What are the signs of Vitamin A deficiency symptoms?

Vitamin A deficiency symptoms may include the following

• Faulty teeth and slow bone formation
• Night blindness means difficulty in vision in dim light
• Prolonged deficiency may cause xerophthalmia (dry eyes) which will ultimately lead to blindness
• Skin may be rough dry and scaly .
• Bumpy skin
• There is increased susceptibility to cold and viral infections such as sinusitis (chronic inflammation of the sinuses) 
• There may be frequent infections of the bladder or urinary tract
• Person with Vitamin A deficiency has tendency to abcesses in the ear
• Rapid weight loss may occur
• There may be loss of smell, taste or appetite.

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Role of vitamin C in the body and its deficiency disorders

Vitamin C is also called Ascorbic acid, which is an important dietary antioxidant. It is required for collagen synthesis in the body. Traditional cooking method destroy it as vitamin C is very heat sensitive.

Actions of vitamin C include

1.Antioxidant activity.

2.Help the absorption of non heme iron .

3.Carnitine biosynthesis.

4.Required for the conversion of dopamine to norepinephrine.

5.Help the production of  of peptide hormones.

6.Vitamin C is important  for collagen synthesis .

7.It is a part of many drug-metabolizing enzyme systems.

Significance of vitamin C in  the body

1. During stress and hospital admission and disease need of vitamin c increases. It may be due to decreased  absorption  or increased catabolism.

2. Need of vitamin c is increased during trauma and surgery for  extra collagen synthesis.

3. Vitamin C supplementation (e.g., 1–2 g/d) may slightly reduce.

 the symptoms and duration of common cold .

4.Vitamin C supplementation is also useful in Chédiak-Higashi syndrome and osteogenesis imperfecta.

5. It is proposed that high dose of vitamin C intake will increase the anti oxidant property of body. So it will delay the development of degenerative disease such as cataract and  atherosclerosis

6. High vitamin C will help to prevent certain cancers especially stomach cancer and esophageal cancers. It may be because vitamin C prevent the conversion of nitrites and secondary amines to carcinogenic nitrosamines..

7. Parenteral ascorbic acid  is also tried in the treatment of advanced cancers.

8. Those people with past history of kidney stone  and chronic kidney disease should not use high dose of vitamin C ,because  in these patients.plasma Vitamin C  can reach  to levels above the normal range.

9. Absorption of Vitamin C enhances the non-haem iron absorption that is taken at the same time. Thus help to prevent iron deficiency anemia.

Clinical  features of vitamin deficiency

Vitamin C deficiency produce the following clinical features 

1. Scurvy.

2. Bleeding around the hair follicle (Perifollicular petechiae).

3. Bleeding gums-Swollen spongy gum with bleeding ,loosening of teeth.

4. Follicular hyperkeratosis ( Thickening of skin around the  hair follicle )

5. Delayed wound healing.

6. Infection.

7. Anemia.

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Food sources of vitamin C

All fresh fruit and vegetables  contain Vitamin C. Unfortunately, vitamin c is easily leached out of vegetables if they are placed in water and is also easily destroyed  during cooking or exposure to copper or alkali. So fresh fruit and juices and salads are encouraged. Also advised to cook vegetables lightly and quickly. Vitamin  is lost during storage. About  40% of the U.S. population consumes vitamin C as a dietary supplement in which “natural forms” are no more bio available than synthetic forms.

The recommended  nutrient intake for adults

90 mg/day for males  in the United States - for healthy people.

75 mg/d for females

Following  are the rich sources of vitamin C.

1. Blackcurrants, guavas.

2. Rosehip syrup, green peppers.

3. Oranges, other citrus fruit, strawberries.

4. Cauliflower, broccoli.

5. Sprouts, cabbage, watercress.

6. Potatoes.

7. Liver and milk.

Absorption  of vitamin C

If the dose of vitamin C administered in a single dose is < 100 mg,  complete absorption occurs. At doses more than  1 g less than 50% is absorbed, this is because of increased degradation and fecal and urinary excretion of vitamin C at higher doses. As already mentioned above good dietary sources of vitamin C include citrus fruits, green vegetables (especially broccoli), tomatoes, and potatoes. People get recommended daily allowance by consuming five servings of fruits and vegetables a day. There are several drugs that interfere and cause vitamin C deficiency such as  corticosteroids, aspirin, indomethacin, phenylbutazone, and tetracycline. As the requirement of vitamin C increase during major surgery it is advisable to supplement vitamin C upto 250 mg  a day to cover major surgery. Bottlefed infants are advised to give orange juice. In the elderly scurvy can be avoided by consuming adequate  fruits and vegetables. Careful observation is required  in the elderly people who live alone. Rarely vitamin C supplementation is required.

Vitamin C requirements increase in the following situations.

1. Smoking,

2. Hemodialysis,

3. Pregnancy,

4. Stress

5. Infection

6. Trauma

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Sources of vitamin D

Vitamin D is a fat soluble essential  vitamin (sunshine vitamin). Activeform of vitamin D is vitamin D3. It is also called calcitriol, whose main function is promotion of calcium absorption. Liver and kidney plays important role in formation of D3.

What are the Sources of vitamin D

Sunlight and vitamin D

Skin exposure to sunlight is the main source of vitamin D. Active form of vitamin D  that is vitamin D3 is formed in the skin by the action of ultraviolet B exposure (UV-B wavelength 290–315 nm) on 7-dehydrocholesterol, which is a cholesterol metabolite present in skin. The intensity of UV light decreases as we move from equator, so at a latitude more than  50° (including northern Europe ), in winter seasons vitamin D is not synthesized, and there is seasonal variation even above 30° .These ultra violet B rays (wavelength) are present only if the ultra violet index is more than 3. Number of days with ultra violet index more than 3 decreases as we move from equator. 

Apart from that, during winter, people living at high altitude wear thick clothes, spend nearly all the day indoors and pollution of sky with smoke all decreases the ultra violet exposure. So the dietary intake is crucial during these season. They have to consume the body store  accumulated during summer. People living in tropics can get adequate amount of vitamin D, if they expose their unprotected skin to sunlight 15 minutes session twice a week. Though direct sunlight is a great source of vitamin D people should not overdo it . In United states vitamin D deficiency  is considered to be  an epidemic.

Factors that decrease synthesis of vitamin D by skin

• Living away from equator
• Cloud cover
• Smog
• Sunscreens
• Wearing clothes 
• Living indoor
• People with dark skin pigmentation
• Image of sun exposure

Food

If the body cannot synthesis adequate amount of vitamin D  due to insufficient sunlight you need dietary supplementation. Daily requirement is about 1000 units in the absence of sun exposure. Deficiency risk increased because of change in life style  such as mainly indoor jobs and change in dressing style.Many countries tried to overcome this by fortifying food with vitamin D, but even that is not enough to meet the complete demand of body. Except for  fish and fortified foods availability of vitamin D from other food is  limited.

Food sources of vitamin D are the following

• Fish liver oils.
• Fatty fish (sardines, herring, mackerel, tuna, salmon, pilchards).
• Margarine (fortified).
• Infant milk formulas (fortified).
• Eggs.
• Liver.
• Salmon (447 IUs per serving), tuna (154 IUs per serving) mackerel (388 IUs per serving), and  fish liver oils (one tablespoon -1,360 IUs)  are good source of vitamin D .

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