Chapter 15: Vitamins, Trace Elements and Metals

Vitamins, Trace Elements and Metals delineates the functional differences between fat-soluble vitamins—retinol (A), calciferol (D), tocopherol (E), and vitamin K—and the water-soluble B-complex group and ascorbic acid (C), detailing how their unique solubilities impact absorption and the clinical manifestation of deficiency syndromes such as steatorrhoea. Key metabolic pathways are explored, such as thiamine’s essential role in carbohydrate decarboxylation and the synergistic relationship between folate and cobalamin in nucleic acid synthesis, where deficiencies lead to megaloblastic anaemia or neurological degeneration. The text further investigates the diagnostic relevance of trace minerals, highlighting zinc’s enzymatic functions in wound repair, selenium’s antioxidant mediation through glutathione peroxidase, and the genetic underpinnings of copper dysregulation in Wilson’s disease, noted for its hallmark Kayser-Fleischer rings and caeruloplasmin deficiency. Additionally, the discussion covers the impact of heavy metal toxicity, including mercury exposure and aluminium-related dialysis dementia, while emphasizing the importance of timely laboratory testing for nutritional markers before dietary interventions mask underlying deficiencies. Through clinical case studies and biochemical interrelations, the chapter underscores the necessity of maintaining homeostatic balance in these minute yet vital organic and inorganic substances to prevent conditions ranging from scurvy and pellagra to Wernicke-Korsakoff syndrome.