregnant and lactating women
thyrotoxicosis require increased intake of vitamin
C because of increased utilization.

 anorexia nervosa AIDS or cancer
 type 1 diabetes have increased vitamin C
requirements, hemodialysis and peritoneal
dialysis.

Because vitamin C is absorbed in the small
intestine, people with disease of the small intestine
such as Crohn’s, Whipple, and celiac disease are at
risk.
Iron overload disorders may lead to renal vitamin C
wasting.
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 Formation of intercellular
cement substances in
connective tissues, bones,
and dentin is defective,
resulting in weakened
capillaries with subsequent
hemorrhage and defects in
bone and related structures.
 Hemorrhaging is a hallmark
feature of scurvy and can
occur in any organ.
 Hair follicles are one of the
common sites of cutaneous
bleeding Scorbutic Rosary

Bone tissue formation
impaired in children,
causes bone lesions
and poor bone growth.
Fibrous tissue formation
between diaphysis and
the epiphysis,
costochondrial junctions
enlargement
Densely calcified
fragments of cartilage
are embedded in the
fibrous tissue.
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Subperiosteal hemorrhages, due to small fractures

malaise and
lethargy.

shortness of breath
and bone pain.
After 1-3 months
 Myalgias may occur
because of reduced
carnitine production.
emotional changes.
TaufiqM
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 Dry mouth
dry eyes

jaundice,
generalized edema,
oliguria,
neuropathy,
fever, and convulsions
 Vital signs: Hypotension
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 Skin: Perifollicular
hemorrhages purpura
ecchymoses on legs and
buttocks where hydrostatic
pressure is the greatest.
 Poor wound healing
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Nails: Splinter
hemorrhages may occur.
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Head and neck:
 Gum swelling, friability, bleeding,
 infection with loose teeth;
 mucosal petechiae;
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 Scleral icterus secondary to
hemolysis and pale conjunctiva
 Conjunctival hemorrhage,
 Bleeding into the periorbital area,
eyelids, and retrobulbar space
 Alopecia due to reduced
disulfide bonding. 10

:
 Scorbutic rosary
sternum sinks inward
in children
 High-output heart failure
due to anemia
 Bleeding into the
myocardium
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 Extremities:
 Fractures, dislocations,
and tenderness of bones
are common in children.
 Bleeding into muscles
and joints may be
seen.
 Edema may occur late in
the disease.

Gastrointestinal: Loss of
weight secondary to
anorexia is common. 1
0

 Scurvy occurs at 0.1 mg/dL.
Symptoms occur below 2.5 mg/L
Levels of 2.5-5 mg/L indicate depletion.
Levels can be low in tuberculosis, rheumatic fever, or
other chronic illnesses;
smokers
oral contraceptives.
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 Capillary fragility check by inflating a blood pressure cuff
and looking for petechiae on the forearm.
 Bleeding time, clotting time and Prothrombin are estimated to rule
out bleeding disorders 2/24/2018
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Fe deficiency anemia
decreased absorption of iron from the small
intestine.
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0
5
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 Loss of trabeculae
results in a ground-
glass appearance
 The cortex thins
 A line of calcified,
irregular cartilage
(white line of Fraenkel)
at the metaphysis
 The epiphysis may
be compressed. 2/24/2018
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ascorbic acid 100
mg
3times / day
then 100 mg daily.

 Parenteral
doses are
necessary in
malabsorption
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Citrus fruits, grapefruits and lemons
Vegetables, broccoli, green peppers,
tomatoes, potatoes, and cabbage
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Vitamin C Excess
 Hemochromatosis
– Vitamin C enhances iron absorption
 Oxalate kidney stones
 Erodes tooth enamel

o Excess vitamin C is excreted
o not accumulated
o More than 2000 mg may cause iron over load
Abdominal pain,
Diarrhea
nausea.
kidney stones
iron overload in patients taking supplemental iron.
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•Toxicity
• Nausea, abdominal cramps, diarrhea
• Headache, fatigue, insomnia
• Hot flashes, rashes
• aggravation of gout symptoms,
• kidney stones
• Interference with Lab tests,

Preventive action on chronic
disease
 Free radicals are constantly produced in
normal metabolism .
cause serious damage to proteins ,lipids,
DNA and cell membranes.
These free radical are implicated in the
development of cancer, heart diseases .
Vit C prevents these diseases.
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TaufiqMufti 112

Vitamin c 18

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