As dietitians, we all know why Popeye got a burst of strength after swallowing spinach. It's not just magic (though maybe a little)! Spinach is packed with Vitamin A, which plays a crucial role in keeping our eyes sharp. But that's just the tip of the iceberg. Vitamins don't work alone; they function like a secret society within our bodies, with each member playing a specific role and interacting with others to optimise health. This blog looks into the fascinating world of vitamin synergy and explores how vitamins work together.

Vitamins play a vital role in the body, with each organ having different vitamin requirements and all the biochemical processes in the body depending upon water-soluble and fat-soluble vitamins. If one vitamin is deficient, it can disturb the functions of other vitamins. The right combination of vitamins protects the body from different diseases. Hence, the synergistic interaction of vitamins is important in reducing the risk of various illnesses.

Vitamins are organic substances, which our body needs to perform everyday functions and stay healthy. These are required in adequate amounts from the foods we eat because the body does not produce them. Each vitamin has different functions in the body, ¹ too little or too high an intake of certain vitamins can cause diseases such as obesity, diabetes, cancer and various immune system disorders.²

B-complex vitamins and vitamin C, for example, being water soluble do not stay in the body (see Figure 1), so they are required on a daily basis because they leave the body through urine. Fat-soluble vitamins on the other hand, can stay in the fatty tissues and liver for days or months.³

Figure 1: Types of vitamins⁴

THE ROLE OF VITAMINS IN THE BODY

Two reactions occur between vitamins to a greater or lesser extent:

1. Synergistic: a positive interaction between two or more vitamins
2. Antagonistic: a negative interaction when the first vitamin effect diminishes or cancels the effect of a second vitamin

Table 1: Functions and food sources of vitamins⁴

Vitamins	Chemical name	Functions in the body	Food Sources
A	Retinol	Helps in formation and maintenance of skin hair and mucous membrane. Supports vision and growth	Pumpkin, sweet potatoes, eggs, Cantaloupe, carrots
B1	Thiamine	Provides energy to the body	Cereals ( bread, rice), Sunflower seeds
B2	Riboflavin	Involved in the metabolism of fat, protein and carbohydrates	Meat, milk, spinach, seafood
B3	Niacin	Converts food into energy	Beans, nuts, poultry
B5	Pantothenic acids	Promotes healthy liver and skin	Yoghurt, avocadoes,  mushrooms
B6	Pyridoxine	Protects body from inflammation	Potatoes, chick peas, fish (salmon and tuna)
B7	Biotin	Strengthens hair and nails	Legumes, bananas, eggs
B9	Folic acids	Help in the formation of body’s genetic material	Leafy greens Citrus fruits
B12	Cyanocobalamin	Production of red blood cells	Dairy products, eggs, meat, fortified cereals
C	Ascorbic acids	Formation of collagen and connective tissue Improves immune function and wound healing	Kiwi fruit, strawberries, citrus fruits (oranges, grapefruit, etc)
E	Tocopherol	Acts as an Antioxidant Blood vessels formation	Nuts and seeds, peanuts, green vegetables
D	Calciferol	Regulation of blood pressure Neuroprotective Hormone formation	Dairy products, eggs, fish
K	Phylloquinone	Blood clotting Makes bones strong	Green vegetables

 

SYNERGISTIC INTERACTIONS

This is when the combined effect is greater than the sum of effects observed when a vitamin is given alone. This interaction is beneficial for the body because it decreases the risk of disease. For example, in one study, the interaction between B2, B3 and B7 showed synergistic effects with B6,⁵  enhancing the bioavailability of the nutrients and boosting absorption.

Synergistic effects on growth from the B-complex category were observed between vitamins B1 with B5, B1 with B2 and B1 with B6 and reported to have powerful synergistic actions. The combined action of these vitamins provides various benefits to the body in the protection of the nerve tissues and nourishes the myelin sheath (protective membrane around the nerves). Hence, we can prevent various illnesses, such as digestive system problems and nervous system disorders through the synergistic interaction of certain vitamins.⁵

Vitamin E with B12

Vitamin E exhibits anti-inflammatory and immune-enhancing activity, whilst B12 help in the formation of red blood cells. The intake of both vitamins in a combined form increases the process of reducing inflammation in the body and forming red blood cells, rather than the effects of separate intake. Their synergistic interaction prevents anaemia, which is a deficiency of blood cells in the body.⁶

Vitamin E with C during exercise

During exercise, oxidative stress rises in the body and produces free radicals. These free radicals are toxins that damage healthy cells in the body. Vitamin C, a water-soluble vitamin, acts as an electron donor to free radicals produced by vitamin E during oxidative stress. Vitamin C scavenge-free radicals to protect the body from damage. Hence, these vitamins combined provide synergistic action and positive health effects when taken during exercise.⁶

Many other vitamin combinations benefit the body due to their synergistic effects. The following are explained in Figure 3. Positive signs in the figure indicate the synergistic effects of the vitamins on the body.⁷

Figure 2: Synergistic interaction of the fat soluble and water-soluble vitamins

 

Osteoporosis and Vitamin K

Some diseases do not occur due to a single vitamin deficiency, as this depends on the presence or absence of other vitamins. Osteoporosis is caused by vitamin D and vitamin K deficiency. Vitamin K promotes the osteoblast (specialised cells to stimulate bone growth and development), whilst vitamin D regulates the absorption of calcium and phosphorus to make bones strong and healthy. Osteoporos is best treated by the combined intake of both vitamins to ensure synergistic actions on the bones.⁸

Vitamin C with B12

Vitamin C is crucial for the growth and repair of the tissues around the body. B12 makes the body's blood and nerve cells healthy and facilitates the formation of the genetic material of the cells. The intake of these vitamins shows powerful synergistic interaction in the body, as they speed up the recovery of damaged tissues that occur due to diseases. Both vitamins depend upon each other to perform their function in the body.⁹

CONCLUSION

Our body is a complex ecosystem, and vitamins function best when they work together. By incorporating a variety of nutrient-rich foods into our diets, we can provide the perfect environment for this vitamin synergy to thrive, thus enabling vitamins to work wonders on our overall health and well-being.

Shabana Kousar

Shabana is a dietitian with a master's degree in Philosophy. She has worked in hospitals
in Rawalpindi, Pakistan and as a lecturer in a campus affiliated with Government College
University in Faisalabad. Shabana specialises in obesity, PCOS and weight management,
with a research interest in inflammatory bowel disease.

References

1. Syring JG, Crouse MS, Neville TL, Ward AK, Dahlen CR, Reynolds LP, Borowicz PP, McLean KJ, Neville BW and Caton JS (2023). Concentrations of vitamin B12 and folate in maternal serum and fetal fluids, metabolite interrelationships, and hepatic transcript abundance of key folate and methionine cycle genes: the impacts of maternal nutrition during the first 50 d of gestation. Journal of Animal Science, 101, p.skad139
2. Samson ME, Yeung LF, Rose CE, Qi YP, Taylor CA and Crider KS (2022). Vitamin B-12 malabsorption and renal function are critical considerations in studies of folate and vitamin B-12 interactions in cognitive performance: NHANES 2011-2014. The American Journal of Clinical Nutrition, 116(1), pp74-85
3. Jungert A and Neuhäuser-Berthold M (2020). Interrelation between plasma concentrations of vitamins C and E along the trajectory of ageing in consideration of lifestyle and body composition: a longitudinal study over two decades. Nutrients, 12(10), p 2944
4. Uebanso T, Shimohata T, Mawatari K and Takahashi A (2020). Functional roles of B‐vitamins in the gut and gut microbiome. Molecular nutrition & food research, 64(18), p 2000426
5. Calderón‐Ospina CA and Nava‐Mesa MO (2020). B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neuroscience & Therapeutics, 26(1), pp 5-13
6. Higgins MR, Izadi A and Kaviani M (2020). Antioxidants and exercise performance: with a focus on vitamin E and C supplementation. International Journal of Environmental Research and Public Health, 17(22), p 8452
7. Mustafi S, Sinha R, Sarkar S, Giri D, Saha AP and Yadav P (2021). Comparative estimation of serum levels of vitamin A, vitamin B12, vitamin D and vitamin E in patients with recurrent aphthous stomatitis and normal individuals - A case-control study. Journal of Indian Academy of Oral Medicine and Radiology, 33(4), pp 442-446
8. Varsamis N, Christou GA, Derdemezis C, Tselepis A and Kiortsis D (2023). The Associations of Dietary Vitamin K Intake and circulating vitamin 25 (OH) D with serum lipoprotein levels: the vitamin Deficiency matters. Hormone and Metabolic Research, 55(03), pp 196-204
9. Skiold LCJ, Estefania RPP, Carolina GPMP, Mery LMR, Fernando CHE and Jair LC (2021). Synergistic interaction between B vitamins and statins to counter nociception in rats. Drug Development Research, 82(3), pp 440-447