This document discusses vitamin E, including its structure, sources, absorption, functions, and deficiency. Some key points: - Vitamin E refers to a family of antioxidants that protect cell membranes from free radical damage. Major food sources include plant oils, nuts, and green vegetables. - It is absorbed along with fat in the small intestine and transported by lipoproteins in the bloodstream. Stores primarily in liver, adipose tissue, and muscle. - Functions include protecting PUFAs from oxidation, maintaining cell membrane integrity, and supporting neurological and reproductive health. - Deficiency is rare in humans but may cause fragile red blood cells. Toxicity is also rare, with no adverse effects

1. DR SHAHNAWAZ F SHAH
MD, FPM, FIAPM,FCPM (MUHS)
Interventional Spine & Pain Physician
Surat

2. Previous Lecture
• What are VITAMINS?
• What role does they play in our body?
• Classification
• Difference
• Vitamin A & its functions
• Xeropthalmia, Keratomalacia, Phrynoderma
• Vitamin D, its metabolism & functions
• Rickets, Osteomalacia

4. VITAMIN E
Describes a family of eight antioxidants:
four tocopherols
four tocotrienols
Yellow oily liquid freely soluble in fat solvent
Naturally occuring anti-oxidant
Anti-aging factor

5. Vitamin E
The word tocopherol is derived from the word
toco = child birth
pheros = to bear.
Essential for normal reproduction in many
animals, hence known as anti-sterility vitamin.
Described as a 'vitamin in search of a disease’,
due to the lack of any specific vitamin E
deficiency disease in humans.

6. Absorption, Transportation and
Storage
• Absorbed along with fat in the small intestine.
• Bile salts are necessary for the absorption.
• In the liver, it is incorporated into lipoproteins
(VLDL and LDL) and transported.
• Stored in adipose tissue, liver and muscle.
• The normal plasma level of tocopherol (vit E)
is less than 1 mg/dl

7. How free radicals produced?
Natural byproduct
of
energy metabolism
Ultraviolet rays
Air pollution
Tobacco Smoke
Stress
Poor nutrition
Unhealthy lifestyles
Elevated cholesterol level
High blood sugar levels
Exercise
Free
Radicals

9. Why free radicals may be harmful?
• Free radicals, such as superoxide, hydroxyl ions and
nitric oxide all contain an unpaired electron. These
radicals can have a negative effect on cells causing
oxidative damage that leads to cell death

10. How antioxidants may help
Antioxidants, such as vitamin E, prevent cell damage by binding to the free radical and
neutralising its unpaired electron

11. FUNCTIONS OF VITAMIN E
• Antioxidant (most powerful natural)
• Free radical scavenger
• Protects cell membranes
• Protects LDL from oxidation
• Protection of double bonds in
polyunsaturated fatty acids
• Plays a role in neurological functions, and
inhibition of platelet aggregation.

12. FUNCTIONS OF VITAMIN E
• Essential for the membrane structure and
integrity of the cell
• Protects RBC from hemolysis by oxidizing
agents (e.g. H2O2)
• Reproductive functions
– preserves and maintains germinal epithelium of
gonads
– closely associated with and prevents sterility.

13. FUNCTIONS OF VITAMIN E
• Increases the synthesis of heme by enhancing
the activity of enzymes 6- aminolevulinic acid
(ALA) synthase and ALA dehydratase.
• Prevents the oxidation of vitamin A and
carotenes
• Cellular respiration through electron transport
chain (believed to stabilize coenzyme Q)

14. FUNCTIONS OF VITAMIN E
• Optimal absorption of amino acids from the
intestine
• Proper storage of creatine in skeletal muscle
• Protects liver from being damaged by toxic
compounds such as carbon tetrachloride
• Works in association with vitamins A, C and p-
carotene, to delay the onset of cataract.

15. Sources
• Vitamin E is found in plant-based oils, nuts, seeds, fruits,
and vegetables.
• Wheat germ oil, cotton seed oil, peanut oil, corn oil and sunflower
oil
• Almonds
• Peanuts, peanut butter
• Beet greens, collard greens, spinach
• Pumpkin
• Red bell pepper
• Asparagus
• Mango
• Avocado
• present in meat, milk, butter and eggs

16. Deficiency symptoms
• The symptoms of vitamin E deficiency vary from
one animal species to another
• In many animals, the deficiency is associated with
sterility, degenerative changes in muscle,
megaloblastic anaemia and changes in central
nervous system
• Severe symptoms of vitamin E deficiency are not
seen in humans except increased fragility of
erythrocytes and minor neurological symptoms,

18. Toxicity of vitamin E
• Among the fat soluble vitamins (A, D, E, K),
vitamin E is the least toxic.
• No toxic effect has been reported even after
ingestion of 300 mg/ day
• Normal RDA is 8mg -10mg per day

20. Vitamin K
• only fat soluble vitamin with a specific
coenzyme function.
• Required for the production of blood clotting
factors, essential for coagulation (in German-
Koagulation; hence the name K for this
vitamin).

21. Structure of Vitamin K
Vitamin K exists in different forms.
• Vitamin K1 (phylloquinone) – plants
• Vitamin K2 (menaquinone)- produced by the
intestinal bacteria and also found in animals
• Vitamin K3 (menadione) is a synthetic form
All the three vitamins (K1, K2, K3) are
naphthoquinone derivatives.

22. Dietary sources
• Green vegetables
– Cabbage
– Cauliflower
– Tomatoes
– spinach
• present in egg yolk, meat, liver, cheese and
dairy products.

23. RDA
• Strictly speaking, there is no RDA for vitamin
K, since it can be adequately synthesized in
the gut.
• Recommended that half of the body
requirement is provided in the diet, while the
other half is met from the bacterial synthesis.
• Accordingly, the suggested RDA for an adult is
7o- 140 ug/day

24. Absorption, transport and storage
• Vitamin K is taken in the diet or synthesized by
the intestinal bacteria.
• Its absorption takes place along with fat
(chylomicrons) and is dependent on bile salts.
• Vitamin K is transported along with LDL and is
stored mainly in liver and, to a lesser extent, in
other tissues

25. Biochemical Function
• Concerned with blood clotting process.
• Brings about the post-translational (after
protein biosynthesis in the cell) modification
of certain blood clotting factors.
• The clotting factors 2 (prothrombin), 7, 9 and
10 are synthesized as inactive precursors in
the liver.

26. FUNCTIONS
• Essential for the hepatic synthesis of
coagulation factor II, V, VII, IX, X.
• CLOTTING – it prevents hemorrhage only in
cases when there is defective production of
prothrombin

27. FUNCTIONS
• BONE MINERALISATION :
– Required for the carboxylation of glutamic acid
residues of osteocalcin, a calcium binding protein
present in the bone
• OXIDATIVE PHOSPHORYLATION:
– acts as a co- factor in oxidative phosphorylation
associated with lipid

28. • The deficiency of vitamin K is UNCOMMON
– present in the diet in sufficient quantity
– adequately synthesized by the intestinal bacteria.

29. VITAMIN K DEFICIENCY
• Who is at risk?
– Common in new borns.
– Chronic small intestinal diseases with billiary
obstruction or small bowel resection (lack of bile
salts)
– Due to broad spectrum antibiotic therapy (killing
of intestinal flora)
– Due to malabsorption syndrome
– Patient on anticoagulant therapy

30. DEFICIENCY SYMPTOMS
Deficiency of Vitamin K
lack of active prothrombin in
the circulation
blood coagulation adversely
affected
The blood clotting time is
increased

31. DEFICIENCY SYMPTOMS
• Easy Bruising
• Bleeds profusely even for minor injuries
• Oozing from the nose or gums
• Excessive bleeding from the wounds,
injections or surgical sites
• Heavy menstrual periods
• GI Bleed
• Blood in Urine &/or Stool

32. Treatment
• Prophylactically 0.5 to 1 mg IM at delivery to
newborns
• For Treatment in Adults- 10 mg IM
• For patients with chronic malabsorption-
– 1-2 mg/d orally or 1-2 mg per week IM

33. Hypervitaminosis K
• Administration of large doses of vitamin K
produces hemolytic anaemia and jaundice,
particularly in infants.
• The toxic effect is due to increased breakdown
of RBC

34. Antagonists of vitamin K
• The compounds-namely
– Heparin
– bishydroxycoumarin -act as anticoagulants
– salicylates
– dicumarol

36. VITAMIN C
• Active form
– L- ascorbic acid.
• Antiscorbutic factor
• RDA
– Adult Males- 90mg/d
– Adult Females- 75mg/d
– Children- 15-25mg/d
– Pregnant and Lactating mothers- 120mg/d

37. SOURCES
Indian Gooseberry/Amla (Richest Source)
Vegetables
Tomato
Potato
Citrus fruits
Orange
Lemon
Apple
Cherrie

39. METABOLIC FUNCTION
• Act as reducing agent
• Biosynthesis of adrenal steroid hormones.
• Collagen synthesis
• Antioxidant activity
• Aids in the prevention of heart disease
• Prevents formation of carcinogens from
precursor compounds

40. METABOLIC FUNCTION
• Maintenance – necessary for maintenance of
bones & proper functioning of the adrenal &
thyroid gland
• Stimulates immune function,
• Combats bacterial infection,
• Reduces effects of allergy-producing
substances
• Protects vitamins, A, E and some B complex
vitamins from oxidation.

41. VITAMIN C DEFICIENCY
• Scurvy (impaired formation of mature connective
tissue)
• Skin Bleeding( petechiae, ecchymoses)
• Bleeding into Joints(haemarthrosis), Peritoneum
& Pericardium
• Slow healing of wound and fractured bone
• Fatigue and joint pain.
• Impaired Bone growth in Children
• Compromised immunity

43. What Is Scurvy?
• Scurvy is a vitamin C (ascorbic acid) deficiency
that results from a few weeks to months of no
vitamin C
• We’ve known of it since ancient Greek and
Egyptian times
• It was most common in sailors throughout the
16th -18th century due to vitamin C
deprivation for long periods of time
• Cases today are rare

44. Who Is Susceptible?
• People with chronic malnutrition
• Alcoholics
• Elderly
• Men who live alone (bachelor or widower scurvy)
• Children
• People on peculiar diets or food fads
• Dialysis patients
• Malabsorption disorders
• Severe dyspepsia.

45. Cause
• It is caused by environmental factors, not
genetic factors
• Deprivation of vitamin C due to famine,
anorexia, restrictive diets, or difficulty orally
ingesting foods

46. Symptoms
• Early Symptoms
– Appetite loss
– Poor weight gain
– Diarrhea
– Rapid breathing
– Fever
– Irritability
– Tenderness and discomfort in legs
– Swelling over long bones
– Bleeding

47. • Progressed Symptoms
– Bleeding of the gums
– Loosened teeth
– Petechial hemorrhage of the skin and mucous
membranes
– Bleeding in the eye, proptopsis of the eyeball
– Hyperkeratosis

48. • Healthy daily dose of vitamin C contributes to
healthy teeth and gums
• Deficiency can cause deterioration of the gums.
• Periodontal problems are a symptom of a vitamin
C deficiency

49. Treatment
• Adult dose
– 800-1000mg/day for at least 1 week,
– then 400mg/day untill complete recovery.
• High dose treatment i.e. 1-2 g/d decreases
symptoms and duration of upper respiratory
tract infections.

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