THE MERCK MANUAL HOME HEALTH HANDBOOK
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Overview of Vitamins

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Vitamins are a vital part of a healthy diet. The recommended dietary allowance (RDA)—the amount most healthy people need each day to remain healthy—has been determined for most vitamins. A safe upper limit (tolerable upper intake level) has been determined for some vitamins. Intake above this limit increases the risk of a harmful effect (toxicity).

Consuming too little of a vitamin can cause a nutritional disorder. However, people who eat a variety of foods are unlikely to develop most vitamin deficiencies. Deficiency of vitamin D is an exception. It is common among certain groups of people (such as older people) even if they eat a variety of foods. For other vitamins, a deficiency can develop if people follow a restrictive diet that does not contain enough of a particular vitamin. For example, vegans, who consume no animal products, may become deficient in vitamin B12, which is available in animal products. Deficiency of biotin or pantothenic acid almost never occurs.

Consuming large amounts (megadoses) of certain vitamins (usually as supplements) without medical supervision may also have harmful effects.

Vitamins are called essential micronutrients because the body requires them but only in small amounts.

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Some vitamins—A, D, E, and K—are fat soluble. Other vitamins—B vitamins and vitamin C—are water soluble. B vitamins include biotin, folate (folic acid), niacin, pantothenic acid, riboflavin (vitamin B2), thiamin (vitamin B1), and vitamins B6 (pyridoxine) and B12 (cobalamins).

Vitamins: Fat Versus Water Soluble

Vitamins are classified as fat soluble:

  • Vitamin A
  • Vitamin D
  • Vitamin E
  • Vitamin K

or water soluble:

  • B vitamins
  • Vitamin C

This difference affects nutrition in several ways.

Fat-soluble vitamins: These vitamins dissolve in fats (lipids). They are stored in the liver and in fatty tissues. If too much of the fat-soluble vitamins A or D are consumed, they can accumulate and may have harmful effects.

Because fats in foods help the body absorb fat-soluble vitamins, a low-fat diet may result in a deficiency. Some disorders interfere with absorption of fats and thus of fat-soluble vitamins. Examples are chronic diarrhea, Crohn disease, cystic fibrosis, certain pancreatic disorders, and blockage of the bile ducts. Some drugs, such as mineral oil, have the same effect. Fat-soluble vitamins dissolve in mineral oil, which the body does not absorb. So when people take mineral oil, it carries these vitamins unabsorbed out of the body.

Cooking does not destroy fat-soluble vitamins.

Water-soluble vitamins: These vitamins dissolve in water. They are eliminated in urine and tend to be eliminated from the body more quickly than fat-soluble vitamins. Water-soluble vitamins are more likely to be destroyed when food is stored and prepared. Refrigerating fresh produce, storing milk and grains out of strong light, and using the cooking water from vegetables to prepare soups can help prevent the loss of the vitamins.

The body does not store most vitamins. Therefore, people must consume them regularly. Vitamins A, B12, and D are stored in significant amounts, mainly in the liver.

Disorders that impair the intestine's absorption of food (called malabsorption disorders) can cause vitamin deficiencies. Some disorders impair the absorption of fats. These disorders can reduce the absorption of fat-soluble vitamins—A, D, E, and K—and increase the risk of a deficiency. Such disorders include chronic diarrhea, Crohn disease, cystic fibrosis, certain pancreatic disorders, and blockage of the bile ducts.

Some types of weight-loss (bariatric) surgery can also interfere with absorption of vitamins.

Liver disorders and alcoholism can interfere with the processing (metabolism) or storage of vitamins. In a few people, hereditary disorders impair the way the body handles vitamins and thus cause a deficiency.

Drugs can also contribute to deficiency of a vitamin. They may interfere with absorption, metabolism, or storage of a vitamin.

Because many people eat irregularly or do not eat a variety of foods, they may not get enough of some vitamins from foods alone. If they do not get enough, the risk of certain cancers or other disorders may be increased. People may then take a multivitamin. However, for most people, taking multivitamins does not appear to reduce risk of developing cancer.

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Last full review/revision February 2013 by Larry E. Johnson, MD, PhD

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