Vitamin

Description Beta-carotene is a precursor form of vitamin A.  It is converted to vitamin A in the body on an ‘as-required’ basis.
Function/ Used for In its unconverted form, beta-carotene acts as an antioxidant in the body, neutralising potentially damaging free radicals.

If it is converted in the body then its actions are those of vitamin A.

Intake Recommended intake

EU NRV: Not established.

 

UK average daily intake

In the UK, the average adult diet provides 2.58 mg (beta-carotene) daily.1

Five portions of fruit and vegetables per day will usually provide about 6mg of beta-carotene. However, apples, bananas and onions provide almost no beta-carotene.

As a supplement Not generally available as a single supplement. Commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Beta-carotene gives yellow and orange fruit and vegetables their colour. Therefore, rich sources include brightly coloured fruit and vegetables such as carrots, red pepper, spinach (and other dark green leafy vegetables), mango, peaches and apricots (60 per cent of the average UK intake comes from carrots).

Levels are stable during cooking, but losses occur due to exposure to light and air.

Deficiency There are no known deficiency symptoms.
Precautions and contraindications High intakes are not recommended for smokers. Two large-scale studies have shown an association between beta-carotene supplementation (20mg/day) and an increased incidence of lung cancer in smokers and individuals with previous high-level exposure to asbestos.2,3

Safe Upper Level: 7mg/day4

Use in pregnancy and breastfeeding Beta-carotene is converted to vitamin A in the body on an ‘as required’ basis which reduces the risk of vitamin A toxicity. This makes it safe during pregnancy when high levels of vitamin A itself (retinol) should be avoided.
Interactions e.g. with other medications Beta carotene may interact with alcohol increasing the liver toxicity of alcohol5
Adverse effects Carotenoids are generally non-toxic.

Intake of >30mg daily may lead to hypercarotenemia which is characterised by a yellowish colouration of the skin (including soles of feet and palms of hand). This is harmless and reversible.6

References 1 DEFRA. Family Food 2014.UK Purchases and expenditure on food and drink and derived energy and nutrient intakes. National Statistics, December 2015. https://www.gov.uk/government/statistics/family-food-2014

2 The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. New England Journal of Medicine 330, 1029-1035.

3 Omenn, G.S., Goodman, G.E., Thornquist, M.D., Balmes, J., Cullen, M.R., Glass, A., Keogh, J.P., Meyskens, F.L., Valanis, B., Williams, J.H., Barnhart, S., Hammer, S. (1996). Effects of a combination of beta-carotene and vitamin A on lung cancer and cardiovascular disease. New England Journal Medicine 334, 1150-1155

4 Expert Group on Vitamins and Minerals, 2003.

5 Leo M. A & Lieber C.S. Alcohol, Vitamin A and βcarotene: adverse interactions including hepatotoxicity and carcinogenicity. American Journal of Clinical Nutrition. June 1999 vol 69:6 pp1071-1085 http://ajcn.nutrition.org.content/69/6/1071.full

6 Mason, P. Dietary Supplements. Pharmaceutical press, London, 2001

 

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Description Formerly known as Vitamin H or Co-enzyme R, biotin is a water soluble vitamin and a member of the B-vitamins group.
Function/ Used for Biotin works synergistically with other B vitamins. It is involved in energy production through the metabolism of carbohydrates, proteins and fats. It is also essential for the production of RNA and DNA and helps to maintain the mucous membranes, healthy skin and nails.
Intake Recommended intake

EU NRV: 50µg

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Not generally available as a single supplement. Commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Biotin is found in many foods and is also synthesised by the microflora in the gut.

The richest sources of biotin are liver, kidney, egg yolks, brewer’s yeast and soya beans. Meat, wholegrain cereals, wholemeal bread, milk and cheese are also good sources. Green vegetables contain very little biotin.

Deficiency Symptoms include patches of hair loss (alopecia), reversible baldness, depression, muscle pains and wasting. Also, dry, flaky skin, rash around the eyes, nose and mouth, brittle hair, tiredness and loss of appetite.
Precautions and contraindications Safe Upper Level: 970µg/day2
Use in pregnancy and breastfeeding Suitable to be used during pregnancy and breastfeeding.
Interactions e.g. with other medications Biotin may interact with anticonvulsant drugs. Long term treatment with anticonvulsant drugs may decrease blood levels of biotin. To avoid side effects, individuals taking anticonvulsants should supplement with biotin either alone or as part of a multivitamin. 3,4
Adverse effects None known.
References https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2 Expert Group of Vitamins and Minerals, 2003.

3 Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

4. Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

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Description Folic Acid, known as folate in its natural form, is a synthetic water-soluble vitamin and is part of the B-vitamins group. Folic acid is generally consumed in the form of food supplements or in fortified foods.
Function/ Used for Essential during pregnancy for efficient neural tube development which forms the brain and spinal cord. ‘Neural tube defects’, such as spina bifida, in babies appear to be linked to a ‘metabolic defect’ in folate metabolism in the mother. This means that, even though the mother may have an adequate dietary intake of folic acid, her body cannot use it efficiently. Taking extra folic acid at the time when the neural tube is forming can reduce the chance of the baby having a neural tube defect. However, the neural tube is formed very early during pregnancy – about a month after conception. Women are advised to take folic acid for 12 weeks prior to conception and to continue taking folic acid supplements until the 12th week of pregnancy.

 

In addition, folic acid is essential for the formation of red blood cells and has been shown to reduce the levels of an amino acid (homocysteine). This reduction may have a protective effect against heart disease.1

Intake Recommended Intake

EU NRV: 200µg

 

Women of childbearing age (14-49 years) who are planning or who may become pregnant are advised to take a supplement containing 400µg folic acid every day.

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes2.

As a supplement Available as a single supplement. Also commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) ‘Folate’ can be found naturally in yeast extract, wholegrain cereals, liver, brussels sprouts, broccoli, leafy green vegetables, beans, oranges and beer.

Levels of folate are unstable, unless the foods are refrigerated, and can also be destroyed by processing and cooking.

‘Folic acid’ can be sourced from fortified foods, such as breakfast cereals, marmite, bovril and fat spreads.

Deficiency Folate deficiency may lead to an increased risk of neural tube defect (spina bifida) in babies.

Folate deficiency may cause macrocytic megaloblastic anaemia (enlarged but fewer red blood cells).5

Precautions and contraindications Safe Upper Level: 1000µg/day3
Use in pregnancy and breastfeeding No problems have been reported. Supplements are required during pregnancy and when planning a pregnancy.
Interactions e.g. with other medications Those taking anti-epileptic drugs should seek doctor’s advice. Prolonged use of oral contraceptives may cause folic acid depletion4.

Adequate amounts of all B vitamins are required for optimal functioning. Deficiency or excess of one B vitamin may lead to abnormalities in the metabolism of another. Folic acid may reduce the absorption of zinc.

Adverse effects Folic acid is generally considered to be safe even in high doses, but it may lead to convulsions in patients taking anticonvulsants and  to neuropathy in patients with pernicious anaemia.5

 

Some gastrointestinal disturbance has been reported at doses of 15 mg daily. Allergic reactions (shortness of breath, wheezing, fever, erythema, skin rash, itching) have been reported rarely.5

References 1.       NHS Choices. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vitamins-minerals-supplements-pregnant.aspx#Folic

2.       https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

3.       Expert Group on Vitamins and Minerals, 2003.

4.       Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

5.       Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001. 4.

 

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Description Pantothenic acid is also sometimes referred to as Vitamin B5. It is water soluble and part of the B-vitamins group. Pantothenic acid and calcium pantothenate (a more stable form of pantothenic acid) are available in the form of tablets and capsules, but they are found mainly in multivitamin and mineral preparations.
Function/ Used for Pantothenic acid forms part of two substances, co-enzyme A and the acyl carrier protein. These have key roles in the release of energy from foods.

Pantothenic acid is involved in the metabolism of protein and fat, and is also needed for healthy growth.

Intake Recommended intake

EU NRV: 6mg

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Not generally available as a single supplement. Commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Fortified breakfast cereal, wholegrains (such as brown rice and wholemeal bread), dairy products, liver, kidneys and eggs.
Deficiency Deficiency of pantothenic acid is extremely rare. Symptoms include poor muscle co-ordination, muscle cramps, numbness and tingling, painful burning feet, depression, fatigue, weakness, headache and loss of appetite.3
Precautions and contraindications None known.

Safe Upper Level (Guidance Level): 210mg total dietary intake per day2

Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy.
Interactions e.g. with other medications Excessive alcohol intake may increase requirement for pantothenic acid.

Oral contraceptives may also increase requirement for pantothenic acid.

Adequate amounts of all B vitamins are required for optimal functioning as deficiency or excess of one B vitamin may lead to abnormalities in the metabolism of another.3

Adverse effects No adverse effects, except for occasional diarrhoea, have been reported in humans.
References 1.     https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2.     Expert Group on Vitamins and Minerals, 2003.

3.     Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

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Description Vitamin A is a fat-soluble vitamin stored mainly in the liver.

Dietary Reference Values express the requirement for vitamin A in terms of retinol equivalents.

Function/ Used for Vital for maintaining good eyesight, particularly for the normal function of the retina and visual adaptation to darkness, and healthy skin. It is also important for growth in children.
Intake Recommended intake

EU NRV: 800µg

 

Chief Medical Officer recommendations are that all children aged six months to five years should take a daily supplement containing vitamins A, C and D.

 

UK average daily intake

Requirements vary depending on age and gender.  The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes.1

As a supplement Not generally available as a single supplement. Commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) The richest natural sources are fish liver oils. It is also very concentrated in animal liver. Other sources include oily fish, egg yolk, fortified margarine, butter and full fat milk.
Deficiency Vitamin A deficiency is prevalent in young children in developing countries and is associated with general malnutrition in these countries.2,3

In the UK, deficiency is relatively rare (especially in adults). Deficiency symptoms include an increased susceptibility to infections, scaly skin, flaking scalp, brittle, dull hair; poor eyesight and night vision, loss of appetite.2,3

Precautions and contraindications Just before, or during the first three months of pregnancy, women are advised by the Department of Health that they should not eat liver, or take vitamin A supplements which contain more than the 800µg NRV unless under medical supervision. As vitamin A (retinol) is teratogenic, it may induce developmental abnormalities in a foetus if taken in high amounts just before, or during the first three months of pregnancy. However, too little vitamin A in pregnancy can also cause problems.3

 

Safe Upper Level: 1500µg/day2

Use in pregnancy and breastfeeding The Department of Health recommends that women who are (or may become) pregnant should not take dietary supplements that contain vitamin A (including fish liver oil), except on the advice of a doctor or antenatal clinic, and should also avoid eating liver and products containing liver (e.g. liver pate and liver sausage).4
Interactions e.g. with other medications People taking anticoagulants, retinoids, or statins should seek medical advice before taking Vitamin A.

The weight-loss drug orlistat and cholesterol-reducing drugs may reduce the absorption of vitamin A and other fat-soluble vitamins (D, E, K).3,5

Adverse effects Acute toxicity may be induced by single doses of 300mg retinol in adults, 60 mg retinol in children or 30 mg retinol in infants. Signs and symptoms are usually temporary (usually occurring about 6 hours after ingestion of acute dose and disappearing after 36 hours) and include severe headache (due to raised intracranial pressure), sore mouth, bleeding gums, dizziness, vomiting, blurred vision, irritability and (in infants) bulging of the fontanelle.

Signs of chronic toxicity may appear when daily intake is >15mg retinol in adults and 6 mg in infants and young children. Signs may include dryness of the skin, dermatitis, skin rash, skin scaliness, disturbed hair growth, bone and joint pain, headache, fatigue, irritability, insomnia, anorexia, nausea, vomiting, diarrhoea, and weight loss.2

References 1.       https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2.       Expert Group on Vitamins and Minerals, 2003.

3.       Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

4.       NHS Choices. Foods to avoid in pregnancy. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/foods-to-avoid-pregnant.aspx#vitamin

5.       Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

 

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Description Thiamin is water soluble and part of the B-vitamins group.
Function/ Used for Thiamin aids the nervous system and is essential for the functioning of some important enzymes. These enzymes have vital roles in the processes that make energy available in the body. Thiamin is essential for the transmission of certain types of nerve signal between the brain and the spinal cord.
Intake Recommended intake

EU NRV: 1.1mg

 

Thiamin requirements depend on energy intake; values are therefore often given as mg/1000 kcal and also as total values based on estimated average energy requirements for the majority of people in the UK.

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Not generally available as a single supplement. Commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Brown rice, peas, beans and other vegetables, fortified breakfast cereals, wholemeal breads and cereals, eggs, pork, bacon and liver.
Deficiency Thiamine deficiency may lead to beri-beri (rare in the UK) which affects the cardiovascular and nervous systems. Deficiency is associated with abnormalities of carbohydrate metabolism.

Early signs of deficiency include depression, poor memory, muscle weakness and stiffness, nerve tingling, burning sensation and numbness, tiredness, headache, loss of appetite and nausea.3

Precautions and contraindications Known hypersensitivity to thiamin. Safe Upper Level: 100mg/day2
Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy.
Interactions e.g. with other medications Excessive alcohol intake induces thiamin deficiency.

Prolonged use of oral contraceptives may induce thiamin deficiency.

Adequate amounts of all B vitamins are required for optimal functioning; deficiency or excess of one B vitamin may lead to abnormalities in the metabolism of another.3

Adverse effects There appear to be no toxic effects (except possibly gastric upset) with high oral doses. There have, however, been rare reports of anaphylactic reactions (coughing, difficulty in breathing and swallowing, flushing, skin rash, swelling of face, lips and eyelids).
References 1.     https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2.     Expert Group on Vitamins and Minerals, 2003.

3.     Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

 

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Description Vitamin B12 is a water soluble vitamin and a member of the B-vitamins group.
Function/ Used for Vitamin B12 is essential in the functioning of the nervous and immune systems; red blood cell formation and RNA and DNA synthesis.

It is also involved in energy production and works synergistically with vitamin B6 and folic acid in homocysteine (an amino acid) metabolism.

Intake Recommended intake

EU NRV: 2.5µg (micrograms)

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Available as a single supplement. Also commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Vitamin B12 is found only in animal products and certain foods fortified with the vitamin, therefore, vegans and strict vegetarians are at risk of deficiency. Good sources include meat, liver, kidney, poultry, fish, eggs, dairy products and fortified breakfast cereals.
Deficiency Deficiency of vitamin B12 leads to enlarged, but fewer red blood cells (megaloblastic anaemia).

Other deficiency symptoms include mood changes, sore tongue, fatigue, weakness and lack of concentration.3

Precautions and contraindications None known.

Safe Upper Level: 2000µg/day1

Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy with normal intakes.
Interactions e.g. with other medications Excessive intake of alcohol may reduce the absorption of vitamin B12.

Oral contraceptives may reduce blood levels of vitamin B12.

Large doses of folic acid given continuously may reduce vitamin B12 in blood or may mask symptoms of megaloblastic anaemia.

Vitamin C may destroy vitamin B12 (avoid large doses of vitamin C within one hour of taking oral vitamin B12).3,4

 

All B vitamins act synergistically and excess levels of one may lead to imbalance or deficiency in others.  It is advisable to take B vitamins as a complex rather than as single substance supplements.

Adverse effects Vitamin B12 may occasionally cause diarrhoea and itching skin. Megadoses may exacerbate acne.
References 1.       https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2.       Expert Group on Vitamins and Minerals, 2003.

3.       Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

4.       Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

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Description Riboflavin is water soluble and part of the B-vitamins group.
Function/ Used for Riboflavin is essential for the formation of two substances: FAD (flavin adenine dinucleotide) and FMN (flavin mononucleotide). Both are vital for the processes that make energy available in the body. Riboflavin works effectively with iron, vitamin B6 and folic acid. It is important for the nervous system, skin and eye health.
Intake Recommended intake

EU NRV: 1.4mg

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Not generally available as a single supplement. Commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Liver, kidneys, fortified breakfast cereals, meat, milk, some green vegetables, eggs, cheese, yeast extracts.

Riboflavin is degraded by heat and also exposure to light. This is significant with respect to milk, which is a major source of riboflavin (i.e. if milk is exposed to bright sunlight/light for long periods of time).

Deficiency Trembling, dizziness, poor concentration and memory. Also, blood-shot, red, tired or gritty eyes; Mouth ulcers or sores and cracks at the corner of the mouth; Red, inflamed tongue and lips and scaly eczema-like skin rash.3
Precautions and contraindications Safe Upper Level: 40mg/day2
Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy.
Interactions e.g. with other medications Excessive alcohol intake induces riboflavin deficiency.

Prolonged use of oral contraceptives may induce riboflavin deficiency.

Deficiency of riboflavin may impair iron metabolism and produce anaemia.

Adequate amounts of all B vitamins are required for optimal functioning; deficiency or excess of one B vitamin may lead to abnormalities in the metabolism of another.3

 

Adverse effects None known, although large doses may cause a yellow discolouration of the urine.
References 1.     https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2         Expert Group on Vitamins and Minerals, 2003.

3         Mason, P. Dietary Supplements

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Description Niacin is water soluble and is part of the B-vitamins group. Vitamin B3 comes in two common forms: Nicotinamide (the active form) and Nicotinic Acid.
Function/ Used for Niacin is vital for energy release in tissues and cells. It helps form NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate), two coenzymes which are involved in the release of energy from food.

Niacin helps maintain healthy nervous and digestive systems. It is also essential for normal growth and for healthy skin.

Intake Recommended intake

EU NRV: 16mg (nicotinamide)

 

Niacin requirements depend on energy intake; values are therefore given as mg/1000 kcal and also as total values based on estimated average energy requirements for the majority of people in the UK.

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

 

As a supplement Not generally available as a single supplement. Commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Meat, oily fish, poultry, bread, potatoes and breakfast cereals. Niacin can be synthesised from tryptophan (an essential amino acid).
Deficiency Niacin deficiency (rare in the UK) may lead to pellagra which means ‘raw skin’.

Early signs of deficiency are vague and non-specific and may include loss of appetite, headache, nausea, fatigue, mouth ulcers, dry skin, difficulty sleeping, poor memory and irritability.

The severe deficiency state of pellagra is characterised by dermatitis (predominantly in the areas of skin exposed to sunlight), dementia (associated with confusion, disorientation, seizures and hallucinations) and  diarrhoea.3

Precautions and contraindications Large doses of niacin are best avoided in gout (may increase uric acid levels); peptic ulcer (large doses may activate an ulcer); and liver disease (large doses cause deterioration). Large doses should also be used with caution in diabetes mellitus.3

 

Safe Upper Level: 500mg/day2 (nicotinamide); 17mg/day2 (nicotinic acid).

Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy.
Interactions e.g. with other medications Prolonged use of oral contraceptives may induce niacin deficiency.

Adequate amounts of all B vitamins are required for optimal functioning; deficiency or excess of one B vitamin may lead to abnormalities in the metabolism of another.3

Adverse effects Doses of over 150mg of the nicotinic acid form may cause temporary flushing of the skin in some people.
References 1.     https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2.     Expert Group on Vitamins and Minerals, 2003.

3.     Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

 

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Description Vitamin B6 is also known as pyridoxine. It is a water soluble vitamin and member of the B-vitamins group.
Function/ Used for Vitamin B6 is important in the functioning of more than 60 enzymes including those responsible for energy production; protein metabolism; RNA and DNA synthesis and the production of red blood cells and antibodies which fight infections.

It also supports healthy skin and is essential for maintaining a healthy nervous system.

It may also be helpful in reducing the severity of pre-menstrual syndrome.

Intake Recommended intake

EU NRV: 1.4mg

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Available as a single supplement. Also commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Wholemeal bread, meat (especially liver and pork), fish, bananas, wheat bran and fortified breakfast cereals.
Deficiency Vitamin B6 deficiency is unusual. Symptoms include anaemia; cracks in the corners of the mouth; red and inflamed tongue; sensation of burning skin and poor blood sugar balance.

Advanced deficiency may produce weakness, irritability, depression, dizziness, peripheral neuropathy and seizures. Diarrhoea, anaemia and seizures are particular characteristics of deficiency in infants and children.2

Precautions and contraindications Safe Upper Level: 10mg/day3
Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy with normal intakes.
Interactions e.g. with other medications Oral contraceptives may increase requirement for vitamin B6.4
Deficiency of vitamin B6 may lead to vitamin C deficiency.
All B vitamins act synergistically and excess levels of one may lead to imbalance or deficiency in others.  It is advisable to take B vitamins as a complex rather than as single substance supplements.
Adverse effects Adverse effects usually occur with large doses only.  Taking more than 200mg a day for a long time can lead to a loss of feeling in the arms and legs (peripheral neuropathy), unsteady gait, numbness and tingling in feet and hands, loss of limb reflexes, impaired or absent tendon reflexes, photosensitivity on exposure to sun, dizziness, nausea, breast tenderness, and exacerbation of acne.2
References 1 https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2 Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

3 Expert Group on Vitamins and Minerals, 2003.

4 Gaby A.R. A-Z Guide to Drug-Herb-Vitamin Interactions. Health Notes. Three Rivers Press. New York. 2006

 

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Description Vitamin C, also known as ascorbic acid, is a water soluble vitamin.
Function/ Used for Vitamin C acts as an anti-oxidant, neutralising free radicals to protect cells.

Vitamin C is involved in the synthesis of collagen and other constituents of bone, teeth and capillaries. It aids wound healing.

It is also necessary for the function of several enzymes and it increases the absorption of iron in the gut.

Vitamin C may have a role in protecting against the common cold as well as conditions such as cancer, cardiovascular disease, cataracts, diabetes and Parkinson’s disease.

Intake Recommended intake

EU NRV: 80mg

 

Chief Medical Officer recommendations are that all children aged six months to five years should take a daily supplement containing vitamins A, C and D.

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Available as a single supplement. Also commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Foods of plant origin, particularly citrus and soft fruits (such as oranges, strawberries, kiwi, blackcurrant, guava) and vegetables (such as kale, broccoli, brussels sprouts, peppers, potatoes, tomatoes) are major sources of vitamin C.

Vitamin C is readily lost during storage and cooking.

Deficiency Vitamin C deficiency may lead to scurvy. Early symptoms in adults include fatigue, weakness, aching joints and muscles. In later stages, symptoms of scurvy include anaemia, swollen and bleeding gums and delayed wound healing. In children, bones, teeth and blood vessels develop abnormally and growth is affected.

Low levels of vitamin C have been associated with poor wound healing and ulceration.3

Precautions and contraindications Vitamin C supplements should be used with caution by people with diabetes and by sufferers of disorders of iron metabolism or storage e.g. haemochromatosis and thalasaemia.3

 

Safe Upper Level: 1000mg/day2

Use in pregnancy and breastfeeding Long term intakes of large doses of vitamin C in pregnancy may result in increased requirements for the vitamin and scurvy in the offspring.
Interactions e.g. with other medications Vitamin C has an impact on how drugs are metabolized in the liver. Large doses of vitamin C may affect how drugs are absorbed and utilized.

Prolonged use of oral contraceptives may reduce blood levels of vitamin C.

Taking aspirin may lead to increased loss of vitamin C.

Vitamin C may reduce the activity of the anti-coagulant warfarin (a blood-thinner). People taking warfarin should consult with their doctor before taking vitamin C supplements.3,4

Adverse effects There is no evidence of serious health risks associated with high doses of vitamin C but daily doses over 1g may lead to diarrhoea and gastric discomfort.

Doses of 2g and above may result in increased risk of kidney stones.

References
  1. https://www.gov.uk/government/collections/national-diet-and-nutrition-survey
  2. Expert Group on Vitamins and Minerals, 2003.
  3. Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.
  4. Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

 

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Description A fat-soluble vitamin.
Function/ Used for Vitamin D helps the body to absorb and use calcium and phosphorus; which are essential for maintaining strong and healthy bones and teeth, as well as other body functions such as heart and muscle function.

Vitamin D is also important for blood clotting, the immune system and muscle growth, development and function.

Intake Recommended intake

EU NRV: 5µg (micrograms)

 

In July 2016 Public Health England published guidelines for vitamin D1:

·         Babies from birth to 1 year: 8.5-10µg/day all year round.

·         Children over 1 year and adults: 10 µg /day in the winter months

·         Pregnant and breastfeeding women and population groups at risk of vitamin D deficiency (those with minimal exposure to sunshine and those from minority ethnic groups with dark skin): 10 µg /day all year round

 

Chief Medical Officer recommendations are that all children aged six months to five years should take a daily supplement containing vitamins A, C and D.

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes2.

As a supplement Available as a single supplement. Also commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

In 2018 the UK food supplements industry agreed a voluntary safe upper level of vitamin D for food supplements of 75µg. Read statement

Found in (dietary sources) Good food sources include full-fat dairy products, oily fish, egg yolks and fortified margarine.
Food alone is unlikely to provide sufficient vitamin D.
Vitamin D is also formed by the action of sunlight on the skin (from May to September in the UK).
Deficiency Vitamin D deficiency results in poor growth, bone pain and deformities (rickets in children and osteomalacia in adults), osteoporosis, gum disease, constipation and muscle weakness.5
Precautions and contraindications Vitamin D should be avoided in hypercalcaemia (high levels of calcium in the blood).

Safe Upper Level: there are differences of opinion.
In 2003 the UK Expert Group on Vitamins and Minerals set a safe upper level of 25µg for vitamin D in food supplements.
In 2010 the American Institute of Medicine set a safe upper intake level of 100µg for total vitamin D intake3
In 2012 the European Food Safety Authority set a safe upper intake level of 100µg for total vitamin D intake4

In 2018 the UK food supplements industry set a voluntary safe upper level of 75µg for vitamin D in food supplements which allows for dietary intakes of up to 25µg without exceeding the most widely accepted safe upper level.

Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy at normal intakes.
Interactions e.g. with other medications Anticonvulsants (used to prevent epileptic seizures) may reduce the effect of vitamin D by accelerating its metabolism.

The weight loss drug orlistat and cholesterol-lowering drugs can reduce the absorption of vitamin D and other fat-soluble vitamins (A, E and K).

Calcium may increase risk of hypercalcaemia.5,6

Adverse effects There is no risk of vitamin D toxicity from prolonged exposure to sunlight.

Excessive dietary intake may lead to hypercalcaemia, which can weaken the bones and damage the kidneys and heart.

References 1 https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d

2 Expert Group on Vitamins and Minerals, 2003.

3 Institutes of Medicine. Dietary reference Intakes for Calcium and Vitamin D. November 2010.

4 European Food Safety Authority. Scientific Opinion on the Tolerable Upper Intake Level of Vitamin D. June, 2012

5 Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

6 Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

 

 

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Description Vitamin E is a family of fat soluble vitamin substances which include both tocopherols and tocotrienols.
Function/ Used for Vitamin E acts as an antioxidant helping to neutralise potentially damaging free radicals in the body.

Vitamin E is particularly important for the protection of cell membranes as well as maintaining healthy skin, heart and circulation, nerves, muscles and red blood cells.

Intake Recommended intake

EU NRV: 12mg

 

UK average daily intake

Requirements vary depending on age and gender. The UK National Diet and Nutrition Survey lists up-to-date intake requirements and average intakes1.

As a supplement Available as a single supplement. Also commonly available as part of a multivitamin and mineral formula.

Different multivitamin and minerals products will vary in the percentage NRVs they include. People should always check the label for information about a specific product.

Found in (dietary sources) Seed oils, and the outer germ of cereals are the richest sources of vitamin E as well as olive oil, avocado pear, muesli, nuts, leafy green vegetables, wholemeal bread, cereals and egg yolks.

Vitamin E is not very stable and is readily lost during storage and cooking, particularly if there is significant exposure to heat and oxygen.

Deficiency None known.
Precautions and contraindications Vitamin E supplements should be avoided by patients  taking oral anticoagulants and by patients with iron deficiency anaemia and hyperthyroidism.

Safe Upper Level: 540mg/day2

Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy at normal intakes.
Interactions e.g. with other medications Prolonged use of oral contraceptives may reduce blood levels of vitamin E.

The weight loss drug orlistat and cholesterol-lowering drugs can reduce the absorption of vitamin E and other fat-soluble vitamins (A, D and K).

Vitamin E supplements may affect blood coagulation and should be avoided by patients taking oral anticoagulants such as warfarin (blood thinners).3

Adverse effects Vitamin E is relatively non-toxic. Large doses in excess of 1000mg daily for prolonged periods have occasionally been associated with increased bleeding tendency in vitamin K-deficient patients; and rarely, blurred vision, diarrhoea, dizziness, fatigue and weakness, headache and nausea.3
References 1.     https://www.gov.uk/government/collections/national-diet-and-nutrition-survey

2.     Expert Group on Vitamins and Minerals, 2003.

3.     Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

4.     Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

 

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Description Vitamin K is a fat-soluble vitamin.
Function/ Used for Vitamin K is required for the formation of several of the proteins, called ‘clotting factors’ that regulate blood clotting, which means it helps heal wounds.

Vitamin K is also required for the formation of some proteins which are important for the maintenance of healthy bones and teeth

Intake Recommended intake

EU NRV: 75µg

 

UK average daily intake

UK dietary intake is unknown.

As a supplement
Found in (dietary sources) Green vegetables such as kale and spinach, potatoes, liver, soya beans and vegetable oils.

Vitamin K is also synthesised by gut bacteria and this contributes significantly towards the daily requirement of the vitamin.

Deficiency None known.
Precautions and contraindications Safe Upper Level: 1000µg/day1
Use in pregnancy and breastfeeding There is no evidence of adverse effects in pregnancy at normal intakes.

New-born infants are routinely given vitamin K injections or supplements.

Interactions e.g. with other medications Those taking anti-coagulants (such as warfarin) should not take supplements containing over 100mg Vitamin K except on the advice of a doctor.

Antibiotics can destroy vitamin K producing bacteria in the gut and may increase requirements for vitamin K.

The weight-loss drug orlistat and cholesterol-reducing drugs may reduce the absorption of vitamin K and other fat-soluble vitamins (A, D, E)2,3

Adverse effects None known.
References 1.     Expert Group on Vitamins and Minerals, 2003.

2.     Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

3.     Gaby, A. R. A-Z Guide to Drug-Herb-Vitamin Interactions. HealthNotes 2006.

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