DIP Episode 243 - Water Soluble Vitamins and The USMLEs

Okay, welcome. My name is Divine. This is episode 243 of the Divine Intervention podcast. In this podcast, I'll be talking about the USMLE and its relationship to vitamin. Some vitamin questions or questions that show up a lot. And these USMLE exams. So I think it makes a perfect sense to go ahead and talk through this. So let's just go ahead and jump right into it. And again, don't forget, if you're interested in the 10 hour 1 D review course, I have next Saturday on the 27th for step 2 CK. Just send me an email and I will give you some more information. Okay, let's jump right into it. So the first vitamin right I want to talk about. So what if they give you a question about a patient? And they tell you that this patient, this patient, you know, was found on the street by the police, brilliant to the emergency room. He was swimming from side to side, has an estagmas. Because he know how he goes to the hospital. If you see that, you know, I would really hope you're thinking about renexies and cephalopathy. Remember, renexies and cephalopathy? It's classically an alcoholic, but remember, anyone that has had like long-term starvation of any sort can potentially have renexies and cephalopathy, like for example, a person that has a high premises, gravidire, that can be a presentation of renexies. A person that has, when any of these like long-term eating disorders, like anorexia, bulimia, binge eating disorder, they could potentially have renexies and cephalopathy.

And remember that renexies right it's a triad, right? So, you know, confusion of thermoplesia and etaxia. And they're not going to say, oh, a patient comes in with confusion of thermoplesia and etaxia. No, no, no. They're not going to do that on the USMLE, right? Like, basically, they're going to give you some derivatives of those things, right? Like, they'll give you something that shows that, oh, this person is not really right mentally. This person has like my stagmas. They'll give you some weird eye-finding, then they'll talk about etaxia, right? Like, swing from side to side or blah, blah, blah, blah. And they may not even give you all of the triad, right? But if you see that, you want to think about renexies. And remember, if you then add the person making stuff up, right? Or person having any kind of aninsia, right? And you've gone into the realm of Corsacov syndrome, right? And what's the path of this behind renexies? Obviously, it's a deficiency of thymine. And remember thymine is a very key enzyme for many things. I mean, for those of you studying for step one, you probably remember that thymine is part of that tender loving care for anancy, mnemonic, right? Where, you know, it's a rate limiting in, it basically, it's a cofactor for like the pyruid dehydrogenase complex. It's a cofactor for alpha-ketoglutarid dehydrogenase, which is part of the TC cycle. And it's also a cofactor for this enzyme, branching ketoacid dehydrogenase.

The only thing though is that branching ketoacid dehydrogenase remember, if that enzyme doesn't work, that's the thing that causes amypocerepyrin disease, those people have issues with metabolizing the branch chain amino acids like leucine, isolucine and veily. So that's something that's like an added side gig, I guess you want to know for example. But the big thing you want to know about phyramine, that causes problems with alcoholics is that those people have a dysfunction of transketolase. So if you have like decreased function of transketolase, right? Many people believe at least that's what the amypocereprys wants you to believe that you have problems with wreniciza and cephalopathy. I remember wreniciza is reversible, cofacerecopsis not, right? Well, you treat both situations with IV thymine, right? And remember, you give thymine before you give glucose. If you give glucose first because glucose will very rapidly go through glycolysis. And then the next, it's next point of call is the pyruvateidrogenase complex, well, surprise, surprise. That uses vitamin B1 as a cofactor. So if you place, if you give a present glucose first, unless you don't have wreniciza but they are close to having wreniciza, you place a metabolic demand for vitamin B1 services, right? And you can trigger wreniciza, cofacerecopsis, syndrome in those people, right? So and don't forget neuron atomically, right? Because your friends at the amy-mi really love neuron at the tondicola integrations.

Don't forget that, don't forget that people can get, what is it called? People can get hemorrhagic infarctions of the mammillary bodies if they have a wreniciza and cephalopathy, right? If they have a B1 deficiency. And don't forget though that people can also get like a, people can also get like from thymine deficiency, they can get like dry berry, berry, berry, berry. Basically like the way to think about these things is that thymine, right? And just think about it thymine. Look at all the enzymes I mentioned, transkydolese, alpha-kydogloderate dehydrogenase, pyruvateidrogenase complex, branching, ketoacid dehydrogenase. Again, you don't need to memorize all these enzymes, if you're not studying for step one, the transkydolese part though you should know with wrenicis, right? But all these enzymes are very necessary for glucose metabolism, right? So if you have abnormal glucose metabolism, people can begin to have like berry berry, right? There's like dry berry, berry, berry, berry, berry, berry, berry is basically like a never-system problem, right? So those people have like etaxia, they have paralysis, they'll have like many of the antioxidants we see with wrenicic or socafs, but wet berry, berry. So the first one I talked about is dry berry, berry, don't know why my mouth is so dry this morning, but wet berry, berry is mostly cardiac tissue that's affected, right? So those people, essentially they'll be wet, right? So they'll have like cardiac problems, right?

They'll have heart failure, they'll have like a dima everywhere. That's one thing that can't tell. So if you see like a dima, like generalize a dima in an alcoholic and you know they give you, they don't give you any antioxidants of like liver dysfunction, you probably want to think about wet berry berry on your exams. And then for vitamin B2, right? B2 is another, it's another B-vitamin, remember that's riboflavin, the only thing I'm going to say about riboflavin is I remember it's required for the production of like FEDH2, right? So that's more for people that are studying for step one, but remember FEDH2 again is one of enzymes in the tenderloving care for Nansia, Numonic, right? So for those three enzymes I mentioned, of a keto-glittery dehydrogenase, bio-videohydrogenase complex, and branching keto-acid dehydrogenase. And then for vitamin B3, right? This way you do want to know quite a bit about, right? So I mean B3, that's Naisin, right? You know that Naisin is very important. If your person has a I mean you literally need Naisin to make like any DHH, you need to make any DPH, right? So obviously if a person has a deficiency of Naisin, that's bad, right? That's what causes Pallagra, right? So those people have like the three D's, actually I call them four D's, right? Because they have like dermatitis, again the Mbimilmokamon and say, oh a patient has dermatitis, no, you see, Peshasa Rache, right? Peshasa Rache, right?

So they'll have dermatitis, they'll have diarrhea, right? Like chronic diarrhea, they'll have dementia, right? They'll have dementia, right? And then the fourth D's death, right? Naisin deficiency is really bad, right? And they don't forget, I guess as a pharmacology integration, you can actually use Naisin to boost the levels of HDL of all the agents that are available, the cholesterol agents that are available, the one that is the best at boost HDL, the liver or not is Naisin, right? Although remember starting is also the one that's the best, right? Is is is a Naisin, right? And remember, Naisin, remember that each side effect, right? That you can get with that, a lot of people can get like a lot of flush, I mean a lot of like flushing and they can also get parietus with with Naisin, although over time it kind of goes away, right? But key thing you want to keep at the back of your mind with Naisin is remember there are many ways you can get Naisin deficiency, right? So let's say for example you have issues of reabsorbing neutral amino acids, right? Remember heart and up disease, so heart and up disease, it's a problem at the level of the GI tract and at the level of proximal tributum, right? Those people have trouble reabsorbing neutral amino acids, the one you probably care the most about is triptophane, right? If you have problems of reabsorbing triptophane, right?

Well, triptophane is used to make a Naisin, if I think it's maybe triptophane, no, I can't remember the exact thing, Zain, I know you can also convert triptophane to serotonin, I'll talk about that in a second, but will basically triptophane is used to make a Naisin, right? So if you're not able to reabsorb triptophane, you're not going to be able to make Naisin. If you can't make Naisin, you get parlor, right? So that's one way you can get parlor and an NB, you just have heart and up disease, can reabsorb neutral amino acids. But another way people, the more nifty way that your friends at the NB, love to throw people into a Naisin deficiency, will be a person that has, what if they tell you about a person that keeps having all these like flushing episodes, they have chronic diarrhea, and they have like, you know, the material that they have a holosis, stomach murmur, right? At the left-lowstone border that increases with inspiration, right? So that's curvalosign, right? Remember whenever you have a murmur that's ascent with, ascent with it with inspiration, that typically will tell you that it's probably right-sided heart murmur, right? So this person likely has a tri-cospital regert, right? If you see that, that's carcinoid syndrome, right? Remember carcinoid syndrome, you won't get symptoms if it's just in the GI tract, but once it has been exercised to deliver or anywhere distal, person is going to get into trouble, right? So the thing is in carcinoid syndrome, right?

You have this tumor that's making a crap ton of serotonin, right? And again, the reason you need met to deliver distal is deliver can metabolize the serotonin, right? And you may wonder, oh, why is it the right side of the heart that's affected? Well, the lungs, remember the lungs, the pulmonary capillaries, they have amazing metabolic activity. I mean, it's the same pulmonary capillaries that contain angiotensin, convertin enzyme, right? So, you know, you have all these metabolic activities with your with your pulmonary capillaries, right? So one of the things that can in fact metabolize is serotonin, believe it or not. So that's why these people don't get left side heart problems, they get right side heart problems, right? So if a person has carcinoid syndrome, they're making a ton of serotonin, right? Again, if you're just thinking in terms of Lushatli principle, that's probably the most useful principle I've learned in all of my career, like, you know, like a science principle. It just makes things make so much sense. It's basically done by your chemistry and many of these metabolic diseases, but Lushatli principle, right? If you have an equation being driven towards, oh, you're taken, um, triptophan and pu-pube-pube-pube, you're shunting it all the way to serotonin. I mean, literally, serotonin is 5-HT, right? 5-hydroxy-triptofet, right? 5-hydroxy-triptofet.

So I think it's like, uh, it would make sense that an enzyme, like, I don't know, like maybe like triptophan hydroxylis, convert triptophan to serotonin, right? So, if you're driving, again, Lushatli principle, if you're driving or you're triptophan towards serotonin production, then there'll be less triptophan driving towards nice in production. And those people will get, uh, those people will get, uh, we get pelagra, pelagra with that. Okay, so that's again, very high yield and important to keep at the, at the back of your mind, right? So, those are the high-out integrations you want to know with D3. I mean, for those studying for step one, you know, vitamin B5, that's, uh, what's known as, uh, panthotenic acid. That's what's used to me, coins, I mean, again, remember panthotenic acid is part of, uh, that, uh, business that we have for tenderloving care for an enzyme, for those, uh, through special enzymes. Basically, those, those through special enzymes tend to loving care for an enzyme. We have like poic acid, and then we have vitamins B1, B2, B3, and B5. So B1 is timing, B2 is riboflavin for FDH2, B3 is nice in for any DH, and then B5 is panthotenic acid for coins, I mean. Now, um, B6, I mean B6, uh, again, this is a big, big, big, big, big high-value enzyme, right? Remember, um, it helps with many things, right?

I mean, like, vitamin B6 is very necessary for the metabolism or even like a co-factor for like many, like neurotransmitters for, um, all those transaminase enzymes using the body like ALT, EST, all those things use B6 as a co-factor. And then if you remember, right, the first step of hymnsynthesis, where you take glycine, slapping some succinochoid to make a, uh, delta amylolevolinic acid, right? On that the action of a loss, right? We need that, I mean, B6 as a co-factor, right? So, kind of setting that stage theory will help you understand why, uh, you kind of need B6. So, remember B6 is another name for that is a paradoxophosphate, right? So, paradoxophosphate. So, the thing is, um, um, basically if a person, what, what gives people B6 deficiency on exam, right? Then they use people B6 deficiency is basically, um, they take hysonizer, they don't listen to the doctors' advice to take B6 at the same time, right? So, you know, um, if you don't, um, then, um, um, um, it's gonna be a problem for you. Let's just put it that way, right? So, because the thing is B6 is necessary for many things, right? So, like, um, if you're going from glutamate to GABA, right? So, remember GABA is actually a, believe it or not, GABA is actually a derivative of glutamate, right? So, uh, the enzyme that makes that conversion happen is a, an enzyme known as a glutamidicurboxelis, right? Glutamidicurboxelis. So, if you're going from glutamate to GABA, right?

You need glutamidicurboxelis to kind of help you out there, right? So, if glutamidicurboxelis uses B6 as a cofactor, right? So, if that B6 doesn't work, well, the person is going to be in big, big, big, big trouble, right? So, you have a beautiful glutamate and less GABA, so you have seizures, right? That's one. The second thing is, again, we need B6 as a cofactor for the first step of hym synthesis, right? Going from, again, glycemic plus succinyl-queue to, uh, delta-minu level lemic acid, right? So, if you have a B6 deficiency, because, again, you are taking, um, isonize it impredently, right? Then that person likely getting two problems with, uh, getting two problems with, uh, uh, person likely getting two problems with, um, with, uh, hym synthesis, right? So, they will have a micrositic anemia, right? Most specifically, they will have a acetyroblastic anemia, right? And then, again, remember, you need B6 for just many, many, many, many, many of the things, right? So, again, a person could potentially run into many problems by having a B6 deficiency and don't forget, right? The theory that the person is being treated for TBN, they develop a male or a rash, I would really hope you're thinking about like drug induced lupus on those circumstances. In fact, for the sake of time, I think, in this podcast, I think I'm just maybe going to focus solely on the, on the water solubile vitamins, right? And then I'll make a fat solubile vitamin, uh, podcast.

Okay, so, um, I guess the next water but let me just also do a drive by, right? So, biotin vitamin B7, the big thing you wouldn't know about that is it's a cofactor, this is more for step one for x, right? It's a cofactor for caboxalase enzymes. Um, remember that, uh, you know, it's really hard to get a B7 like a biotin deficiency, right? But if you consume like a ton of egg whites, right? Those things contain a protein known as a avidin, you'll bind up your biotin and you could potentially get a B7 deficiency, but I'm going to keep going, right? So, uh, B9, right? Fully castate, that's what you want to know, right? So remember, Fully castate, very, very high iodine enzyme to know about, right? Like, I mean, sorry, vitamin to know about, right? So that's vitamin B9. Basically, you use it to synthesize DNA, right? And you also use it to convert a homocysteine to methionine, right? So if, for example, a person has a, uh, uh, fully deficiency, right? Then, you know, they wouldn't be able to make DNA. If you don't know what to make DNA, right? Then you can have a macrositic anemia. Most specifically, you can call that a mega-loblastic anemia, right? You can call it a mega-loblastic anemia, mega-loblastic anemia. That's actually very high iodine, for example, right? And what are the things that can cause fully deficiency? Well, it could be an alcoholic, right? If you see a macrositic anemia in an alcoholic, it's actually going to be from a fully deficiency, not B12, right?

That's one. Another classic thing you may see is, um, if, um, um, if a person has, um, I stick it on non-typileptica drug, right? Again, those people can get fully deficiency. You may see, divine white, those alcoholism causes a fully deficiency, well, the reason is that that's pretty simple, right? So there's an enzyme known as a conjugase that helps you reabsorb a fully, remember, fully is reabsorbed in the JaJunah, right? So alcohol inhibits conjugates, right? So you kill conjugates, well, and now you're going to be able to reabsorb fully, right? So you're going to get into problems there. I'm also if a person has like celiac disease, or any of these like small bowel malabsorptive disorders, especially ones that torch the JaJunah, right? You're going to reabsorb fully. Um, also if a person is like a T and Tos diet kind of person, right? Like, you know, elderly person T and Tos diet that can cause a fully deficiency. So there are many things that can potentially cause a fully deficiency. Another thing actually, a pretty classic one, MVM is actually is if a person has like a chronic immunoclinemia, right? Like, oh, like sickle cell disease or like sickle cell disease or um, go on divine, think, hairdresser source like Tos, yep, hairdresser, Tos, right? If you're chronically like breaking down red blood cells, right? Like, to me, those red blood cells require some DNA, right? So those people can get a fully deficiency very quickly.

That's why people with sickle cell disease, they require daily full eaters, supplementation, I remember. If you're a productive age woman, right? You really should be on, really should be on full eat. Um, and I mean, don't forget again, some other drugs that can kind of like precipitate fully problems, phenetone, methyl trexiae, try remember, methyl trexiae inhibits the hydrofolioreductase. You also phonomides, TMPSMX, right? Those things cannot precipitate a fully deficiency, right? And obviously, if a person is having problems and you're taking those drugs, right? You want to go ahead and let's see, they have like bone marrow suppression, right? Because again, those drugs have kind of clobbered, those people's for lead. You can give them a full liniq, not full liniq acid analog, right? Like look, worry, right? To help with the risk in those people's are bone marrow, right? I remember, when people have fully deficiency and their pregnant, right? They can give better kids that have like neuro tube defects, right? Like spina befida, meningoma, elocials and all those, all those bad, a malia neuro tube defects, right? And don't forget, that fully deficiency, right? Those not cause your logical problems, right? Those can cause any neurological problems and your homo-sistine will actually be elevated, right? When you have full litre deficiency, right? And you can actually get a fully deficiency relatively quickly.

You get full litre from plants, remember, get full litre from full yeast, right? So, you know, if you don't consume full litre, you can actually build up that deficiency within like three months or there about, right? And then the next thing I'll talk about is B12, right? So B12 is a cobalamin, right? So you need B12 for many things, right? So you need it to make DNA, you need to make fatty acids and B12 only does true reactions in the body, right? So one reaction it does is that, you know, it helps this enzyme methanine, same face convert homo-sistine to methanine, right? So if you have a B12 deficiency, your homo-sistine is going to go up, right? But there's also this other enzyme, right? That helps you go from methyl, malonic acid to, like methyl, malonokoi to succino-quue, right? Called a methyl malonokoi mutate, and that uses that in B12 as well as a co-factor, right? So you'll see that if you have a B12 deficiency, you're going to get a methyl malonica acidemia on an imbim exam, right? And remember that again, because you need B12 for fatty acid synthesis, right? Those people can get a little like peripheral neuropathy, they can get a, they can get a dementia, right? In fact, B12 deficiency can actually cause a lot of dementia, right? And these people can also get problems with like this subacute combined degeneration of the spinal cord, right? Where the, where the brussel columns and the lateral corticospinal tracks don't work, right?

So I work and cause B12 deficiency, well, if you make a little antibodies against your parietal cells, right? Like, you know, perneasious anemia, that will cause a B12 deficiency, right? If a person has problems with terminal helium, they say they have like cross disease, again, they're going to have problems, sorry, observing B12. If a person has, if a person is on a vegan diet, because remember, you get only B12 only from a animal product, right? Again, that can cause a B12 deficiency. And you know, the fish tape one, if it's having a good time in your GI tract, remember that bug that one known as a dive phylobothrium latham, right? It can definitely cause a B12 deficiency as well, right? So, you know, just all things to keep at the back of your mind that can cause a B12 deficiency. So, and then the final vitamin I'll talk about, right? Water soluble vitamin C, right? Basically, right? Remember, it's a co-factor for the, you know, for the synthesis of collagen, especially if you want to cross-link those collagen fibers. If you have a vitamin C, the efficiency, you'll get scurvy, right? And so those people have like bleeding gums, poor wound helium, and all that badness, right? And remember that vitamin C. It actually helps in keeping iron in the two plus form. It can actually help you go from Fe3 plus to Fe2 plus. So believe it or not, you can actually treat a methemoglobinemia by giving a vitamin C on an in-beam exam.

And again, those are, I think, the kind of big things you want to keep at the back of your mind with water soluble vitamins. Again, as I do at the end of every podcast, I'll throw one on one two to learn for many exams. Step one, step two, CK, step two, CS, step three, pre-clinical medical exams, 30-ish-off exams. I do these booster courses. It's one on one, it's 20 hours each for step one, step two, CK, and step three. And then I also have these are group courses, right? Which again, I cannot talk about at the beginning. For now, I'm really for step two, CK, about step one and step three will be coming up soon. God willing. And then again, if you need help with like ERAS, applications, personal statements, recliders, editing your application, and all that stuff, again, if you have tricky applications, right? Especially with this COVID cycle, just let me know, just send me an email, either reach out to me through the website, or send me an email at Divine Intervention Podcasts with an S at the end at gmail.com. Unfortunately, I have to run today. I don't really have a life lesson, but I will give a life lesson in my upcoming podcast. So thank you for listening. I will see you next time. I'll make a podcast relating to Fatsorebub item, means on the USMLE. So I'll see you then. God bless you. Thank you.

Thiamine (Vitamin B1), resulting in Wernicke-Korsakoff syndrome.

Dermatitis, Diarrhea, and Dementia (the fourth D is Death).

Vitamin C (Ascorbic Acid).

The presence of Wernicke-Korsakoff triad symptoms.

Carcinoid Syndrome; the excessive serotonin production shunts Tryptophan away from Niacin synthesis (B3).

Microcytic or Acetyroblastic anemia.

Thiamine (Vitamin B1).

Macrocytic anemia and Subacute Combined Degeneration of the spinal cord.

Celiac disease or any small bowel malabsorptive disorder; chronic hemolysis/sickle cell crisis.

It acts as a cofactor for transaminase enzymes, necessary for converting glutamate to GABA.

Folate (B9) or Cobalamin (Vitamin B12).

Scurvy involves poor wound healing, bleeding gums, and impaired collagen cross-linking due to lack of Vitamin C.

Thiamine (Vitamin B1).

Macrocytic anemia and Subacute Combined Degeneration of the spinal cord.

Celiac disease or any small bowel malabsorptive disorder; chronic hemolysis/sickle cell crisis.

It acts as a cofactor for transaminase enzymes, necessary for converting glutamate to GABA.

Folate (B9) or Cobalamin (Vitamin B12).

Scurvy involves poor wound healing, bleeding gums, and impaired collagen cross-linking due to lack of Vitamin C.