hey guys it's medicosa's perfect snail is where medicine makes perfect sense let's continue our biochemistry playlist in previous videos we have talked about vitamins why did we call them vitamins it's a misnomer we thought they were vital amines but they are actually not we talked about vitamin B1 vitamin B2 vitamin B3 B4 does not exist so we skipped it and we talked about vitamin B5 and B6 and B7 we skip B8 because it does not exist then we talked about vitamin B9 which is folate and vitamin B12 then we talked about vitamin C and vitamin K and vitamin E and vitamin d and vitamin A and even the vitamin-like substance known as choline today we shall review all of them very quickly indeed let's get started if you want to dig deeper into each topic I have separate videos on each of these vitamins and after today's video we'll start talking about minerals including Trace elements zinc copper chromium selenium you name it remember it's a misnomer they are organic molecules micronutrients essential your body does not make them therefore you have to eat them in the diet they are co-enzymes I.E they are assistants to enzymes some of them are antioxidants especially vitamin E some of them help you make collagen especially vitamin C some of them replicate cells helping your bone marrow make blood cells such as red blood cells especially folate and vitamin B12 vitamin D is not only a vitamin it's also a hormone we divide vitamins into water soluble and fat soluble vitamins water soluble vitamins include vitamin B's and vitamin C fat soluble vitamins include vitamin k e d and a they are co-enzymes vitamin B1 helps with the decarboxylation and dehydrogenase reactions what's dehydrogenase good all reduction oxidation B2 reduction oxidation B3 reduction oxidation P5 anytime you see co-a such as a cell Co a acetyl COA Etc you should say thank you to vitamin B5 and of course this has to do with lipid or fat lipoic acid also acyl transfer vitamin B6 transamination the trans-aminases include aspartate trans ammonase and alanine transaminase you can call them trans amnesis or you can call them Amino transferases vitamin B7 which is biotin carboxylation reactions and these carboxyl groups serve as binding sites for calcium vitamin B9 transfer of one carbon unit which is different from vitamin B1 which transferred to carbon units vitamin B12 alkylation reaction it helps the isomerases the mutasis and DNA synthesis just like folate that's how your cells replicate such as your red blood cells in in the bone marrow that's why deficiency of this one or this one gives you anemia leukopenia thrombocytopenia add them together pan cytopenia vitamin C hydroxylation reaction especially while making collagen choline which is water soluble is for methylation it's a methyl group donor Vitamin K carboxylation Vitamin E antioxidant vitamin D it's a hormone mineralization of your bones vitamin A also antioxidant redoxin of your eye water soluble fat soluble pause and review let's start with the water soluble ones where deficiency is more likely but toxicity is less likely because they are easily excreted by the kidney vitamin B1 is thiamine many enzymes especially the famous dehydrogenases need thiamin as a cofactor deficiency of this one is here deficiency of this one deficiency of this one is maple syrup urine disease many alcoholics are malnourished they forget to eat vitamin B1 or thiamine deficiency is very common this can lead to wet beriberi which affects the heart dry berry berry which affects the nerves Wernicke korsakov syndrome which affects the brain please do not confuse Wernicke's aphasia not caused by thiamine deficiency versus Wernicke's encephalopathy or Wernicke's disease caused by vitamin B1 deficiency it's a Triad of ophthalmoplegia gait Ataxia and Global confusion I see double I cannot walk I am confused the acute symptoms of alcoholism can lead to Wernicke's encephalopathy chronically I can develop korsakov syndrome with amnesia due to problems in the mammillary bodies vicinity of the temporal lobe proximity to the amygdala and hippocampus vitamin B1 deficiency is beriberi known as Kake in Japan discovered by doctor foreign that's why it's called Kake berry berry which is time and deficiency can be divided into infantile and adult the adult could be wet dry or gastrointestinal we discussed all of them in great detail before here are the signs and symptoms of infantile beriberi the treatment is intravenous administration of vitamin B1 pause and review here is dry very nerve issues and wet very very cardiomyopathy with edema and CHF and here is vitamin B1 in one slide next vitamin B2 riboflavin don't forget fad and if you're talking about the reduced one which is fadh2 this will give you about two ATP molecules in the electron transport chain you can say two or you can say one and a half depending on which textbook you're using so when you think of fad or fmn you should say thank you to your riboflavin if you want to learn about flavor proteins check out my metabolism playlist why did I get vitamin B2 deficiency maybe due to decreased intake or maybe because of malabsorption syndrome here is the fnemonic to help you remember riboflavin F me and the mnemonic just keeps expanding riboflavin deficiency can lead to stomatitis angular stomatitis kelosis and Colitis next vitamin B3 or niacin it came from tryptophan what else came from tryptophan serotonin so if I have carcinoid syndrome all of my tryptophan is going this way to become serotonin leaving almost no tryptophan to become niacin which means patients who have carcinoids syndrome lack niacin and when I have niacin deficiency it's called pellagra This is vitamin B3 deficiency niacin has two functions at lower dose it's your good old vitamin B3 nicotinamide at a higher dose it's the anti-hyperlipidemic medication it tends to decrease your total body cholesterol but it increases the good cholesterol HDL fad goes with ripoflavin which is vitamin B2 but NAD and nadp goes with vitamin B3 and this vitamin B3 derivative is going to give you three ATP molecules in the electron transport chain you can say 3 or 2.5 atps depending on which textbook you're using what's the most common cause of vitamin B3 deficiency eating only a Corn based diet which lacks niacin and lacks tryptophan unless it has been artificially enriched these famous enzymes that required thiamine as equal Factor also require riboflavin and require niacin vitamins are precursors to cofactors so the pyruvate dehydrogenase complex the alpha-ketoglutarate dehydrogenase complex the branch chain Alpha keto acid dehydrogenase complex require all of these I call them my Teflon company t f l n Company Co pearls for the pros heart no disease is a disease where I have a defect in the protein that transports neutral amino acids including tryptophan therefore I get tryptophan deficiency if I am deficient in tryptophan I'll be deficient in his son or daughter niacin so I get niacin deficiency which is pellagra which is a great name for my future daughter come on pellagra how are you today she will have a happy life until she goes to medical school carcinoids syndrome is a cause of pellagra next we skip vitamin B4 because it does not exist and we talk about vitamin B5 a pantothenic acid panto means everywhere inclusive then it means strength basically this means I am present everywhere in every food you can imagine you can find vitamin B5 that's why you will almost never hear of vitamin B5 deficiency sources anything deficiency rare biochemically it's important for acelco a acetyl COA any coenzyme a you can imagine even the famous succinyl COA which belongeth to the TCA cycle next vitamin B6 pyridoxine it's important for the transamination reactions alanine transaminase and aspartate transaminase or amino transferases but it's not just about transamination it's also deamination decarboxylation making swingomyelin of your nerves very important and much more here is AST and ALT the function please pause and review since vitamin B6 helps make sphingomyelin which makes myelin therefore this pyroduction deficiency is going to lead to what nerve problem problems peripheral neuropathy and since we need Vitamin B6 to make him which makes hemoglobin of your red blood cells without it I get anemia the enzyme ala synthase is now history and since cystothine and synthase is also history without vitamin B6 as ecoenzyme I'll get homocystinemia and homocystenuria increasing my risk of myocardial infarctions Strokes dvts low IQ lens subluxation joint contracture morphinoid body habitus kyphosis and osteoporosis oh by the way you can download all of these doozy handwritten notes on my website maricosisperfectsnelist.com here is everything you need to know about pyridoxine in one slide don't forget the famous TB medication isoniazid can lead to vitamin B6 deficiency therefore if you prescribe this medication to any patient you should also give that patient pyridoxine otherwise the poor patient might develop all of these symptoms because you were a doofus with a stethoscope next biotin which is vitamin B7 avidin is present in raw egg whites it inhibits the absorption of biotin why do I need biotin it's a cofactor for carboxylation reactions anytime you see carboxylase in your textbook you should say thank you to biotin biotin will also help you make proteins and replicate your cells it's present in all of these foods but do not eat raw eggs the yolk of the egg has biotin egg white symptoms of biotin deficiency include dermatitis golusitis alopecia and tritus next vitamin C ascorbic acid where do we absorb iron well remember the mnemonic first you iron your clothes then you fold them and then put them in the closet iron is absorbed in the duodenum have you ever wondered why is iron absorbed here which is the first part of the intestine because iron requires the presence of vitamin C and the acid of your stomach in order to be absorbed and since the stomach can barely absorb anything iron will be absorbed in the first part of the small intestine the duodenum you need the acid of the stomach and vitamin C to reduce cell the ferric iron into the ferrous iron you cannot absorb this but you can absorb this fe2 goes into the bloodstream fresh fruits and vegetables especially citrus fruits are rich sources of vitamin C vitamin C has many functions do not forget collagen please which Step of collagen synthesis the hydroxylation of Proline and lysine residues so with vitamin C deficiency what do I get scurvy do you think I'll be able to make collagen no who's gonna suffer any tissue that has collagen including blood vessels so they get weaker and I leak blood houses on the skin bleeding gums bleeding skin you name it and here are more symptoms of vitamin C deficiency which we talked about in detail in my video on vitamin C Quest time why do we use vitamin C to treat meth hemoglobinemia answer it's easy meth hemoglobinemia is a condition where the normal fe2 in the hemoglobin became fe3 fe3 cannot bind oxygen only fe2 binds O2 so if I now have the abnormal ferric iron in my hemoglobin we call this met hemoglobinemia metamines change of the hemoglobin met hemoglobinemia is this normal no it's not what do I need to do I need to reduce this fe3 back to fe2 which will bind O2 how do you do this by a reduction reaction reductase which is aided by vitamin C that's why you give vitamin C to treat meth hemoglobinemia you also give the patient and methylene blue patient with metamoglobinemia can experience cyanosis mnemonic time when the patient is blue give methylene blue get it next vitamin B9 folate functions transfer of one carbon unit function DNA synthesis cell replication don't forget my green leafy vegetables we need Vitamin B12 and folate in order for homocysteine to become methionine and in order for you to replicate your cells I.E DNA synthesis and that's why if I lack folate or B12 what do I get lack of DNA synthesis I cannot replicate my cells I can suffer from anemia leukopenia or thrombocytopenia put them together pancytopenia next vitamin B12 cobalamin why do you call it cobalamin because it's made of cobalt where do we absorb folate jejunum about cobalamin terminal ileum and that's why if I have Crohn's disease and it was so bad that they had to remove my terminal ileum surgically this think I'll be able to absorb vitamin B12 no what's going to happen vitamin B12 deficiency anemia lecomenia thrombocytopenia pancytopenia and neurological symptoms sources of vitamin B12 are many strict vegans who do not consume fish meat milk eggs organ meat clams Etc are at a higher risk than the normal population of developing B12 deficiency this of course does not mean that most vegans have B12 deficiency it just means that they are more likely manufacturers have to align together so that you can absorb vitamin B12 a problem in any of them can end up with vitamin B12 deficiency examples include being malnourished chronic cell adenitis pernicious anemia a chlorohydra gastrectomy chronic pancreatitis prolonged use of antibiotics the parasite diaphrilobotrium later mad absorption syndrome ileal resection after Crohn's disease if I like folate or B12 homocysteine will not become methionine what's going to happen to homocysteine level in the blood it will go up and in the urine it will go up homocystinemia homocystinuria risk of heart attacks Strokes dvts low IQ lens subluxation joint contractures Etc here's a very important comparison between folate and b12 only B12 deficiency causes neurological symptoms only B12 deficiency elevates the level of methylmelon COA both folate deficiency and B12 deficiency can lead to anemia pancytopenia and homocystinemia pause and review we're done with the water-soluble vitamins let's review the fat soluble vitamins the most important two slides about the FED soluble vitamins is this one and this one remember in order for you to absorb fat or fat soluble vitamins three organs have to be healthy you need a healthy liver and gallbladder and bidiary system you need lovely pancreas and a doozy intestine to do the actual absorption therefore liver disease bile disease pancreatic disease intestinal disease can lead to male absorption of fat and fat soluble vitamins the fat soluble vitamins are k e d and a if I like vitamin K I bleed if I like vitamin A I get anemia with acanthocytes I get neurological symptoms and myopathy I may lose my dorsal column of the spinal cord leading to loss of vibration proprioception fine touch and fine pressure Sensations as well as two point discrimination vitamin D deficiency can lead to Bone problems in the young it's called rickets in the old it's called osteomalacia vitamin A deficiency equals nectalopia kerato Malaysia Vitamin K Vitamin K is important for gamma carboxylation of the coagulation factors it's important for calcium binding proteins as well as oxidative phosphorylation so normally vitamin K makes me clot my blood after injury it increases bone calcification which is amazing and it decreases soft tissue calcifications because soft tissue calcifications are evil Ergo its deficiency can lead to bleeding and Bone problems and abnormal vessel calcifications here is the process of vitamin K gamma carboxylation of glutamic acid residue from glue to glass look at all of this carboxylation action the lovely epoxide reductase is inhibited by Warfarin that's why it's a blood thinner it can lead to bleeding which specific coagulation factors need this gamma carboxylation 2 7 9 10. causes of vitamin K deficiency I'm not eating it or I have something interfering with its absorption or I have a problem in the liver or Berry system or a pancreas a problem or a gut problem these are the three organs needed to absorb fat and fat soluble vitamins or I have liver failure no liver no gamma carboxylation because it takes place in the liver or if I'm taking Warfarin which inhibits the gamma carboxylation vitamin K normal functions abnormal levels symptoms of deficiency normally it's carboxylation coo abnormally it's BBC and here is Vitamin K deficiency in one slide pause and review if I have vitamin K deficiency plated count normal bleeding time normal PT and PTT both are prolonged next vitamin E antioxidant bake time we'll see who's gonna remember this for my upcoming video on selenium vitamin E is important for your red blood cells your muscles your nerves and your retina precisely because it's an antioxidant normal functions symptoms of deficiency each one corresponds with the symptom and here are the symptoms of vitamin A deficiency pause and review be very careful because vitamin E excess inhibits gamma carboxylation which means it acts as if it's Warfarin and that's why there is an interaction between vitamin A and Warfarin so if you prescribe warfarin to your patient tell them not to take vitamin E supplements vitamin K and vitamin E are kinds of opposite Vitamin K is pro-coagulation vitamin E is pro bleeding deficiency of vitamin K I bleed deficiency of vitamin E I get a hemolytic anemia vitamin kxs hemolytic vitamin A excess bleeding next vitamin D when you hear of ergosterol dehydrocholesterol think of vitamin D Ergo calciferol and colicalciferol respectively thanks to ultraviolet light is it UVA or UVB well UVA is for your Koh it's the Wood Lamp but UVB is the one that activates your vitamin D also it's the one that increases your risk of skin cancer this pathway of making the active form of vitamin D calcitri trial is very important you need your skin you need your liver you need your gut you need sunlight to provide you with UVB the liver has the 25 hydroxylase and then the kidney has the one alpha hydroxylase boosted by parathyroid hormone magnesium is a cofactor here and here how does the active form of vitamin D acts on the target organ like your bone your gut your kidney Etc Etc by zinc fingers we'll talk about these in Greater detail in my upcoming video on zinc because after we finish talking about vitamins we'll start talking about minerals symptoms of vitamin D deficiency are many don't forget bone problems coming up next vitamin A also works by zinc fingers also The receptors inside the cell don't forget vitamin A can terminate a pregnancy it's also teratogenic functions of vitamin A and symptoms of deficiency don't forget the night blindness the metabolasia the abnormal keratinization keratomalacia of my cornea bone and teeth problems dry skin dry mouth dry eyes symptoms of vitamin A deficiency pause and review if you need to recall these please refer to my video on vitamin A next choline the vitamin like molecule that is water soluble and important because from choline you make acetylcholine and sphingomyline and lecithin choline removes fat from the liver decreasing the accumulation of lipids in the liver I.E choline is lipotropic and therefore choline deficiency equals accumulation of fat in the liver fatty liver disease increased alt muscle weakness let's review water-soluble vitamins in one slide and then the fat soluble vitamins vitamin B1 deficiency can lead to wet very very dry very very Wernicke korsakov syndrome vitamin B2 deficiency equals stomatitis chelitis angular stomatitis kelosis Etc vitamin B3 3DS of pellagra diarrhea dermatitis dementia vitamin B6 neuropathy and cideroblastic anemia vitamin B7 deficiency especially if you eat raw egg whites can lead to dermatitis glossitis alopecia enteritis folate deficiency megaloblastic anemia B12 deficiency megaloblastic anemia and neuropathy scurvy bleeding and Corkscrew hair important choline deficiency fatty liver disease muscle weakness next the fat soluble vitamins deficiency vitamin K deficiency bleeding vitamin E deficiency equals retinopathy anemia with acanthocytes peripheral neuropathy vitamin D deficiency rickets or osteomalacia vitamin A deficiency nectarlopia and keratumalation do you want to learn more 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