3: The physiology of hemodynamics: Metabolism and circulation
Metabolism and Nutirion Physiology
Transcript of Metabolism and Nutirion Physiology
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Human Anatomy and Physiology
II
Biology 1414
Unit 8Metabolism and Nutrition
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Objective 1
Define metabolism and differentiatebetween catabolism and anabolism. Be
able to apply the latter two terms to
various metabolic reactions.
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Definition of Metabolism
Metabolism is defined as the sum total ofall chemical reactions that occur in the
body.
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Catabolism
Catabolism is that part of metabolism that
involves the break down oflarge, complex
molecules into smaller, more simplified
products. This occurs during digestion,
removal of hydrogen (dehydrogenation),
carboxyl groups (decarboxylation) andamino groups (deamination), oxidation,
etc.Unit 8 - Objective 1
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Anabolism
Anabolism is that part of metabolism that
involves the synthesis of larger, more
complex molecules from small, simple
reactants. Examples of anabolism wouldinclude the synthesis of glycogen from
glucose, protein from amino acids, fat
from glycerol and fatty acids andconstruction of new antibodies and new
enzymes.Unit 8 - Objective 1
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Objective 2
Indicate the location of , diagram and describe
the majormetabolic pathways involved in the
catabolism of glucose to carbon dioxide and
water. Indicate where hydrogens are given off,
where ATP is made where oxygen is utilized,
where water is produced and identify keyassigned intermediates.
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Glucose Catabolsm
Glucose Catabolism is one of the primary
metabolic events that occurs during cell
metabolism. The portion of cell metabolismthat breaks down glucose is generally called
cellular respiration. Cellular respiration has
three major events; glycolysis, the Krebscycle and the electron transport system
(ETS).
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Location of the Major Metabolic
Pathways
Metabolic Pathway Location
Glycolysis Cytoplasm
Krebs Cycle Mitochondria
(matrix)
Electron Transport Mitrochondria
System (cristae)
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Events ofGlycolysis
In phase one, Glycolysis takes in glucose as afuel and transforms it into a super active
intermediate compound called Fructose-1,6-
Diphosphate (F-1,6-DP). This is accomplished
by using two ATP molecules to phosphorylate
the sugar at carbons 1 and 6. In phase two, the
F-1,6-DP sugar then splits (lysis) into two, half
sized sugar fragments which becomeGlyceraldehyde Phosphate and
Dihydroxyacetone Phosphate.
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Events ofGlycolysis
In phase three, the two half sized intermediatesare oxidized down to two pyruvic acid
molecules. During this process, inorganic
phosphate is added from the substrate of the
cytoplasm to each intermediate, hydrogen along
with its electrons are removed from each
intermediate, NAD picks up the hydrogens for
transport and all of the phosphate is removed (4total) from the intermediates. This phosphate is
added to ADP to form four ATP molecules.
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Events ofGlycolysis
The removal of hydrogen is calleddehydrogenation and is an oxidation process.
When NAD picks up hydrogen, a reduction
process occurs. The addition of phosphate iscalled phosphorylation and results in the net
production of two ATP molecules ( two used up
in phase one minus four produced in phase three).
The overall transformation ofglucose into twopyruvic acids is also an oxidationprocess.
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Events ofGlycolysis
Examine the following slide in order to visualizethe event ofGlycolysis.
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Summary ofGlycolysis
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Events of The Krebs Cycle
The Krebs cycle is named after Hans Krebs andis a metabolic event that follows glycolysis. This
process occurs in the fluid matrix of the
mitochondrion, uses the pyruvic acid from
glycolysis and is aerobic. To begin the Krebs
cycle, pyruvic acid is converted to acetyl COA.
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Conversion of Pyruvic Acid to
Acetyl COA
The conversion of pyruvic acid to acetyl COA is a three step
process:
1. First, each of the two pyruvic acids are
decarboxylated . At this point, two carbondioxides are produced and diffuse to the
blood. This event yields two acetyl groups.
2. Next, hydrogen is removed from each
acetyl group and added to NAD.The removal of hydrogenis called dehydrogenation which is an oxidation process.
The addition of hydrogen to NAD is a reduction process.
3. Finally, COA is added to each acetyl group.Unit 8 - Objective 2
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Events of The Krebs Cycle
AcetylCOA which results from the conversion of pyruvic acid
then reacts with oxaloacetate using an enzyme called citrate
synthase. This results in the first major product of the Krebs cycle
called citric acid. Because of this, the Krebs cycle is sometimescalled the citric acid cycle. The citric acid is then systematically
decarboxylated and dehyrogenated in order to use up the acetyl
groups that were attached to the oxaloacetate. This allows
oxaloacetate and COA to be used in the next cycle.
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Events of The Krebs Cycle
The conversion of citric acid back to oxaloacetateinvolves three dehydrodenations that form three
reduced NAD (NADH2) molecules, one
dehydrogenation that forms one reduced FAD
(FADH2), two decarboxylations that form two
carbon dioxides and one substrate
phosphoporylation that forms an ATP molecule.
When two acetylCOAs are utilized, two cyclesoccur and the above output is doubled.
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Output of The Krebs Cycle
1. Six CO2 molecules
2. Eight reduced NAD molecules (NADH2)
3. Two reduced FAD molecules (FADH2)
4. Two ATP molecules
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Events of The Krebs Cycle
Examine the following slide in order to visualizethe events of the Krebs Cycle.
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Summary of the Krebs Cycle
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Events of the Electron Transport
System (ETS)
The electron transport system can also be calledthe electron transport chain. This metabolic
process uses the reduced NAD and FAD that is
produced by glycolysis and the Krebs cycle. The
ETS takes place in the cristae of the
mitochondrion and uses oxygen directly
(aerobic). This system contains respiratory
enzyme complexes that include iron compoundscalled cytochromes. The cytochromes accept
hydrogen from NAD and FAD.
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Events of the Electron Transport
System
After receiving hydrogen, the cytochromes split
hydrogen into an electron and a hydrogen ion.
Electrons from hydrogen are passed through the
chain to oxygen. Hydrogen ions are passed intothe space between the inner and outer membane
of the mitochondrion where they accumulate and
create an elevated hydrogen potential. The highpotential causes the hydrogen ions to pass
through an ATP synthase protein portal.
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Events of the Electron Transport
System
The hydrogen from NAD will yield 3 ATPs and
the hydrogen from FAD will yield 2 ATPs. The
ETS will process 10 reduced NADs from
glycolysis and the Krebs cycle to yield 30
ATPs.The ETS will also process 4 reduced
FADs from the Krebs cycle to yield 4 ATPs.
The hydrogen ions that pass back into themitochondrial matrix then combine with the
oxygen that has gained electrons to form water.
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Summary of the Electron
Transport System
When hydrogen loses electrons in the ETS, this iscalled oxidation. When Oxygen accepts those
electrons, it is called reduction. When ATP
synthase adds phosphate to ADP when it passes
hydrogen ions to reduced oxygen, this process is
called oxidative phosphorylation. The addition of
hydrogen ions to oxygen creates enough water to
yield a net of 6 waters for the process of cellularrespiration. Make note of this when you observe
the slide for Objective 3.
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Summary of the Electron
Transport System
Examine the following slides in order to visualizethe events of the electron transport system.
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Processing Reduced NAD in the
ETS
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Processing Reduced FAD in the
ETS
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Oxidative Phosphorylation
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Summary of Total ATP
Production
Examine the following slide in order to view thesummary of total ATP production in Glycolysis,
the Krebs cycle and the Electron Transport
System.
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Objective 3
Write the general balanced equation that shows
the catabolism of glucose to carbon dioxide and
water. Include in the equation the formation of
ATP from ADP and phosphate and oxygen
utilization.
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General Equation for Cellular
Respiration
C6H12O6 + O6 + 36 ADP + 36 PO4
6CO2 + 6H2O + 36 ATP + Heat
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Objective 4
Diagram and describe how lipids and proteins are
catabolized into carbon dioxide and water.
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Catabolism ofLipids
Lipids such as triglycerides are broken down to
fatty acids and glycerol. Fatty acids are broken
down to acetylCOA through a process of beta
oxidation. AcetylCOA is then taken into theKrebs cycle and converted into carbon dioxide,
reduced NAD and FAD and ATP. Glycerol is
converted intoG
lyceraldehyde phosphate ordihydroxyacetone phosphate in Glycolysis and
converted into reduced NAD , ATP and pyruvic
acid.Unit 8 - Objective 4
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LIPID METABOLISM
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Catabolism of Proteins
Proteins are broken down to amino acids. Amino
acids are deaminated and converted into
metabolic fragments. For example, glycine is
converted into an acetyl group that can become
acetyl COA. AcetylCOA is then broken down in
the Krebs cycle as discussed in the slide beforelast. The amine group from glycine is then used
as part of urea formation.
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Amino Acid Metabolism
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Summary ofLipid and Protein
Catabolism
View the following slide for a summary of lipid
and protein catabolism
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Catabolism ofLipids and Proteins
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Objective 5
Describe what is meant by the following: beta
oxidation, deamination, glycerol catabolism,
ketone body formation, fatty acid catabolism,
amino acid catabolism.
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Beta Oxidation
Beta oxidation is a catabolic process that breaks
down fatty acids two carbon units at a time.
The two carbon units become acetyl groups that
are converted into acetyl COA. An acetyl COA isthen used in the Krebs Cycle to make one ATP ,
3 NADH2 and 1 FADH2. If a fatty acid has 18
carbon units, then 9 acetyl COA units would bemade. Think how much extra ATP and reduced
NAD And FAD can be made because of this!
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Deamination
Deamination is a catabolic process that removes
an amino group from an amino acid in
preparation for its use in the Krebs Cycle or a
similar metabolic pathway.
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Glycerol Catabolism
When fat is digested it is broken down to glycerol
and fatty acids. Glycerol is then converted to
glyceraldehyde phosphate (GALP) and used at a
mid point in glycolysis (see Glycolysis inObjective 2). The GALP is then broken down to
form ATP, reduced NAD and pyruvic acid.
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Fatty Acid Catabolism
When fat is digested it is broken down to glycerol
and fatty acids. The fatty acids are then broken
down by the process of beta oxidation to produce
acetyl COA as discussed in a previous slide.
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Ketone Body FormationIf a person is not getting enough glucose through
the diet (rare!) because of fasting, starvation, etc.
or if glucose is not being transferred from the
blood to body cells (as in diabetes mellitus), then
oxaloacetate from the Krebs Cycle is convertedto new glucose. Without oxaloacetate, Acetyl
COA cannot be used and accumulates. The liver
then converts excess acetyl COA into ketones
(acetone, acetoacetate, etc.). These ketones are
acidic and as they accumulate, they cause
ketoacidosis.Unit 8 - Objective 5
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Amino Acid CatabolismIf more amino acids accumulate than can be used
in the synthesis of new proteins, then they can be
catabolized or broken down by a process called
deamination. Deamination removes amino groups
from the amino acid to yield a fragment that canbe used in the Krebs Cycle.
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Role ofLDL in Cholesterol
Metabolism
LDL stands forlow density proteins made in the
liver. These metabolic units contain small
portions of phospholipids an triglycerides and
large quantities of cholesterol. The LDL is
designed to transport its stored material from
the liver to cells and tissues. Cholesterol fromLDLs can be transported to blood vessels and
stored aspart of plaque deposits
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Role of HDL in Cholesterol
Metabolism
HDL stands for high density lipoprotein which is
made in tissues during increased activity. This
metabolic unit transports phospholipid,
triglyceride and cholesterol from tissues,including blood vessels, back to the liver.
The cholesterol that is transported back to the
liver is converted into Bile which is excreted andstored in the gall bladder. This is a good way to
eliminate cholesterol from the body.
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Summary ofLipoproteins
Observe the following slide for the lipid
composition of lipoproteins.
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Comparison ofLDL, HDL,
Triglycerides and Cholesterol
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Objective 7
Define the following as they relate to
metabolism: oxidation, reduction,
decarboxylation, dehydrogenation,
oxidative phosphorylation, celllar
respiration, glycolysis, pyruvic acid,
coenzyme A, Krebs cycle, electron
transport system (ETS), glycogenesis,
glycogenolysis, gluconeogenesisUnit 8 - Objective 6
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Cellular Respiration
Cellular respiration is a group of catabolic
reactions in the cell that breaks down food fuels
such as glucose. These reactions can be grouped
into metabolic processes called glycolysis, the
Krebs cycle and the electron transport system. The
main purpose of cellular respiration is to provide aconstant supply of ATP for various cell activities.
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Glycolysis
Glycolysis (= splitting sugar) is an anaerobic
process that occurs in the cell cytoplasm. This
process breaks down glucose into two pyruvic
acids. During this conversion, ATP and reduced
NAD is formed.
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Pyruvic Acid
Pyruvic acid is the end product of glucose
breakdown that occurs in the process ofGlycolysis.
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Coenzyme A
Coenzyme A, which is made using the vitamin
pantothenic acid, is an important cofactor that is
used to transport acetyl groups into the Krebs
Cycle.
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Krebs Cycle
The krebs cycle is a part of cellular respiration
that occurs in the matrix of the mitochondrion.
This process regenerates oxaloacetate during
each cycle which is used to pick up acetyl groupsto form citric acid. As acetyl groups are broken
down during this cycle, ATP and reduced NAD
and FAD are synthesized. Since themitochondrion uses oxygen this process is
considered aerobic.
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Electron Transport System
The electron transport system (ETS) occurs in the
cristae of the mitochondrion and is aerobic. This
part of cellular respiration uses the reduced NAD
and FAD from glycolysis and the Krebs Cycle
and oxygen to generate large quantities of ATP
and water.
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Oxidative PhosphorylationOxidative phosphorylation is a process that
occurs in the electron transport system (ETS) and
involves the addition of phosphate to ADP tomake ATP. ATP production occurs in the ETS
when electrons are removed from the hydrogen
being transported by reduced NAD and FAD.
The electrons from the hydrogen are ultimatelypassed on to Oxygen. Oxygen is the final electron
acceptor in the body!Unit 8 - Objective 7
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Glycogenesis
Glycogenesis is an anabolic process that occurs
mainly in the liver and muscle when there is
excess glucose. This process combines hundredsof glucose molecules to form glycogen. Glycogen
is then stored in the cell as a starch-like
compound .
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Glycogenlolysis
Glycogenolysis is a catabolic process that occurs
mainly in the liver an muscle. This process is
essentially a reversal of glycogenesis (seeprevious slide). During glycogenolysis, stored
glycogen is broken down to release glucose for
use in the body.
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Comparison ofGlycogenesis and
Glycogenolysis
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GluconeogenesisGluconeogenesis is a process that produces new
glucose from non-carbohydrate sources. The
metabolic pathways can convert materials such asoxaloacetate (from the Krebs cycle), lactic acid,
amino acid fragments and fat derivatives into
glucose. Even though gluconeogenesis is
anabolic, other factors in the body aresacrificed to make the new glucose. This can
ultimately cause deterioration.Unit 8 - Objective 7
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Definition of Nutrient
A nutrient is defined as a substance in food
that is used by the body to promote growth,
repair and maintenance.
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Major Classes of Nutrients
1. Carbohydrates
2. Lipids3. Proteins
4. Minerals
5. Vitamins
6. Water
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Objective9
Define the term mineral and give the proper symbol and
function of the following: calcium, phosphorous, iron,
iodine, sodium, potassium, magnesium, zinc.
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Definition of Mineral
A mineral is an inorganic substance made from a
metal and a nonmineral. For exmple, The metalsodium forms a sodium ion in water that can
react with a chloride ion that forms from chlorine
gas that can dissolve in water. This results in
sodium chloride which is an inorganic salt andone of the more abundant minerals in the earth.
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CalciumCalcium ( Ca+2) is a cation that has multiple
uses in the body. Included in the list of uses
are:
1. Assists blood clotting
2. Assists hardening of teeth and bones
3. Assists nerve cell function
4. Helps to initiate muscle contraction
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PhosphorousPhosphorous is used mainly in the form of
phosphate ( PO4-3). This anion can be used
to:
1. Combine with ADP to form ATP
2. Combine with calcium to form
a crystalline bone salt called
calcium phosphate.3. Form buffers for acid-base control
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Iron
Iron ( Fe+2) is a cation that has several uses
in the body. Included in the list are:
1. Used as a cofactor in enzyme
activity2. Used to make cytochromes found in
the ETS
3. Used to form hemoglobin
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Iodine
Iodine ( I-1) is an anion that is used mainly
to form thyroid hormones.
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SodiumSodium (Na+1) is a cation that is used to:
1. Create a positive condition outside
the cell.
2. Assist depolarization of nerve andmuscle cells
3. Osmotically control water in the
extracellular fluid (ECF)
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PotassiumPotassium (K+1) is a cation that is used to:
1. Assist repolarization in nerve and
muscle cells
2. Assist osmotic control of water in theintracellular fluid (ICF)
3. Contribute to synthesis reactions
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Magnesium
Magnesium (Mg+2) is a cation that is used
to:
1. Assist enzymes that are involved in
in the formation of ATP2. Maintain sensitivity in nerve cells
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Zi
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Zinc
Zinc (Zn+2) is a cation that is used to:
1. Assist enzymes such as carbonic
anhydrase
2. Contribute to structure of certainproteins e.g. tumor suppressor protein
3. Required for normal growth, wound
healing, taste, smell, sperm
production, prostate activity, etc.
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Obj i 10
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Objective 10Define what is meant by the term vitamin
and give or recognize the function (s) of the
following vitamins. Indicate whether each
vitamin is water or fat soluble and discuss
how this characteristic influences vitaminretention: Vitamins A, D, E, K, C, Niacin,
Riboflavin, Thiamine and Pantothenic Acid.
Unit 8 - Objective 10
D fi i i f Vi i
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Definition of VitaminA vitamin is a specialized organic
compound that is used to assist enzymes in
various metabolic reactions. For example
the enzyme succinate dehydrogenase
removes hydrogen from succinic acid in theKrebs cycle and then transfers this
hydrogen to FAD which is made from
riboflavin. The hydrogen transfer to FAD iscalled reduction. Reduced FAD then
transports hydrogen to the ETS.Unit 8 - Objective 9
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Vitamin A
Vitamin A is a fat soluble vitamin that can take the form
of retinol or retinal. This vitamin can be stored in fats
and oils, and, if there is excessive storage, toxicity can
result. The functions forVitamin A include:
1. Serves as an antixoidant
2. Assists the formation of light sensitive pigments
in rod and cone cells of the retina.
3. Assists growth of teeth, bones and reproductive
cells.
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Vitamin D
Vitamin D is a fat soluble vitamin that is made in the
skin due to exposure to sunlight, This vitamin can be
stored in fats and oils, and, if there is excessive storage,
toxicity can result. The functions forVitamin D include:
1. Stimulates calcium absorption in the body
2. Assists bone formation, blood clotting and nerve
function.
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Vitamin E
Vitamin E is a fat soluble vitamin that is found in
vegetables. This vitamin can be stored in fats and oils,
toxicity seldom results. The functions forVitamin E
include:
1. Antioxidant
2. Helps protect cell membranes
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Vitamin K
Vitamin Kis a fat soluble vitamin that is found in
vegetables, liver and can be made by bacteria in the
large intestine. This vitamin is not stored in large
amounts in the body. The functions forVitamin K
include:
1. Formation of blood clotting proteins
2. Used as an part of the electron transport system
and assists ATP formation
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Vitamin C
Vitamin C is a water soluble vitamin that is found in
fruits and vegetables. This vitamin cannot be stored in
the body and must be consumed on a constant basis. The
functions forVitamin C include:
1. Antioxidant
2. Assists connective tissue formation
3. Assists formation of serotonin, bile and active
folacin
4. Assists iron absorption
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Niacin
Niacin is a water soluble vitamin that is found in green,leafy vegetables meats and nuts. This vitamin cannot be
stored in the body and must be consumed on a constant
basis. The functions for Niacin include:
1. Assists formation of NAD for use in cellular
respiration
2. Inhibits cholesterol formation
3. Dilates peripheral blood vessels and causesflushing
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Riboflavin
Riboflavin is a water soluble vitamin that is found inlegumes, eggs, milk, yeast, meats and nuts. This vitamin
cannot be stored in the body and must be consumed on a
constant basis. The functions for Riboflavin include:
1. Assists formation of FAD for use in cellular
respiration
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Thi i
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Thiamine
Thiamine is a water soluble vitamin that is found in
legumes, eggs,, yeast, meats and green leafy vegetables.
This vitamin cannot be stored in the body and must be
consumed on a constant basis. The functions for
thiamine include:
1. Assists transformation of pyruvic acid to
acetyl COA
2. Assists formation of pentose sugars such as
ribose and deoxyribose. Remember these!
3. Assists the formation of acetylcholine
4. Assists the oxidation of alcoholUnit 8 - Objective 10
P t th i A id
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Pantothenic Acid
Pantothenic Acid is a water soluble vitamin that is
found in legumes, eggs,, yeast, meats and grains. This
vitamin cannot be stored in the body and must be
consumed on a constant basis. The functions for
pantothenic acid include:
1. Used in the formation of coenzyme A
2. Involved in the synthesis of steriods and the heme
unit of hemoglobin
Unit 8 - Objective 10
Objective 11
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Objective 11
Give the source and functions of the
following hormones and indicate the causeand symptoms of the hormonal disorders
listed below: insulin, thyroid stimulating
hormone (TSH), thyroxine, growthhormone (GH), diabetes mellitus,
hypoglycemia, hyperglycemia, cretinism,
giantism, acromegaly, dwarfism
Unit 8 - Objective 11
Insulin
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Insulin
Insulin is a hormone produced by the beta
cells of the pancreas. This hormone helpstransfer glucose from the blood into the
body cells and tissues. This hormone also
helps tissues convert glucose into fat anglycogen.
Unit 8 - Objective 11
Hypoglycemia
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Hypoglycemia
If an excess of insulin is produced, it can
cause too much glucose to move out of theblood and into the cells and tissues of the
body. This can result in a low blood sugar
condition called hypoglycemia
Unit 8 - Objective 11
Hyperglycemia
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Hyperglycemia
If too little insulin is produced, blood
glucose accumulates and does not go intocells and tissues. This results in a high
blood glucose condition called
hyperglycemia.
Unit 8 - Objective 11
Diabetes Mellitus
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Diabetes Mellitus
If the beta cells of the pancreas become
diseased and stop producing insulin at anearly age, this results in a pathological
condition called diabetes mellitis. This
disease is sometimes called Type I ,orjuvenile, diabetes because it results in
chronic hyperglycemia that must be
controlled for the life of the individual.Type II diabetes mellitus is due to age and
poor response to insulin.Unit 8 - Objective 11
Thyroid Stimulating Hormone
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Thyroid Stimulating HormoneThyroid stimulating hormone (TSH) is
produced and released from the anteriorpituitary. As the name suggests, this
hormone stimulates the thyroid to release
thyroxine; either in the form T4 or T3.
Unit 8 - Objective 11
Thyroxine
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ThyroxineThyroxine is a hormone produced by the
follicles of the thyroid gland and is used toincrease cell metabolism. This function
helps to maintain proper growth, repair and
body temperature. Excess thyroxine leads tohyperthyroidism and very high metabolism.
Below normal thyroxine production leads to
hypothyroidism and very low metabolism.
Unit 8 - Objective 11
Cretinism
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CretinismCretinism is a disease of very young
children and occurs when below normalamounts of thyroxine are produced. This
results in very low metabolism, growth and
development. Cretins become severelystunted and retarded.
Unit 8 - Objective 11
Growth Hormone
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Growth Hormone
Growth Hormone (GH) is produced and
released from the anterior pituitary. Thishormone increases fat utilization, protein
production and body organ development.
The long bones of the body are especiallystimulated to grow in length.
Unit 8 - Objective 11
Giantism
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Giantism
Giantism is a disease caused by excess
secretion of growth hormone (GH). Thisdisease occurs in young, fast growing
children and results in excessive height for
the persons age and genetic background.
Unit 8 - Objective 11
Acromegaly
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AcromegalyAcromegaly is a disease also caused by
excess secretion of growth hormone (GH).This disease occurs in adults and results in
overdeveloped body parts such as hands,
feet, forehead, jaw and internal organs.
Unit 8 - Objective 11
Dwarfism
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DwarfismDwarfism is a disease caused by below
normal secretion of growth hormone (GH).This disease occurs in young children and
results slow growth and very short height.
Unit 8 - Objective 11
Objective 12
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Objective 12Recognize and/or list five products
produced by lipid and protein anabolism
Unit 8 - Objective 12
Lipid Anabolism
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Lipid AnabolismLipid anabolism is a constructive metabolic
process that produces new lipids from suchmaterials as glycerol, fatty acids,
phosphates, etc. Products of lipid anabolism
include:
1. Fats (triglycerides)
2. Oils
3. Waxes
4. Phospholipids 5. SteriodsUnit 8 - Objective 12
Protein Anabolism
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Protein AnabolismProtein anabolism is a constructive
metabolic process that produces newproteins from amino acids. Products of
protein anabolism include:
1. New enzymes
2. New antibodies
3. New muscle proteins; actin, myosin, etc.4. New Collagen for the skin
5 New keratin for the hair and fingernails