Nutrition, part 3: Water Soluble Vitamins - B-complex vitamins, vitamin C

by Cathy Parkes July 16, 2021 Updated: August 06, 2021

Why do water soluble vitamins need to be replenished more often? What conditions can be caused by deficiencies in the different B vitamins? Which one is Riboflavin? Why did pirates get scurvy? We'll answer all of this and more in this overview on water-soluble vitamins (B-complex vitamins and vitamin C). This series follows along with our Nutrition Essentials for Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Nutrition plays a key role in patient wellness, and patient teaching regarding nutrition is a key part of EVERY nurse’s job. These flashcards will help you understand the basics of nutrition, along with key nutritional and lifestyle considerations for common health disorders.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

What are water-soluble vitamins?

Water-soluble vitamins are vitamins that can dissolve in water. Water-soluble vitamins are carried to the body's tissues and organs but are not stored in the body long-term, like fat-soluble vitamins are. Vitamin C and B-complex vitamins are the water soluble vitamins you will need to know about.

Water-soluble vitamins cycle through the body quickly and need to be replenished daily through diet or supplementation. Because of this, they carry a lower risk for toxicity than do fat-soluble vitamins.

B-Complex Vitamins

B-complex vitamins (B1, B2, B3, B5, B6, B7, B9 and B12) serve important functions in the body, including biochemical reactions, body growth and development, healthy skin, metabolism, heart and nerve function, and red blood cell formation.

In general, people are at low risk for toxicity related to B-complex vitamins because they are water-soluble, leave the body very quickly, and require regular replenishment through diet.

What are the B-complex Vitamins?

There are eight B-complex vitamins.

  • Thiamin (B1)
  • Riboflavin (B2)
  • Niacin (B3)
  • Pantothenic acid (B5)
  • Pyridoxine (B6)
  • Biotin (B7)
  • Folate/Folic Acid (B9)
  • Cobalamin (B12)

Sources

B-complex vitamins can be found in meat, fish, poultry, eggs, dairy products, leafy green vegetables, beans, peas, and fortified cereals and bread.

B-complex vitamin supplements

Manufactured folic acid is used as an antianemic agent and to prevent neural tube defects. 

Cyanocobalamin (manufactured B12) is used to prevent and treat pernicious anemia and is administered intranasally.

These are some of the many important medications covered in our Pharmacology Flashcards for Nursing Students.

Risk factors for B-Complex vitamin deficiency

Risk factors for deficiency in B-complex vitamins include alcohol use disorder, malnourishment, malabsorption syndromes (like short bowel syndrome), and bariatric surgery.

B-Complex Vitamin Deficiencies

B-Complex vitamin deficiencies can lead to specific problems in the body, depending on which B vitamin it is. It is more likely that you will be tested on these specific deficiencies than the specific functions of each vitamin. So in this section, we'll explain the deficiencies that can be seen with vitamins B1, B2, B3, B6, B9 and B12.

Thiamin (B1)

Deficiency in vitamin B1 can lead to Wernicke-Korsakoff syndrome (degenerative brain disorder), and beriberi. Beriberi affects the cardio and neurovascular systems, leading to increased heart rate and peripheral neuropathy.

Riboflavin (B2)

Deficiency in vitamin B2 can lead to cheilosis, which is a condition of dry swollen lips and fissures (cracks) at the corners of the mouth.

Cool Chicken Your 2 lips will Be swollen and cracked from a lack of B2.

Niacin (B3)

Deficiency in vitamin B3 can lead to pellagra, which is a systemic disease that can result in diarrhea, dermatitis, and dementia. The FDA requires enriched bread products to be fortified with niacin.

Cool Chicken 3Ds: Diarrhea, Dermatitis, Dementia.

Pyridoxine (B6)

Deficiency in vitamin B6 can lead to peripheral neuropathy and anemia.

Folate/Folic Acid (B9)

Deficiency in vitamin B9 can lead to fetal neural tube defects, which can cause fetal spine or brain defects.

Very often patients who are pregnant, or considering getting pregnant, will be put on a folic acid supplement because it prevents these birth defects.

As a public health measure, In 1998, the U.S. Food and Drug Administration required that folic acid be added to enriched grain products (such as bread, pasta, rice, and cereal). This is called fortification.

Cobalamin (B12)

Pernicious anemia is known as vitamin B12 anemia. A protein called intrinsic factor binds B12 so that it can be absorbed. If the gastric mucosa doesn't produce enough intrinsic factor, then the B12 can't be absorbed.

When someone has pernicious anemia due to a lack of intrinsic factor, they need B12, but can't be given it orally because they can't absorb it. A patient with pernicious anemia would need to be administered B12 intranasally.

Vitamin C

Vitamin C is an antioxidant that supports collagen growth, bone formation, wound healing, iron absorption, and immune function. Vitamin C is also called ascorbic acid.

Sources

Vitamin C can be found in citrus fruits (like oranges or grapefruits), tomatoes, potatoes, red or green peppers, broccoli, kiwi, and strawberries.

Vitamin C deficiency

A deficiency in vitamin C can cause the disease scurvy. You've probably heard of scurvy in the context of pirates—historically many sailors (pirates and otherwise) died of scurvy because they did not have access to fresh fruits and vegetables, or adequate nutrition overall, aboard ships.

Cool Chicken The letter C is Curvy (to remind you of sCurvy).

Risk Factors

Risk factors associated with scurvy include smoking, poor nutrition, and alcohol use disorder.

Signs and Symptoms

Signs and symptoms associated with scurvy are swollen and bleeding gums, tooth loss, and poor wound healing.


Full Transcript

Hi. I'm Cathy with Level Up RN. And in this video, we are going to talk about water-soluble vitamins. If you are new to our channel, welcome. We're so glad you're here. Be sure to subscribe.

So our water-soluble vitamins include our B-complex vitamins as well as vitamin C. And I would not get hung up on the individual functions of each and every B-complex vitamin because there's a lot of them.

But, in general, B-complex vitamins help with a number of functions in the body, including biochemical reactions, body growth and development, healthy skin, metabolism, heart and nerve function, and red blood cell production.

In terms of food sources that contain a lot of B-complex vitamins, you can find these vitamins in a lot of foods that have a lot of protein, so meat, poultry, eggs, fish, dairy products.

You can also find B-complex vitamins in green leafy vegetables, beans, peas, and fortified cereals, and bread.

So, in general, people are at low risk for toxicity related to B-complex vitamins because they're a water-soluble vitamin, and they leave the body very quickly and require regular replenishment.

However, deficiency can occur with certain conditions. So risk factors that can lead to deficiency include alcohol use disorder, which is definitely something I see at the hospital when we have people who come in with alcohol abuse disorder. They are often lacking in B-complex vitamins.

Malnourishment is another risk factor, as well as malabsorption syndromes. And then bariatric surgery is another risk factor that can cause a deficiency in B-complex vitamins.

So while it's not important, in my opinion, to know the individual functions of every individual B-complex vitamin, it is important to know what can occur if an individual has a deficiency in each one of these B-complex vitamins.

So if you're following along with cards, definitely pay close attention to card number 9, there's a lot of bold red text on the back, a lot of important concepts that will take some repetition to get down.

So let's review some of those key concepts. If a patient is lacking in B1, that can cause a condition called Beriberi as well as another condition called Wernicke-Korsakoff syndrome.

If your patient is lacking in B2, that can cause a condition called cheilosis. This is where you have dry, swollen lips that are cracked, or have fissures there at the corner.

So, our little Cool Chicken hint to help you remember this is that your '2' lips will 'B' swollen if you're lacking in B2. So two lips, B2. Hopefully, that'll help you remember.

B3. If you're lacking in B3, this causes a condition called pellagra, which I'm pretty sure I've been mispronouncing forever. But I looked it up before I did this video, and it is pellagra.

Pellagra is a disorder characterized by the three Ds. These Ds include diarrhea, dermatitis, and dementia.

B6. If your patient is lacking in B6, they may have conditions such as anemia and peripheral neuropathy.

B9 is folic acid, and anybody who is considering getting pregnant or who is pregnant will definitely be put on a prenatal vitamin that includes folic acid, or B9, because it prevents fetal neural-tube defects.

So our Cool Chicken hint here for B9, or folic acid, is that folic acid prevents fetal problems. So they both start with F.

And then lastly, a lack of B12 can cause pernicious anemia.

And the leading cause of pernicious anemia isn't that someone isn't getting enough oral B12, right? They're getting sufficient B12 in their food. The problem lies with their gastric mucosa. So if their gastric mucosa doesn't contain something called intrinsic factor, then that B12 isn't absorbed. They can eat all the B12 they want, but it's not going to get into their body because it's not being absorbed because of that lack of intrinsic factor.

So when someone has pernicious anemia due to that lack of intrinsic factor, they obviously need B12, but we're not going to give it to them orally because they're not going to be able to absorb it. So we are going to have to give it to them through a different route such as intranasally in order for them to get sufficient B12 and not have this pernicious anemia.

Alright. Let's move on to vitamin C, which is another water-soluble vitamin. And I don't have to pronounce any crazy disorders, so that'll be a lot better with this vitamin. So vitamin C plays a number of functions in the body. It's an antioxidant, and it's essential for collagen growth, bone formation, wound healing, iron absorption, as well as immune function.

You can find vitamin C in a variety of food sources, including citrus fruits. So oranges and grapefruit. You can find it in tomatoes, potatoes, kiwi, broccoli, red and green peppers, as well as strawberries.

A deficiency in vitamin C can cause scurvy. So if you look at the letter C, it's curvy, right, and that will help you to remember that if you don't get enough vitamin C, it will cause scurvy, which rhymes with curvy, obviously. So, hopefully, that's helpful.

Risk factors associated with scurvy include smoking, poor nutrition, and alcohol use disorder. Also pirates, right? You always hear about pirates back in the day getting scurvy. But that's not really a thing anymore, so I didn't list it as a risk factor on this card.

Signs and symptoms of scurvy include swollen, bleeding gums, tooth loss, and poor wound healing.

Okay, you guys ready for quiz-time now?

Beriberi is caused by a lack of what vitamin? If you said B1, you're correct.

Next question: pernicious anemia is caused by a lack of what vitamin? B12 is the answer.

And last question: deficiency in vitamin C can cause what condition? Scurvy. So if you remember the C, it's curvy, to help you remember scurvy.

So, thank you so much for watching, and I'll see you in our next video, which we-- in that video, I'll be going through the fat-soluble vitamins; A, D, E, and K. See you then!

I invite you to subscribe to our channel and share a link with your classmates and friends in nursing school. If you found value in this video, be sure and hit the like button, and leave a comment and let us know what you found particularly helpful.


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