When vitamins are not moderated....

Author: Dr. Shunmukha Priya. S

**** Though vitamins are required in small quantities, absence for a longer duration results in deficiency diseases. These spectra of diseases range from simple dry skin to cardiovascular and neural disorders. Hence regular intake of vitamins is a must,

When these vitamins are consumed as supplements for a longer duration, it results in hypervitaminosis, which is very rare, but at times, it is fatal too. **** There are biological markers for each vitamin. Assessment of it will give a clear picture of the vitamin levels in the body. Based on that, vitamins can be consumed.

Vitamins, deficiency diseases, hypervitaminosis and biological markers

Though required in small quantities, the absence of vitamins may cause deficiency diseases, if taken in excess it may lead to hypervitaminosis. The below shows the Vitamins, deficiency diseases, hypervitaminosis and biological marker

Table :1 Vitamins, deficiency diseases, hypervitaminosis and biological marker

Vitamin	Deficiency Diseases	Hypervitaminosis	Biological marker
Fat-Soluble vitamins
A	Ocular disturbances leading to blindnessGrowth retardationDry skinDiarrhoeaFrequent Infections	Hypervitaminosis A or vitamin A toxicity is rare but fatal. This usually happens due to the excessive intake of Vit.A through supplements.Clinical manifestations includenausea, vomiting, headache, dizziness and blurred vision	Blood (serum or plasma)**retinol**is used as a biochemical indicator for the analysis of vitamin A status.
D	Defective bone growth in children (Rickets)Soft bones in adults(Osteomalacia)InfectionsObesityCardiovascular disease and stroke	Vitamin D toxicity also called hypervitaminosis D is a rare condition but could be potentially serious. This happens due to excessive intake of supplements. Not with diet or sunlight. Vit. D toxicity can result in**hypercalcemia**- a condition where calcium will be higher in the blood.It can cause Kidney problems if not treated on time	**25-OHD**is considered to be the best biomarker to assess vitamin D status in blood.
E	Peripheral neuropathyBreakdown of red blood cellsgenetic or malabsorption disordersGastrointestinal disorders	Excessivevitamin E intake can lead to**thinning of blood**and could result in and lead to severe bleeding.It can affect the coagulation of blood.This happens due to excessive intake of supplements.	The status parameter of vitamin E in serum or plasma is**α-tocopherol**
K	Impaired clotting of the bloodInternal bleeding	Hypervitaminosis of K is very rare among adults.In neonate, vitamin K toxicity can lead toanaemia due to rupture of red blood cells and with jaundice.	Prothrombin time_is_the only biomarker for vitamin K.An increase has been associated with vitamin K deficiency
Water-Soluble vitamins
Vitamin B1Thiamine	Beri-beriImpairment of the nervesHeart muscle wastingEmotional DisturbanceSleeplessnessIrritabilityHypotensionMuscular cramps	Hypervitaminosis of (B1) leads to block nerve transmission and causes paralysis, restlessness, convulsions, respiratory paralysis, and cardiac failure.It will also interfere with the functioning of other B vitamins, insulin, and thyroid functions	**Erythrocyte transketolase (ETK)**activityis the functional biomarker for B1
Vitamin B2Riboflavin	Inflammation of the skin, tongue, and lipsVisual disordersNervous disorders	Hypervitaminosis of B2causes liver dysfunction, photophobia, cracks and ulcers in the corners of the mouth, cardiomyopathies, numbness, burning or prickling sensation, hypotension, fatigue, bright yellow urine, vomiting, itching	**Erythrocyte glutathione reductase activation factor (EGRAC)**is currently used as a biomarker for B2
Vitamin B3Niacin	PellagraDermatitisSkin Lesions,Gastrointestinal DisturbancesNervous Symptoms	Hypervitaminosis of Niacin leads toliver toxicity, hypotension, light-headedness, insomnia,peptic ulcer, skin rash, gastrointestinal disorders, aggravation of bronchial asthma, gout etc.	**Total niacin**is the biomarker
Vitamin B5Pantothenic acid	FatigueGastrointestinal disturbancesNervous disordersSleep disturbancesRestlessnessNauseaBurning feet	Overdose of pantothenic acidcauses diarrhoea, gastrointestinal disorders, and water retention leading to oedema.	**RBC B****5**is used to test the recent B5levels
Vitamin B****6	DermatitisMental depressionConfusion,Convulsions,Anaemia	Hypervitaminosis of B6can causedamage to sensory neurons affecting hand and feet, difficulty in the walking, tiredness, heartburn and nausea.	**Pyridoxal 5'- phosphate (PLP)**is the most commonly used marker of B6status.
Vitamin B7Biotin	DermatitisHair lossConjunctivitisNeurological issuesLoss of hair from eyebrows and eyelashes	Hypervitaminosisof Biotin is very rare. Overdose may cause hyperkeratosis of the superficial follicular epithelium.	**3-methylcrotonyl-CoA carboxylase (MCC)andpropionyl-CoA carboxylase (PCC)**is the biological marker.
Vitamin B9Folic Acid	Impaired red blood cells formationWeaknessIrritabilityHeadachePalpitationsInflammation of the mouthNeural tube defects in the foetus	convulsions in the gastric muscles Sleep, stomach disorders, and skin problems are associated with hypervitaminosis of folic acid.	Folate biomarkers are**serum /plasmaandred blood cell folate.**
Vitamin B****12	The smoothness of the tongueGastrointestinal disordersNervous issues	Overdose can cause various allergic reactions, congestive heart failure, palpitations, pulmonary oedema, tingling sensations, and numbness of the feet.	The biomarker used is total vitamin B12, which measures vitamin B12bound to both transport proteins (haptocorrin (HC) and transcobalamin (TC)
Vitamin C	ScurvySpongy bleeding gumsSoreness and stiffness of the jointsBleeding under the skin and in deep tissuesDelay in wound healingAnaemia	In adults, the symptoms of hypervitaminosis C are general weakness, diarrhoea, nausea and vomiting, insomnia, strong headache, skin rashes, heartburn and stomach ache.Among children, it can cause increased nervous excitability, itching and rashes on the skin and unmotivated aggression.	Plasma vitamin C is the biological marker.

Vitamins are micronutrients required in small quantities for the normal functioning of the body. Following a balanced diet will enable one to meet the Recommended Dietary Allowance (RDA).

References

• Roop JK. Hypervitaminosis—an emerging pathological condition. Int J Health Sci Res. 2018;8(10):280-288.
• Nutrient requirements and recommended dietary allowances for Indians (2020). A Short report of the expert group of the Indian Council of Medical Research. Hyderabad: National Institute of Nutrition; Indian Council of Medical Research., P.255.
• Nutrient requirements and recommended dietary allowances for Indians (2010). A report of the expert group of the Indian Council of Medical Research. Hyderabad: National Institute of Nutrition; Indian Council of Medical Research., P.255.
• Codex CAG/GL 2 -1985- Guidelines on nutrition labelling (applied only for individuals older than 36 month)