The Water Soluble VitaminsThe Water Soluble Vitamins

Overview of Water-Soluble Overview of Water-Soluble VitaminsVitamins

Dissolve in waterDissolve in water

Generally readily excretedGenerally readily excreted

Subject to cooking lossesSubject to cooking losses

Function as a coenzymeFunction as a coenzyme

Participate in energy metabolismParticipate in energy metabolism

50-90% of B vitamins are absorbed50-90% of B vitamins are absorbed

Marginal deficiency more commonMarginal deficiency more common

B Complex VitaminsB Complex Vitamins

Co-enzymes (activate enzymes)Co-enzymes (activate enzymes)

Found in the same foodsFound in the same foods– Single deficiency rareSingle deficiency rare

Act together in metabolismAct together in metabolism– Metabolic pathways used by protein, Metabolic pathways used by protein,

carbohydrate, and fatcarbohydrate, and fat

B Complex DigestionB Complex Digestion

Broken down from coenzyme form into Broken down from coenzyme form into free vitamins in the stomach and small free vitamins in the stomach and small intestineintestineAbsorbed, primarily in the small intestine Absorbed, primarily in the small intestine (50%-90%)(50%-90%)Once inside cells, coenzyme forms are Once inside cells, coenzyme forms are resynthesizedresynthesized– No need to ingest coenzyme forms; we can No need to ingest coenzyme forms; we can

make themmake them

B Complex Primary FunctionsB Complex Primary Functions

Energy metabolismEnergy metabolism– Thiamin (B-1), Riboflavin (B-2), Niacin (B-3), Thiamin (B-1), Riboflavin (B-2), Niacin (B-3),

Pyridoxine (B-6), Biotin, Pantothenic AcidPyridoxine (B-6), Biotin, Pantothenic Acid

Red blood cell synthesisRed blood cell synthesis– Folate, B12Folate, B12

Homocysteine metabolismHomocysteine metabolism– Folate, B12, B6Folate, B12, B6

Enrichment Act of 1941 and Enrichment Act of 1941 and 19981998

Many nutrients lost through milling process Many nutrients lost through milling process of grainsof grains

Grain/cereal products are enrichedGrain/cereal products are enriched

Thiamin, riboflavin, niacin, folate, ironThiamin, riboflavin, niacin, folate, iron

Whole grains contain original nutrientsWhole grains contain original nutrients

Enriched grains still deficient in B-6, Enriched grains still deficient in B-6, magnesium and zincmagnesium and zinc

Thiamin (B1)Thiamin (B1)

Contains sulfur and nitrogen groupContains sulfur and nitrogen group

Destroyed by alkaline and heatDestroyed by alkaline and heat

CoenzymeCoenzyme– Releases energy from carbohydrateReleases energy from carbohydrate– CO2 is released from a larger moleculeCO2 is released from a larger molecule– Glucose metabolismGlucose metabolism

Deficiency of ThiaminDeficiency of Thiamin

Occurs where polished rice is the only Occurs where polished rice is the only staplestaple

Beriberi (I can’t I can’t)Beriberi (I can’t I can’t)– Weakness, nerve degeneration, irritability, Weakness, nerve degeneration, irritability,

poor arm/leg coordination, loss of nerve poor arm/leg coordination, loss of nerve transmissiontransmission

– Edema, enlarged heart, heart failureEdema, enlarged heart, heart failure– Symptoms due to poor metabolism of glucoseSymptoms due to poor metabolism of glucose– Depression and weakness can be seen after Depression and weakness can be seen after

only 10 days on a thiamin-free dietonly 10 days on a thiamin-free diet

Wet and Dry BeriBeriWet and Dry BeriBeri

Food Sources of ThiaminFood Sources of ThiaminWide variety of foodWide variety of food

Pork, hot dogs, luncheon meat, cold cerealPork, hot dogs, luncheon meat, cold cereal

Enriched breads and grains/ whole grainsEnriched breads and grains/ whole grains

Green beans, milk, orange juice, organ Green beans, milk, orange juice, organ meats, peanuts, dried beans and seedsmeats, peanuts, dried beans and seeds

ThiaminaseThiaminase found in raw fish found in raw fish– Destroys thiaminDestroys thiamin

RDA For ThiaminRDA For Thiamin

1.1 mg/day for women1.1 mg/day for women1.2 mg/day for men1.2 mg/day for menDaily Value on food label is 1.5 mgDaily Value on food label is 1.5 mgMost exceed RDA in dietMost exceed RDA in dietLow income people and older people may Low income people and older people may barely meet needs (highly processed and barely meet needs (highly processed and unenriched foods, sugar, fat, alcohol)unenriched foods, sugar, fat, alcohol)Surplus is rapidly lost in urine; non toxic; Surplus is rapidly lost in urine; non toxic; no Upper Levelno Upper Level

Alcohol and ThiaminAlcohol and Thiamin

Alcoholics are at greatest risk for thiamin Alcoholics are at greatest risk for thiamin deficiency because absorption and use of deficiency because absorption and use of thiamin are profoundly diminished and thiamin are profoundly diminished and excretion is increased by alcohol excretion is increased by alcohol consumptionconsumption

Poor quality diet makes it worsePoor quality diet makes it worse

Little stored in body, so alcoholic binge of Little stored in body, so alcoholic binge of 1-2 weeks may result in deficiency1-2 weeks may result in deficiency

Riboflavin (B2)Riboflavin (B2)

CoenzymesCoenzymes

Participate in many energy-yielding Participate in many energy-yielding metabolic pathwaysmetabolic pathways– Fatty acids broken down and burned for Fatty acids broken down and burned for

energyenergy

Deficiency of RiboflavinDeficiency of Riboflavin

AriboflavinosisAriboflavinosis– Glossitis, cheilosis, seborrheic dermatitis, Glossitis, cheilosis, seborrheic dermatitis,

stomatitis, eye disorder, throat disorder, stomatitis, eye disorder, throat disorder, nervous system disordernervous system disorder

Occurs within 2 months Occurs within 2 months

Usually in combination with other Usually in combination with other deficienciesdeficiencies

AriboflavinosisAriboflavinosis

Food Sources of RiboflavinFood Sources of Riboflavin

Milk/productsMilk/productsEnriched grainsEnriched grainsReady to eat cerealsReady to eat cerealsLiverLiverOysterOysterBrewer’s yeastBrewer’s yeastVegetables (asparagus, broccoli, greens)Vegetables (asparagus, broccoli, greens)Sensitive to uv radiation (sunlight)Sensitive to uv radiation (sunlight)Stored in paper, opaque plastic containersStored in paper, opaque plastic containers

RDA for RiboflavinRDA for Riboflavin

1.1 mg/day for women1.1 mg/day for women

1.3 mg/day for men1.3 mg/day for men

Average intake is above RDAAverage intake is above RDA

Toxicity not documentedToxicity not documented

No upper levelNo upper level

Niacin (B3)Niacin (B3)

Nicotinic acid and nicotinamideNicotinic acid and nicotinamide

Coenzymes Coenzymes

Needed when cell energy is being utilizedNeeded when cell energy is being utilized

Synthetic pathways require niacin, especially Synthetic pathways require niacin, especially fatty acid synthesisfatty acid synthesis

Deficiency of Niacin: PellagraDeficiency of Niacin: Pellagra

3 Ds 3 Ds – DementiaDementia– DiarrheaDiarrhea– Dermatitis (worse with sun exposure)Dermatitis (worse with sun exposure)

Occurs in 50-60 daysOccurs in 50-60 daysPoor appetite, weight loss, weaknessPoor appetite, weight loss, weakness

PellagraPellagraPrevented with an adequate protein dietPrevented with an adequate protein diet

Enrichment Act of 1941Enrichment Act of 1941

Became epidemic in southern Europe in Became epidemic in southern Europe in early 1700s when corn became a staple early 1700s when corn became a staple food (poor source)food (poor source)

Reached epidemic proportions in the Reached epidemic proportions in the southeastern U.S from late 1800s to southeastern U.S from late 1800s to 1930s1930s– Only dietary deficiency disease to reach Only dietary deficiency disease to reach

epidemic proportions in the USepidemic proportions in the US

PellagraPellagra

Food Sources of NiacinFood Sources of NiacinEnriched grains, ready to eat cerealsEnriched grains, ready to eat cerealsBeef, chicken, turkey, fishBeef, chicken, turkey, fishAsparagus, peanutsAsparagus, peanutsHeat stable; little cooking lossHeat stable; little cooking loss60mg tryptophan can be converted into 1 mg 60mg tryptophan can be converted into 1 mg niacin; meets 50% of our needsniacin; meets 50% of our needsNiacin in corn is bound by a proteinNiacin in corn is bound by a protein– Soaking corn in alkaline solution, like lime water Soaking corn in alkaline solution, like lime water

releases niacinreleases niacin– Hispanic people soak corn in lime water before Hispanic people soak corn in lime water before

making tortillasmaking tortillas

RDA for NiacinRDA for Niacin

14 (mg) NE/day for women14 (mg) NE/day for women

16 (mg) NE/day for men16 (mg) NE/day for men

Daily Value on labels is 20 mgDaily Value on labels is 20 mg

Upper Level is 35 mgUpper Level is 35 mg

Toxicity S/S: headache, itching, flushing, Toxicity S/S: headache, itching, flushing, liver and GI damageliver and GI damage

Megadose can lower LDL and TG and Megadose can lower LDL and TG and increase HDLincrease HDL

Pantothenic AcidPantothenic Acid

Part of Coenzyme-APart of Coenzyme-AEssential for metabolism of CHO, fat, Essential for metabolism of CHO, fat, proteinprotein

Deficiency rareDeficiency rareUsually in combination with other Usually in combination with other deficienciesdeficienciesNo known toxicityNo known toxicity

Food Sources of Pantothenic Food Sources of Pantothenic acidacid

““From every side”From every side”

MeatMeat

MilkMilk

MushroomMushroom

LiverLiver

PeanutPeanut

EggsEggs

Adequate Intake = 5 mg/dayAdequate Intake = 5 mg/day

Daily Value 10 mgDaily Value 10 mg

Average intake meets AIAverage intake meets AI

BiotinBiotin

Free and bound formFree and bound form

Metabolism of CHO and fatMetabolism of CHO and fat

Assists the addition of CO2 to other Assists the addition of CO2 to other compoundscompounds

Synthesis of glucose, fatty acids, DNASynthesis of glucose, fatty acids, DNA

Help break down certain amino acidsHelp break down certain amino acids

Biotin DeficiencyBiotin Deficiency

Raw egg whites avidin bind biotin Raw egg whites avidin bind biotin → → deficiencydeficiencyRequires large amountRequires large amountScaly inflamed skin, tongue, and lip Scaly inflamed skin, tongue, and lip changeschangesPoor appetite, nausea, vomitingPoor appetite, nausea, vomitingAnemiaAnemiaMuscle pain and weaknessMuscle pain and weaknessPoor growthPoor growth

Food Sources of BiotinFood Sources of Biotin

Cauliflower, yolk, liver, peanuts, cheeseCauliflower, yolk, liver, peanuts, cheese

Intestinal synthesis of biotinIntestinal synthesis of biotin

Biotin content only available for a small Biotin content only available for a small number of foodsnumber of foods

Unsure as to bioavailablity of synthesized Unsure as to bioavailablity of synthesized biotinbiotin

We excrete more than we consumeWe excrete more than we consume

Biotin NeedsBiotin Needs

Adequate Intake is 30 ug/day for adultsAdequate Intake is 30 ug/day for adults

This may overestimate the amount needed This may overestimate the amount needed for adultsfor adults

Deficiency rareDeficiency rare

No Upper Level for biotinNo Upper Level for biotin

Relatively nontoxicRelatively nontoxic

Pyridoxine (B6)Pyridoxine (B6)

3 compounds3 compounds

Coenzyme Coenzyme

Activate enzymes needed for metabolism Activate enzymes needed for metabolism of CHO, fat , proteinof CHO, fat , protein

Synthesize nonessential amino acid via Synthesize nonessential amino acid via transaminationtransamination

Synthesize neurotransmittersSynthesize neurotransmitters

Synthesize hemoglobin and WBCSynthesize hemoglobin and WBC

Other Roles of Vitamin B-6Other Roles of Vitamin B-6

HomocysteineHomocysteine

Produces toxic effect on arterial walls Produces toxic effect on arterial walls (atherosclerosis)(atherosclerosis)

Metabolized by vitamins B-6, B-12 and Metabolized by vitamins B-6, B-12 and folate folate

Food Sources of Vitamin B-6Food Sources of Vitamin B-6

Well absorbedWell absorbedMeat, fish, poultryMeat, fish, poultryEnriched cerealsEnriched cerealsPotatoesPotatoesMilkMilk

Less well absorbedLess well absorbedFruits and vegetables: Banana, spinach, Fruits and vegetables: Banana, spinach, avocadoavocado

Heat and alkaline sensitiveHeat and alkaline sensitive

B6 DeficiencyB6 Deficiency

Widespread symptomsWidespread symptoms

DepressionDepression

VomitingVomiting

Skin disordersSkin disorders

Nerve irritationNerve irritation

Impaired immune systemImpaired immune system

B6 ToxicityB6 Toxicity

Nerve damageNerve damage

Difficulty walkingDifficulty walking

Numbness in hands/feetNumbness in hands/feet

RDA for Vitamin B-6RDA for Vitamin B-6

1.3 mg/day for adults1.3 mg/day for adults

1.7 mg/day for men over 501.7 mg/day for men over 50

1.5 mg/day for women over 501.5 mg/day for women over 50

Daily Value set at 2 mgDaily Value set at 2 mg

Average intake is more than the RDAAverage intake is more than the RDA

Athletes may need moreAthletes may need more

Alcohol destroys vitamin B6Alcohol destroys vitamin B6

B-6 As A Medicine?B-6 As A Medicine?

PMSPMS– B-6 to increase the level of serotoninB-6 to increase the level of serotonin– Not a reliable treatmentNot a reliable treatment

Carpal tunnel syndromeCarpal tunnel syndromeToxicity potentialToxicity potentialCan lead to irreversible nerve damage Can lead to irreversible nerve damage with > 200 mg/daywith > 200 mg/dayUpper Level set at 100 mg/dayUpper Level set at 100 mg/day

FolateFolate

CoenzymeCoenzyme

DNA synthesisDNA synthesis– Anticancer drug methotrexateAnticancer drug methotrexate

Homocysteine metabolismHomocysteine metabolism

Neurotransmitter formation Neurotransmitter formation

Deficiency of FolateDeficiency of Folate

Similar signs and symptoms of vitamin B-Similar signs and symptoms of vitamin B-12 deficiency12 deficiency

AnemiaAnemia– RBC grow, cannot divideRBC grow, cannot divide– Megaloblast: large, immature RBCMegaloblast: large, immature RBC

Pregnant womenPregnant women

AlcoholicsAlcoholics

Megaloblastic AnemiaMegaloblastic Anemia

Neural Tube DefectsNeural Tube DefectsNeural tube closes first 28 days of Neural tube closes first 28 days of pregnancypregnancy

Forms brain and spinal cordForms brain and spinal cord

By the time pregnancy is confirmed, By the time pregnancy is confirmed, damage is donedamage is done

Neural Tube DefectsNeural Tube Defects

Spina bifidaSpina bifida– Spinal malformationSpinal malformation– ParalysisParalysis

AnencephalyAnencephaly– No brain cortexNo brain cortex– Stillborn or die within hoursStillborn or die within hours

Importance of folate before and during Importance of folate before and during pregnancypregnancyGovernment requires folate enrichment of flour Government requires folate enrichment of flour and cerealand cerealMay prevent 50% neural tube defectsMay prevent 50% neural tube defects

Folate and HomocysteineFolate and Homocysteine

High homocysteine levels in blood High homocysteine levels in blood associated with increased risk of CVDassociated with increased risk of CVD

Folate deficiency Folate deficiency → homocysteinemia→ homocysteinemia

Food Sources of FolateFood Sources of FolateLiverLiver

Fortified breakfast cerealsFortified breakfast cereals

Grains, legumesGrains, legumes

Foliage vegetablesFoliage vegetables

Susceptible to heat, oxidation, ultraviolet Susceptible to heat, oxidation, ultraviolet lightlight

Synthetic form better absorbedSynthetic form better absorbed

RDA for FolateRDA for Folate

400 ug/day for adults400 ug/day for adults

(600 ug/day for pregnant women)(600 ug/day for pregnant women)

Average intake below RDAAverage intake below RDA

FDA limits nonprescription supplements to FDA limits nonprescription supplements to 400 ug per tablet for non-pregnant adults400 ug per tablet for non-pregnant adults

OTC Prenatal supplement contains 800 ugOTC Prenatal supplement contains 800 ug

Excess can mask vitamin B-12 deficiencyExcess can mask vitamin B-12 deficiency

Upper Level set at 1 mgUpper Level set at 1 mg

Vitamin B-12Vitamin B-12

Compounds containing the mineral cobaltCompounds containing the mineral cobalt

Synthesized by bacteria, fungi, and other Synthesized by bacteria, fungi, and other lower organismslower organisms

Role in folate metabolismRole in folate metabolism

Maintenance of the myelin sheathsMaintenance of the myelin sheaths

RBC formationRBC formation

Pernicious anemia (associated with nerve Pernicious anemia (associated with nerve degeneration and paralysis)degeneration and paralysis)

Deficiency of Vitamin B-12Deficiency of Vitamin B-12

Pernicious anemiaPernicious anemia– Nerve degeneration, weaknessNerve degeneration, weakness– Tingling/numbness in the extremities (parasthesia)Tingling/numbness in the extremities (parasthesia)– Paralysis and deathParalysis and death– Looks like folate deficiencyLooks like folate deficiency

Usually (95%) due to decreased absorption Usually (95%) due to decreased absorption abilityabilityAchlorhydriaAchlorhydria especially in elderly especially in elderlyInjectionInjection of B-12 needed of B-12 neededTakes ~20 years on a deficient diet to see Takes ~20 years on a deficient diet to see nerve destructionnerve destruction

Therapy for Ineffective Therapy for Ineffective AbsorptionAbsorption

Many factors can disrupt this processMany factors can disrupt this process

Monthly injections of vitamin B-12Monthly injections of vitamin B-12

Vitamin B-12 nasal gelVitamin B-12 nasal gel

Megadoses of vitamin B-12 to allow for Megadoses of vitamin B-12 to allow for passive diffusionpassive diffusion

Food Sources of Vitamin B-12Food Sources of Vitamin B-12

Synthesized by bacteria, fungi and algaeSynthesized by bacteria, fungi and algae

(Stored primarily in the liver)(Stored primarily in the liver)

Animal productsAnimal products

Organ meatOrgan meat

SeafoodSeafood

EggsEggs

Hot dogsHot dogs

MilkMilk

Low B12 IntakeLow B12 Intake

Vegans: will have to find alternative sourceVegans: will have to find alternative source

Breastfed infants of vegan mothersBreastfed infants of vegan mothers

Symptoms of Pernicious anemiaSymptoms of Pernicious anemia– Takes longer to developTakes longer to develop– 5-10 years of anemia5-10 years of anemia– 20 years nerve damage20 years nerve damage

RDA for Vitamin B-12RDA for Vitamin B-12

2.4 ug/ day for adults and elderly 2.4 ug/ day for adults and elderly adultsadults

Average intake exceeds RDAAverage intake exceeds RDA

B-12 stored in the liverB-12 stored in the liver

Non-toxic (no Upper Level)Non-toxic (no Upper Level)

Vitamin CVitamin C

Synthesized by most animals (not by Synthesized by most animals (not by humans)humans)Decrease absorption with high intakesDecrease absorption with high intakesExcess excretedExcess excreted

Functions of Vitamin CFunctions of Vitamin C

Reducing agent (antioxidant)Reducing agent (antioxidant)Iron absorption (enhances)Iron absorption (enhances)Synthesis of collagenSynthesis of collagenImmune functionsImmune functions– Does not prevent colds, but may reduce Does not prevent colds, but may reduce

duration of symptoms by a day or soduration of symptoms by a day or so

Wound healingWound healing

AntioxidantAntioxidant

Can donate and accept hydrogen Can donate and accept hydrogen atoms readilyatoms readilyWater-solubleWater-solubleNeeds are higher for smokersNeeds are higher for smokersMay prevent certain cancers May prevent certain cancers (esophageal, oral, stomach cancer, (esophageal, oral, stomach cancer, cardiovascular disease, cataracts)cardiovascular disease, cataracts)

Vitamin C Deficiency: Vitamin C Deficiency: History of ScurvyHistory of Scurvy

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

Scurvy in the British Royal NavyScurvy in the British Royal Navy

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

Deficiency of Vitamin CDeficiency of Vitamin C

ScurvyScurvy– Deficient diet for 20-40 days Deficient diet for 20-40 days – Fatigue, pinpoint hemorrhagesFatigue, pinpoint hemorrhages– Bleeding gums and joints. HemorrhagesBleeding gums and joints. Hemorrhages– Associated with poverty; macrobiotic dietAssociated with poverty; macrobiotic diet

Rebound ScurvyRebound Scurvy– Sudden halt to high levels of vitamin C Sudden halt to high levels of vitamin C

supplementssupplements

ScurvyScurvy

Scorbutic Rosary

Follicular Hemorrhages

Food Sources of Vitamin CFood Sources of Vitamin C

Citrus fruitCitrus fruit

PotatoPotato

Green pepperGreen pepper

CauliflowerCauliflower

BroccoliBroccoli

StrawberryStrawberry

Romaine lettuceRomaine lettuce

SpinachSpinach

Easily lost through Easily lost through cookingcooking

Sensitive to heatSensitive to heat

Sensitive to iron, Sensitive to iron, copper, oxygencopper, oxygen

RDA for Vitamin CRDA for Vitamin C

90 mg/day for male adults90 mg/day for male adults

75 mg/day for female adults75 mg/day for female adults

+35 mg/day for smokers+35 mg/day for smokers

Average intake ~72 mg/dayAverage intake ~72 mg/day

Daily Value is 60 mgDaily Value is 60 mg

Fairly nontoxic (at <1 gm)Fairly nontoxic (at <1 gm)

Body is saturated at intake of 200 mg/dayBody is saturated at intake of 200 mg/day

Upper Level is 2 g/dayUpper Level is 2 g/day

Vitamin C ExcessVitamin C Excess

HemochromatosisHemochromatosis– Vitamin C enhances iron absorptionVitamin C enhances iron absorption

Oxalate kidney stonesOxalate kidney stones

Erodes tooth enamelErodes tooth enamel

Vitamin C DeficiencyVitamin C Deficiency

In the U.S., deficiency is seen mostly in In the U.S., deficiency is seen mostly in alcoholic persons with poor diets and older alcoholic persons with poor diets and older persons who eat poorly (no fresh fruits and persons who eat poorly (no fresh fruits and vegetables)vegetables)

CholineCholine

Newest essential nutrient Newest essential nutrient

All tissues contain cholineAll tissues contain choline

Precursor for acetylcholine Precursor for acetylcholine (neurotransmitter)(neurotransmitter)

Precursor for phospholipidsPrecursor for phospholipids

Some role in homocysteine Some role in homocysteine metabolismmetabolism

Food Sources of CholineFood Sources of Choline

Widely distributedWidely distributed

MilkMilk

LiverLiver

EggsEggs

PeanutsPeanuts

Lecithin added to foodLecithin added to food

Deficiency rareDeficiency rare

Needs for CholineNeeds for Choline

Adequate Intake is 550 mg/day for adult Adequate Intake is 550 mg/day for adult malesmalesAdequate Intake is 425 mg/day for adult Adequate Intake is 425 mg/day for adult femalesfemalesNormal consumption is ~700-1000 mg/dayNormal consumption is ~700-1000 mg/dayHigh doses associated with fishy body odor, High doses associated with fishy body odor, vomiting, salivation, sweating, hypotension, vomiting, salivation, sweating, hypotension, GI effectsGI effectsUpper Level is set at 3.5 g/day (3500 mg/day)Upper Level is set at 3.5 g/day (3500 mg/day)

Vitamin-Like CompoundsVitamin-Like Compounds

CholineCholine

CarnitineCarnitine

InositolInositol

TaurineTaurine

Lipoic acidLipoic acid

Synthesized in the body at the expense of Synthesized in the body at the expense of amino acids and other nutrientsamino acids and other nutrients