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Vitamins & Supplements

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Index Vitamins Supplements Vitamin A Vitamin B12 Vitamin B6 Vitamin C Calcium Vitamin D Vitamin E Folate Iodine Iron Vitamin K Magnesium Zinc Multi-Vitamins


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Vitamins Vitamins are organic compounds containing carbon which is essential for life. They are either water or fat soluble meaning they either need water or fat to be digested and absorbed. Water soluble include (all are B-vitamins expect for Vitamin C): Vitamin C Thiamin Riboflavin Niacin B6 B12 Folic acid Biotin Pantothenic acid Fat soluble include: Vitamin A Vitamin D Vitamin E Vitamin K


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Vitamins Vitamin A Active form is retinal Inactive form (which is activated by the body) is carotene (i.e. beta carotene found in carrots) Vital for vision especially night vision Needed for repair of tissue and bone Involved in reproduction and fetal development Helps immune system function Food sources include whole eggs, dairy, beef liver, dark green vegetables, yellow/orange colored vegetables


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Vitamins B-Vitamins Group of vitamins all involved in turning the food we eat into useable energy by the body Include thiamin, riboflavin, niacin, B6, B12, folic acid, biotin, pantothenic acid Some B vitamins work solely to turn the food we eat into useable energy, others have additional roles Thiamin (B1) assists the nervous system, heart muscle and regulates appetite Riboflavin (B2) plays a role in mucous membrane formation and skin formation B6 helps maintain normal homocysteine levels in the blood, which is an amino acid that helps reduce the risk of heart disease Folic acid (B9) helps form the brain and spinal cord during fetal development and is involved in cell division and red blood cell formation B-vitamins are widespread in the food supply. Found mostly in green vegetables, meats, dairy and fortified foods B12 is the only B-vitamin not found in plant foods and therefore needs to be supplemented for those who are vegan


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Vitamins Vitamin C Also known as ascorbic acid Functions as antioxidant Assists formation of collagen Needed for wound healing Decreases risk of cancer and heart disease Found in fruits, vegetables especially citrus, bell peppers, kiwi, broccoli, strawberries, tomatoes, watermelon, potatoes, bananas and carrots Vitamin D Known as the sunshine vitamin because we get most of what we need from sun exposure Needed for calcium absorption Helps maintain bones and teeth Prevents rickets and osteoporosis Assists in immune function, cell growth and fetal development Lately has been shown to reduce risks of some cancers Found in fatty fish, cod liver oil, dairy that has been fortified, egg yolks and beef liver


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Vitamins Vitamin E Acts as an antioxidant Contributes to immune function and DNA repair Sources include vegetable oil, nuts, beans, whole grains and fortified cereals Vitamin K Plays an essential role in blood clotting Main source is green leafy vegetables, cabbage, beef liver Synthesized somewhat by the bacteria in the large intestine so we get some of what we need by our own body production Vitamin Vacation: Did you know that you should not be taking vitamins every day for weeks, months and years at a time? You become immune to them so after a while you are wasting your money and your time swallowing all those expensive pills. It is good to take a break from your supplements for about a week every other month. Talk to your health coach about what kind of supplements you should be taking.


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Supplements Keep up with supplement safety alerts! The Food and Drug Administration (FDA) keeps a list of dietary supplements that are under regulatory review or that have been reported to cause adverse effects. If you're taking a supplement, it's a good idea to check the FDA website periodically for updates. The dietary guidelines for Americans make it clear that your nutritional needs should be met primarily through your diet. For some people, however, supplements may be a useful way to get nutrients they might otherwise be lacking. Before you go shopping for supplements, get the facts on what they will and won't do for you. Supplements vs. Whole Foods Supplements aren't intended to be a food substitute because they can't replicate all of the nutrients and benefits of whole foods, such as fruits and vegetables. So depending on your situation and your eating habits, dietary supplements may not be worth the expense.


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Supplements Whole foods offer three main benefits over dietary supplements: Greater nutrition: Whole foods are complex, containing a variety of the micronutrients your body needs. An orange, for example, provides Vitamin C plus beta carotene, calcium and other nutrients. A Vitamin C supplement lacks these other micronutrients. Essential fiber: Whole foods, such as whole grains, fruits, vegetables and legumes, provide dietary fiber. Most high-fiber foods are also packed with other essential nutrients. Fiber, as part of a healthy diet, can help prevent certain diseases, such as type 2 diabetes and heart disease, and it can also help manage constipation. Protective substances: Whole foods contain other substances important for good health. Fruits and vegetables, for example, contain naturally occurring substances called phytochemicals, which may help protect against cancer, heart disease, diabetes and high blood pressure. Many are also good sources of antioxidants, substances that slow down oxidation, a natural process that leads to cell and tissue damage.


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Supplements Who needs supplements? If you're generally healthy and eat a wide variety of foods, including fruits, vegetables, whole grains, legumes, low-fat dairy products, lean meats and fish, you likely don't need supplements. However, the dietary guidelines recommend supplements, or fortified foods, in the following situations: Women who may become pregnant should get 400 micrograms a day of folic acid from

fortified foods or supplements, in addition to eating foods that naturally contain folate. Women who are pregnant should take a prenatal vitamin that includes iron or a separate

iron supplement. Adults aged 50 or older should eat foods fortified with Vitamin B-12, such as fortified

cereals, or take a multivitamin that contains B-12 or a separate B-12 supplement.


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Supplements Dietary supplements also may be appropriate if you: Don't eat well or consume less than 1,600 calories a day Are a vegan or a vegetarian who eats a limited variety of foods Are a woman who experiences heavy bleeding during your menstrual period Have a medical condition that affects how your body absorbs or uses nutrients, such as

chronic diarrhea, food allergies, food intolerance or a disease of the liver, gallbladder, intestines or pancreas

Have had surgery on your digestive tract and are not able to digest and absorb nutrients properly


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Supplements Choosing and using supplements: If you decide to take a vitamin or mineral supplement, consider these factors: 1. Check the label. Read labels carefully. Product labels can tell you what the active ingredient

or ingredients are, which nutrients are included, the serving size (e.g. capsule, packet or tsp) and the amount of nutrients in each serving.

2. Avoid megadoses. In general, choose a multivitamin-mineral supplement that provides about 100% of the Daily Value (DV) of all the vitamins and minerals, rather than one which has, for example, 500% of the DV for one vitamin and only 20% of the DV for another.

3. Check expiration dates. Dietary supplements can lose potency over time, especially in hot and humid climates. If a supplement doesn't have an expiration date, don't buy it. If your supplements have expired, discard them.

4. Watch what you eat. Vitamins and minerals are being added to a growing number of foods, including breakfast cereals and beverages. If you're also taking supplements, you may be getting more of certain nutrients than you realize. Taking more than you need is expensive and can raise your risk of side effects. For example, too much iron can cause nausea and vomiting and may damage the liver and other organs.


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Vitamin A What is vitamin A and what does it do? Vitamin A is a fat-soluble vitamin that is naturally present in many foods. It is important for normal vision, the immune system and reproduction. Vitamin A also helps the heart, lungs, kidneys and other organs work properly. There are two different types of vitamin A. The first type, preformed vitamin A, is found in meat, poultry, fish and dairy products. The second type, provitamin A, is found in fruits, vegetables and other plant-based products. The most common type of provitamin A in foods and dietary supplements is beta-carotene. How much vitamin A do I need? The amount of vitamin A you need depends on your age and reproductive status. Recommended intakes for vitamin A for people aged 14 years and older range between 700 and 900 micrograms (mcg) of retinol activity equivalents (RAE) per day. Recommended intakes for women who are nursing range between 1,200 and 1,300 RAE. Lower values are recommended for infants and children younger than 14.


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Vitamin A However, the vitamin A content of foods and dietary supplements is given on product labels in international units (IU), not mcg RAE. Converting between IU and mcg RAE is not easy. A varied diet with 900 mcg RAE of vitamin A, for example, provides between 3,000 and 36,000 IU of vitamin A depending on the foods consumed. For adults and children aged 4 years and older, the U.S. Food and Drug Administration has established a vitamin A Daily Value (DV) of 5,000 IU from a varied diet of both plant and animal foods. DVs are not recommended intakes; they don't vary by age and sex, for example. Trying to reach 100% of the DV each day, on average, is useful to help you get enough vitamin A. Am I getting enough vitamin A? Most people in the United States get enough vitamin A from the foods they eat and vitamin A deficiency is rare. However, certain groups of people are more likely than others to have trouble getting enough vitamin A: Premature infants, who often have low levels of vitamin A in their first year. Infants, young children, pregnant women and breastfeeding women in developing countries. People with cystic fibrosis.




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Vitamin A What foods provide vitamin A? Vitamin A is found naturally in many foods and is added to some foods, such as milk and cereal. You can get recommended amounts of vitamin A by eating a variety of foods, including the following: Beef liver and other organ meats (limit the amount you eat as they are high in cholesterol). Some types of fish, such as salmon. Green leafy vegetables and other green, orange, and yellow vegetables, such as broccoli,

carrots, and squash. Fruits, including cantaloupe, apricots, and mangos. Dairy products Fortified breakfast cereals. What kinds of vitamin A dietary supplements are available? Vitamin A is available in dietary supplements, usually in the form of retinyl acetate or retinyl palmitate (preformed vitamin A), beta-carotene (provitamin A), or a combination of preformed and provitamin A. Most multivitamin-mineral supplements contain vitamin A. Dietary supplements that contain only vitamin A are also available.




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Vitamin A What happens if I don't get enough vitamin A? Vitamin A deficiency is rare in the United States, although it is common in many developing countries. The most common symptom of vitamin A deficiency in young children and pregnant women is an eye condition called xerophthalmia, the inability to see in low light, which can lead to blindness if it isn't treated.




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Vitamin A What are some effects of vitamin A on health? Scientists are studying vitamin A to understand how it affects health. Here are some examples of what this research has shown. Cancer

People who eat a lot of foods containing beta-carotene might have a lower risk of certain kinds of cancer, such as lung cancer or prostate cancer. But studies to date have not shown that vitamin A or beta-carotene supplements help prevent cancer or lower the chances of dying from this disease. In fact, studies show that smokers who take high doses of beta-carotene supplements have an increased risk of lung cancer.

Age-Related Macular Degeneration Age-related macular degeneration (AMD), or the loss of central vision as people age, is one of the most common causes of vision loss in older people. Among people with AMD, a supplement containing antioxidants, zinc and copper with or without beta-carotene has shown promise for slowing down the rate of vision loss.

Measles When children with vitamin A deficiency get measles, the disease tends to be severe. Taking supplements with high doses of vitamin A can shorten the duration of the fever and diarrhea. They can also lower the risk of death in children with measles living in developing countries where this deficiency is common.




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Vitamin A Can vitamin A be harmful? Yes, high intakes of some forms of vitamin A can be harmful. Getting too much preformed vitamin A (usually from supplements or certain medicines) can cause dizziness, nausea, headaches, coma and even death. High intakes of preformed vitamin A in pregnant women can also cause birth defects in their babies. Women who might be pregnant should not take high doses of vitamin A supplements. Consuming high amounts of beta-carotene or other forms of provitamin A can turn the skin yellow-orange, but this condition is harmless. High intakes of beta-carotene do not cause birth defects or the other more serious effects caused by getting too much preformed vitamin A. The safe upper limits for preformed vitamin A in IU are listed here. These levels do not apply to people who are taking vitamin A for medical reasons under the care of a doctor. Safe upper limits for beta-carotene and other forms of provitamin A have not been established.


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Life Stage Upper Safe Limit

Birth to 12 months 2,000 IU

Children 1–3 years 2,000 IU



Teens 14–18 years 9,333 IU

Adults 19 years and older 10,000 IU

Office of Dietary Supplements – National Institutes of Health


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Vitamin A Vitamins & Supplements

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Food mcg RAE per serving

IU per serving

Percent Daily Value

Ready-to-eat cereal, fortified with 10% of the daily value for vitamin A, ¾–1 cup (more heavily fortified cereals might provide more of the daily value)

127–149 500 10

Milk, fat-free or skim, with added vitamin A and vitamin D, 1 cup 149 500 10

Baked beans, canned, plain or vegetarian, 1 cup 13 274 5 Egg, hard boiled, 1 large 75 260 5 Summer squash, all varieties, boiled, ½ cup 10 191 4 Salmon, sockeye, cooked, 3 ounces 59 176 4 Yogurt, plain, low fat, 1 cup 32 116 2 Pistachio nuts, dry roasted, 1 ounce 4 73 1

Tuna, light, canned in oil, drained solids, 3 ounces 20 65 1

Chicken, breast meat and skin, roasted, ½ breast 5 18 0



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Vitamin A Vitamins & Supplements

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Food mcg RAE per serving

IU per serving

Percent Daily Value

Sweet potato, baked in skin, 1 whole 1,403 28,058 561 Beef liver, pan fried, 3 ounces 6,582 22,175 444 Spinach, frozen, boiled, ½ cup 573 11,458 229 Carrots, raw, ½ cup 459 9,189 184 Pumpkin pie, commercially prepared, 1 piece 488 3,743 249 Cantaloupe, raw, ½ cup 135 2,706 54 Peppers, sweet, red, raw, ½ cup 117 2,332 47 Mangos, raw, 1 whole 112 2,240 45 Black-eyed peas (cowpeas), boiled, 1 cup 66 1,305 26 Apricots, dried, sulfured, 10 halves 63 1,261 25 Broccoli, boiled, ½ cup 60 1,208 24 Ice cream, French vanilla, soft serve, 1 cup 278 1,014 20 Cheese, ricotta, part skim, 1 cup 263 945 19 Tomato juice, canned, ¾ cup 42 821 16 Herring, Atlantic, pickled, 3 ounces 219 731 15



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Vitamin B12 What is vitamin B12 and what does it do? Vitamin B12 is a nutrient that helps keep the body's nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak. Two steps are required for the body to absorb vitamin B12 from food. First, hydrochloric acid in the stomach separates vitamin B12 from the protein to which vitamin B12 is attached in food. After this, vitamin B12 combines with a protein made by the stomach called intrinsic factor and is absorbed by the body. Some people have pernicious anemia, a condition where they cannot make intrinsic factor. As a result, they have trouble absorbing vitamin B12 from all foods and dietary supplements.




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Vitamin B12 How much vitamin B12 do I need? The amount of vitamin B12 you need each day depends on your age. Average daily recommended amounts for different ages are listed here (in micrograms (mcg).


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Life Stage Recommended Amount

Birth to 6 months 0.4 mcg

Infants 7–12 months 0.5 mcg

Children 1–3 years 0.9 mcg



Teens 14–18 years 2.4 mcg

Adults 2.4 mcg

Pregnant teens and women 2.6 mcg

Breastfeeding teens and women 2.8 mcg



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Vitamin B12 What foods provide vitamin B12? Vitamin B12 is found naturally in a wide variety of animal foods and is added to some fortified foods. Plant foods have no vitamin B12 unless they are fortified. You can get recommended amounts of vitamin B12 by eating a variety of foods including the following: Beef liver and clams (the best sources of vitamin B12). Fish, meat, poultry, eggs, milk and other dairy products. Some breakfast cereals, nutritional yeasts and other food products that are fortified with

vitamin B12. To find out if vitamin B12 has been added to a food product, check the product labels.

What kinds of vitamin B12 dietary supplements are available? Vitamin B12 is found in almost all multivitamins. Dietary supplements that contain only vitamin B12, or vitamin B12 with nutrients such as folic acid and other B vitamins, are also available. Check the Supplement Facts label to determine the amount of vitamin B12 provided. Vitamin B12 is also available in sublingual forms (dissolved under the tongue). A prescription form of vitamin B12 can be administered as a shot. This is usually used to treat vitamin B12 deficiency. Vitamin B12 is also available as a prescription medication nasal gel form (for use in the nose).




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Vitamin B12 Am I getting enough vitamin B12? Most people in the United States get enough vitamin B12 from the foods they eat. But some people have trouble absorbing vitamin B12 from food. As a result, vitamin B12 deficiency affects between 1.5% and 15% of the public. Your doctor can test your vitamin B12 level to see if you have a deficiency. Certain groups may not get enough vitamin B12 or have trouble absorbing it: Older adults, who do not have enough hydrochloric acid in their stomach to absorb the

vitamin B12 naturally present in food. People over 50 should get most of their vitamin B12 from fortified foods or dietary supplements because, in most cases, their bodies can absorb vitamin B12 from these sources.

People with pernicious anemia whose bodies do not make the intrinsic factor needed to absorb vitamin B12. Doctors usually treat pernicious anemia with vitamin B12 shots, although very high oral doses of vitamin B12 might also be effective.

People who have had gastrointestinal surgery, such as weight loss surgery, or who have digestive disorders, such as celiac disease or Crohn's disease. These conditions can decrease the amount of vitamin B12 that the body can absorb.

Some people who eat little or no animal foods such as vegetarians and vegans. Only animal foods have vitamin B12 naturally. When pregnant women and women who breastfeed their babies are strict vegetarians or vegans, their babies might also not get enough vitamin B12.




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Vitamin B12 What happens if I don't get enough vitamin B12? Vitamin B12 deficiency causes tiredness, weakness, constipation, loss of appetite, weight loss and megaloblastic anemia. Nerve problems, such as numbness and tingling in the hands and feet, can also occur. Other symptoms of vitamin B12 deficiency include problems with balance, depression, confusion, dementia, poor memory and soreness of the mouth or tongue. Vitamin B12 deficiency can damage the nervous system even in people who don't have anemia, so it is important to treat a deficiency as soon as possible. In infants, signs of a vitamin B12 deficiency include failure to thrive, problems with movement, delays in reaching the typical developmental milestones and megaloblastic anemia. Large amounts of folic acid can hide a vitamin B12 deficiency by correcting megaloblastic anemia, a hallmark of vitamin B12 deficiency. But folic acid does not correct the progressive damage to the nervous system that vitamin B12 deficiency also causes. For this reason, healthy adults should not get more than 1,000 mcg of folic acid a day.




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Vitamin B12 What are some effects of vitamin B12 on health? Scientists are studying vitamin B12 to understand how it affects health. Here are several examples of what this research has shown: Heart disease

Vitamin B12 supplements (along with folic acid and vitamin B6) do not reduce the risk of getting heart disease. Scientists had thought that these vitamins might be helpful because they reduce blood levels of homocysteine, a compound linked to an increased risk of having a heart attack or stroke.

Dementia As they get older, some people develop dementia. These people often have high levels of homocysteine in the blood. Vitamin B12 (with folic acid and vitamin B6) can lower homocysteine levels, but scientists don't know yet whether these vitamins actually help prevent or treat dementia.

Energy and athletic performance Advertisements often promote vitamin B12 supplements as a way to increase energy or endurance. Except in people with a vitamin B12 deficiency, no evidence shows that vitamin B12 supplements increase energy or improve athletic performance.




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Vitamin B12 Vitamins & Supplements

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Food Micrograms (mcg) per serving

Percent Daily Value

Clams, cooked, 3 ounces 84.1 1,402 Liver, beef, cooked, 3 ounces 70.7 1,178 Breakfast cereals, fortified with 100% of the daily value for vitamin B12, 1 serving 6.0 100 Trout, rainbow, wild, cooked, 3 ounces 5.4 90 Salmon, sockeye, cooked, 3 ounces 4.8 80 Trout, rainbow, farmed, cooked, 3 ounces 3.5 58 Tuna fish, light, canned in water, 3 ounces 2.5 42 Cheeseburger, double patty and bun, 1 sandwich 2.1 35 Haddock, cooked, 3 ounces 1.8 30 Breakfast cereals, fortified with 25% of the daily value for vitamin B12, 1 serving 1.5 25 Beef, top sirloin, broiled, 3 ounces 1.4 23 Milk, low-fat, 1 cup 1.2 18 Yogurt, fruit, low-fat, 8 ounces 1.1 18 Cheese, Swiss, 1 ounce 0.9 15 Beef taco, 1 soft taco 0.9 15 Ham, cured, roasted, 3 ounces 0.6 10 Egg, whole, hard boiled, 1 large 0.6 10 Chicken, breast meat, roasted, 3 ounces 0.3 5



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Vitamin B6 What is vitamin B6 and what does it do? Vitamin B6 is a vitamin that is naturally present in many foods. The body needs vitamin B6 for more than 100 enzyme reactions involved in metabolism. Vitamin B6 is also involved in brain development during pregnancy and infancy as well as immune function. How much vitamin B6 do I need? The amount of vitamin B6 you need depends on your age. Average daily recommended amounts are listed here in milligrams (mg).


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Birth to 6 months 0.1 mg

Infants 7–12 months 0.3 mg

Children 1–3 years 0.5 mg



Teens 14–18 years (boys) 1.3 mg

Teens 14–18 years (girls) 1.2 mg

Adults 19–50 years 1.3 mg

Adults 51+ years (men) 1.7 mg

Adults 51+ years (women) 1.5 mg

Pregnant teens and women 1.9 mg

Breastfeeding teens and women 2.0 mg



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Vitamin B6 What foods provide vitamin B6? Vitamin B6 is found naturally in many foods and is added to other foods. You can get recommended amounts of vitamin B6 by eating a variety of foods, including the following: Poultry, fish and organ meats. Potatoes and other starchy vegetables. Fruit (other than citrus). What kinds of vitamin B6 dietary supplements are available? Vitamin B6 is available in dietary supplements, usually in the form of pyridoxine. Most multivitamin-mineral supplements contain vitamin B6. Dietary supplements that contain only vitamin B6, or vitamin B6 with other B vitamins, are also available.




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Vitamin B6 Am I getting enough vitamin B6? Most people in the United States get enough vitamin B6 from the foods they eat. However, certain groups of people are more likely than others to have trouble getting enough vitamin B6: People whose kidneys do not work properly, including people who are on kidney dialysis and

those who have had a kidney transplant. People with autoimmune disorders, which cause their immune system to mistakenly attack

their own healthy tissues. For example, people with rheumatoid arthritis, celiac disease, Crohn's disease, ulcerative colitis, or inflammatory bowel disease sometimes have low vitamin B6 levels.

People with alcohol dependence. What happens if I don't get enough vitamin B6? Vitamin B6 deficiency is uncommon in the United States. People who don't get enough vitamin B6 can have a range of symptoms, including anemia, itchy rashes, scaly skin on the lips, cracks at the corners of the mouth and a swollen tongue. Other symptoms of very low vitamin B6 levels include depression, confusion and a weak immune system. Infants who do not get enough vitamin B6 can become irritable or develop extremely sensitive hearing or seizures.




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Vitamin B6 What are some effects of vitamin B6 on health? Scientists are studying vitamin B6 to understand how it affects health. Here are some examples of what this research has shown. Heart disease

Some scientists had thought that certain B vitamins (such as folic acid, vitamin B12 and vitamin B6) might reduce heart disease risk by lowering levels of homocysteine, an amino acid in the blood. Although vitamin B supplements do lower blood homocysteine, research shows that they do not actually reduce the risk or severity of heart disease or stroke.

Cancer People with low levels of vitamin B6 in the blood might have a higher risk of certain kinds of cancer, such as colorectal cancer. But studies to date have not shown that vitamin B6 supplements can help prevent cancer or lower the chances of dying from this disease.

Cognitive function Some research indicates that elderly people who have higher blood levels of vitamin B6 have better memory. However, taking vitamin B6 supplements (alone or combined with vitamin B12 and/or folic acid) does not seem to improve cognitive function or mood in healthy people or in people with dementia.




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Vitamin B6 Premenstrual syndrome

Scientists aren't yet certain about the potential benefits of taking vitamin B6 for premenstrual syndrome (PMS). But some studies show that vitamin B6 supplements could reduce PMS symptoms, including moodiness, irritability, forgetfulness, bloating and anxiety.

Nausea and vomiting in pregnancy At least half of all women experience nausea, vomiting, or both in the first few months of pregnancy. Based on the results of several studies, the American Congress of Obstetricians and Gynecologists (ACOG) recommends taking vitamin B6 supplements under a doctor's care for nausea and vomiting during pregnancy.

Can vitamin B6 be harmful? People almost never get too much vitamin B6 from food. But taking high levels of vitamin B6 from supplements for a year or longer can cause severe nerve damage, leading people to lose control of their bodily movements. The symptoms usually stop when they stop taking the supplements. Other symptoms of too much vitamin B6 include painful, unsightly skin patches, extreme sensitivity to sunlight, nausea and heartburn.




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Birth to 12 months Not established

Children 1–3 years 30 mg



Teens 14–18 years 80 mg

Adults 100 mg

The safe upper limits for vitamin B6 are listed below. These levels do not apply to people who are taking vitamin B6 for medical reasons under the care of a doctor.



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Food Milligrams (mg) per serving

Percent Daily Value

Chickpeas, canned, 1 cup 1.1 55 Beef liver, pan fried, 3 ounces 0.9 45 Tuna, yellow fin, fresh, cooked, 3 ounces 0.9 45 Salmon, sockeye, cooked, 3 ounces 0.6 30 Chicken breast, roasted, 3 ounces 0.5 25 Breakfast cereals, fortified with 25% of the daily value for vitamin B6 0.5 25

Potatoes, boiled, 1 cup 0.4 20 Turkey, meat only, roasted, 3 ounces 0.4 20 Banana, 1 medium 0.4 20 Marinara (spaghetti) sauce, ready to serve, 1 cup 0.4 20 Ground beef, patty, 85% lean, broiled, 3 ounces 0.3 15 Waffles, plain, ready to heat, toasted, 1 waffle 0.3 15 Bulgur, cooked, 1 cup 0.2 10



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Percent Daily Value

Cottage cheese, 1% low-fat, 1 cup 0.2 10 Squash, winter, baked, ½ cup 0.2 10 Rice, white, long-grain, enriched, cooked, 1 cup 0.1 5 Nuts, mixed, dry-roasted, 1 ounce 0.1 5 Raisins, seedless, ½ cup 0.1 5 Onions, chopped, ½ cup 0.1 5 Spinach, frozen, chopped, boiled, ½ cup 0.1 5 Tofu, raw, firm, prepared with calcium sulfate, ½ cup 0.1 5 Watermelon, raw, 1 cup 0.1 5



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Vitamin C What is vitamin C and what does it do? Vitamin C, also known as ascorbic acid, is a water-soluble nutrient found in some foods. In the body, it acts as an antioxidant, helping to protect cells from the damage caused by free radicals. Free radicals are compounds formed when our bodies convert the food we eat into energy. People are also exposed to free radicals in the environment from cigarette smoke, air pollution and ultraviolet light from the sun. The body also needs vitamin C to make collagen, a protein required to help wounds heal. In addition, vitamin C improves the absorption of iron from plant-based foods and helps the immune system work properly to protect the body from disease.




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Vitamin C How much vitamin C do I need? The amount of vitamin C you need each day depends on your age. Average daily recommended amounts for different ages are listed here in milligrams (mg). If you smoke, add 35 mg to the values to calculate your total daily recommended amount.


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Life Stages Recommended Amount

Birth to 6 months 40 mg

Infants 7–12 months 50 mg




Teens 14–18 years (boys) 75 mg

Teens 14–18 years (girls) 65 mg

Adults (men) 90 mg

Adults (women) 75 mg

Pregnant teens 80 mg

Pregnant women 85 mg

Breastfeeding teens 115 mg

Breastfeeding women 120 mg



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Vitamin C What foods provide vitamin C? Fruits and vegetables are the best sources of vitamin C. You can get recommended amounts of vitamin C by eating a variety of foods including the following: Citrus fruits (such as oranges and grapefruit) and their juices, as well as red and green

pepper and kiwifruit. Other fruits and vegetables such as broccoli, strawberries, cantaloupe, baked potatoes and

tomatoes. Some foods and beverages that are fortified with vitamin C. To find out if vitamin C has been

added to a food product, check the product labels. The vitamin C content of food may be reduced by prolonged storage and by cooking. Steaming or microwaving may lessen cooking losses. Fortunately, many of the best food sources of vitamin C, such as fruits and vegetables, are usually eaten raw.




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Vitamin C What kinds of vitamin C dietary supplements are available? Most multivitamins have vitamin C. It is also available alone as a dietary supplement or in combination with other nutrients. The vitamin C in dietary supplements is usually in the form of ascorbic acid, but some supplements have other forms, such as sodium ascorbate, calcium ascorbate, other mineral ascorbates and ascorbic acid with bioflavonoids. Research has not shown that any form of vitamin C is better than the other forms.




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Vitamin C Am I getting enough vitamin C? Most people in the United States get enough vitamin C from foods and beverages. However, certain groups of people are more likely than others to have trouble getting enough vitamin C: People who smoke and those exposed to secondhand smoke (smoke increases the amount of

vitamin C that the body needs to repair damage caused by free radicals). Infants who are fed evaporated or boiled cow's milk, because cow's milk has very little vitamin C and heat can destroy vitamin C. Cow's milk is not recommended for infants under 1 year of age. Breast milk and infant formula have adequate amounts of vitamin C.

People with certain medical conditions such as severe malabsorption, some types of cancer and kidney disease requiring hemodialysis.

People who eat a very limited variety of food.

What happens if I don't get enough vitamin C? Vitamin C deficiency is rare in the United States and Canada. People who get little or no vitamin C (below about 10 mg per day) for many weeks can get scurvy. Scurvy causes fatigue, inflammation of the gums, small red or purple spots on the skin, joint pain, poor wound healing and corkscrew hairs. Additional signs of scurvy include depression as well as swollen, bleeding gums and loosening or loss of teeth. People with scurvy can also develop anemia. Scurvy is fatal if it is not treated.




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Vitamin C What are some effects of vitamin C on health? Scientists are studying vitamin C to understand how it affects health. Here are several examples of what this research has shown. Cancer prevention and treatment

People with high intakes of vitamin C from fruits and vegetables might have a lower risk of getting many types of cancer, such as lung, breast, and colon cancer. However, taking vitamin C supplements, with or without other antioxidants, doesn't seem to protect people from getting cancer.

It is not clear whether taking high doses of vitamin C is helpful as a treatment for cancer. Vitamin C's effects appear to depend on how it is administered to the patient. Oral doses of vitamin C can't raise blood levels of vitamin C nearly as high as intravenous doses given through injections. A few studies in animals and test tubes indicate that very high blood levels of vitamin C might shrink tumors. But more research is needed to determine whether high-dose intravenous vitamin C helps treat cancer in people. Vitamin C dietary supplements and other antioxidants might interact with chemotherapy and radiation therapy for cancer. People being treated for cancer should talk with their oncologist before taking vitamin C or other antioxidant supplements, especially in high doses.




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Vitamin C Cardiovascular disease

People who eat lots of fruits and vegetables seem to have a lower risk of cardiovascular disease. Researchers believe that the antioxidant content of these foods might be partly responsible for this association because oxidative damage is a major cause of cardiovascular disease. However, scientists aren't sure whether vitamin C itself, either from food or supplements, helps protect people from cardiovascular disease. It is also not clear whether vitamin C helps prevent cardiovascular disease from getting worse in people who already have it.

The common cold Although vitamin C has long been a popular remedy for the common cold, research shows that for most people, vitamin C supplements do not reduce the risk of getting the common cold. However, people who take vitamin C supplements regularly might have slightly shorter colds or somewhat milder symptoms when they do have a cold. Using vitamin C supplements after cold symptoms start does not appear to be helpful.




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Vitamin C Age-Related Macular Degeneration (AMD) and cataracts

AMD and cataracts are two of the leading causes of vision loss in older people. Researchers do not believe that vitamin C and other antioxidants affect the risk of getting AMD. However, research suggests that vitamin C combined with other nutrients might help keep early AMD from worsening into advanced AMD. In a large study, older people with AMD who took a daily dietary supplement with 500 mg vitamin C, 80 mg zinc, 400 IU vitamin E, 15 mg beta-carotene, and 2 mg copper for about 6 years had a lower chance of developing advanced AMD. They also had less vision loss than those who did not take the dietary supplement.

More research is needed before doctors can recommend dietary supplements containing vitamin C for patients with AMD. However, people who have or are developing the disease might want to talk with their doctor about taking dietary supplements.

The relationship between vitamin C and cataract formation is unclear. Some studies show that people who get more vitamin C from foods have a lower risk of getting cataracts. But further research is needed to clarify this association and to determine whether vitamin C supplements affect the risk of getting cataracts.




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Vitamin C Can vitamin C be harmful? Taking too much vitamin C can cause diarrhea, nausea, and stomach cramps. In people with a condition called hemochromatosis, which causes the body to store too much iron, high doses of vitamin C could worsen iron overload and damage body tissues. The safe upper limits for vitamin C are listed below:


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Children 9–13 years 1,200 mg

Teens 14–18 years 1,800 mg



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Vitamin C Vitamins & Supplements

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Food Milligrams (mg) per serving Percent Daily Value

Red pepper, sweet, raw, ½ cup 95 158 Orange juice, ¾ cup 93 155 Orange, 1 medium 70 117 Grapefruit juice, ¾ cup 70 117 Kiwifruit, 1 medium 64 107

Green pepper, sweet, raw, ½ cup 60 100

Broccoli, cooked, ½ cup 51 85 Strawberries, fresh, sliced, ½ cup 49 82 Brussels sprouts, cooked, ½ cup 48 80 Grapefruit, ½ medium 39 65 Broccoli, raw, ½ cup 39 65 Tomato juice, ¾ cup 33 55 Cantaloupe, ½ cup 29 48 Cabbage, cooked, ½ cup 28 47 Cauliflower, raw, ½ cup 26 43 Potato, baked, 1 medium 17 28 Tomato, raw, 1 medium 17 28 Spinach, cooked, ½ cup 9 15 Green peas, frozen, cooked, ½ cup 8 13



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Calcium Calcium is important for optimal bone health throughout your life. Although diet is the best way to get calcium, calcium supplements may be an option if your diet falls short. Before you consider calcium supplements, be sure you understand how much calcium you need, the pros and cons of calcium supplements and which type of supplement to choose. Benefits of calcium: Your body needs calcium to build and maintain strong bones. Your heart, muscles and nerves also need calcium to function properly. Some studies suggest that calcium, along with vitamin D, may have benefits beyond bone health, perhaps protecting against cancer, diabetes and high blood pressure. But evidence about such health benefits is not definitive. Risks of too little calcium: If you don't get enough calcium, you could face health problems related to weak bones: Children may not reach their full potential adult height. Adults may have low bone mass, which is a risk factor for osteoporosis. Many Americans don't get enough calcium in their diets. Children and adolescent girls are at particular risk, but so are adults age 50 and older.


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Calcium Calcium requirements: How much calcium you need depends on your age and sex. Note that the upper limit in the chart represents the safe boundary, it's not how much you should aim to get. If you exceed the upper limit, you may increase your risk of health problems related to excessive calcium. Calcium: Recommended Dietary Allowance (RDA) for adults


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Men Daily RDA Daily Upper Limit

19-50 years 1,000 mg 2,500 mg

51-70 years 1,000 mg 2,000 mg

71 and older 1,200 mg 2,000 mg

Women Daily RDA Daily Upper Limit

19-50 years 1,000 mg 2,500 mg

51 and older 1,200 mg 2,000 mg


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Calcium Calcium and vitamin D Your body needs vitamin D to absorb calcium. For this reason, some calcium supplements contain vitamin D. A few foods naturally contain small amounts of vitamin D, such as canned salmon with bones, and egg yolks. You can also get vitamin D from fortified foods and sun exposure. The RDA for vitamin D is 600 international units (15 micrograms) a day for most adults. Calcium and diet Your body doesn't produce calcium, so you must get it through other sources. Calcium can be found in a variety of foods, including: Dairy products, such as cheese, milk and yogurt Dark green leafy vegetables, such as broccoli and kale Fish with edible soft bones, such as sardines and canned salmon Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices


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Calcium Even if you eat a healthy, balanced diet, you may find it difficult to get enough calcium if you: Follow a vegan diet. Have lactose intolerance and limit dairy products. Consume large amounts of protein or sodium, which can cause your body to excrete calcium Have osteoporosis. Are receiving long-term treatment with corticosteroids. Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such

as inflammatory bowel disease or celiac disease.

In these situations, calcium supplements may help you meet your calcium requirements.


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Calcium Types of calcium supplements: Several different kinds of calcium compounds are used in calcium supplements. Each compound contains varying amounts of the mineral calcium, referred to as elemental calcium. Common calcium supplements may be labeled as: Calcium carbonate (40 percent elemental calcium) Calcium citrate (21 percent elemental calcium) Calcium gluconate (9 percent elemental calcium) Calcium lactate (13 percent elemental calcium)

The two main forms of calcium supplements are carbonate and citrate. Calcium carbonate is cheapest and therefore often a good first choice. Other forms of calcium in supplements include gluconate and lactate. In addition, some calcium supplements are combined with vitamins and other minerals. For instance, some calcium supplements may also contain vitamin D or magnesium. Check the ingredient list to see which form of calcium your calcium supplement is and what other nutrients it may contain. This information is important if you have any health or dietary concerns.


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Calcium Choosing calcium supplements: To determine which calcium supplement may be best for you, consider these factors: Amount of calcium

Elemental calcium is key because it's the actual amount of calcium in the supplement. It's what your body absorbs for bone growth and other health benefits. The Supplement Facts label on calcium supplements is helpful in determining how much calcium is in one serving. As an example, calcium carbonate is 40 percent elemental calcium, so 1,250 milligrams (mg) of calcium carbonate contains 500 mg of elemental calcium. Be sure to note the serving size (number of tablets) when determining how much calcium is in one serving.

Tolerability Calcium supplements cause few, if any, side effects. But side effects can sometimes occur, including gas, constipation and bloating. In general, calcium carbonate is the most constipating. You may need to try a few different brands or types of calcium supplements to find one that you tolerate the best.

Supplement form Calcium supplements are available in a variety of forms, including tablets, capsules, chews, liquids and powders. If you have trouble swallowing pills, you may want a chewable or liquid calcium supplement.


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Calcium What prescriptions you take

Calcium supplements can interact with many different prescription medications, including blood pressure medications, synthetic thyroid hormones, bisphosphonates, antibiotics and calcium channel blockers. Ask your doctor or pharmacist about possible interactions and which type of calcium supplement would work for you.

Quality and cost Manufacturers are responsible for ensuring that supplements are safe and claims are truthful. Some companies may have their products independently tested by the U.S. Pharmacopeia(USP) or Consumer Labs (CL). Supplements that bear the USP or CL abbreviation meet voluntary industry standards for quality, purity, potency, and tablet disintegration or dissolution. Different types of calcium supplements have different costs. Comparison shop if cost is a factor for you.

Absorbability Your body must be able to absorb the calcium for it to be effective. All varieties of calcium supplements are better absorbed when taken in small doses (500 mg or less) at mealtimes. Calcium citrate is absorbed equally well when taken with or without food and is a form recommended for individuals with low stomach acid (more common in individuals 50 and older, or if taking stomach acid blockers), inflammatory bowel disease or absorption disorders.


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Calcium Do calcium supplements have risks? Calcium supplements aren't for everyone. For instance, if you have a health condition that causes excess calcium in your bloodstream (hypercalcemia), you should avoid calcium supplements. If you aren't sure if calcium supplements are appropriate for your situation, talk to your doctor. It's not definitive, but there may be a link between calcium supplements and heart disease. It's thought that the calcium in supplements could make its way into fatty plaques in your arteries, a condition called atherosclerosis, causing those plaques to harden and increasing your risk of heart attack. More research is needed before doctors know the effect calcium supplements may have on heart attack risk. There is similar controversy about calcium and prostate cancer. Some studies have shown that high calcium intake from dairy products and supplements may increase risk whereas another more recent study showed no increased risk of prostate cancer associated with total calcium, dietary calcium or supplemental calcium intakes. As with any health issue, it's important to talk to your doctor to determine what's right for you.


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Calcium More isn't always better: too much calcium has risks Dietary calcium is generally safe, but more isn't necessarily better, and excessive calcium doesn't provide extra bone protection. In fact, if the calcium in your diet and from supplements exceeds the tolerable upper limit, you could increase your risk of health problems, such as: kidney stones, prostate cancer, constipation, calcium buildup in your blood vessels and impaired absorption of iron and zinc If you take calcium supplements and eat calcium-fortified foods, you may be getting more calcium than you realize. Check food and supplement labels to monitor how much calcium you're getting a day and whether you're achieving the RDA but not exceeding the recommended upper limit.


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Vitamin D What is vitamin D and what does it do? Vitamin D is a nutrient found in some foods that is needed for health and to maintain strong bones. It does so by helping the body absorb calcium (one of bone's main building blocks) from food and supplements. People who get too little vitamin D may develop soft, thin and brittle bones, a condition known as rickets in children and osteomalacia in adults. Vitamin D is important to the body in many other ways as well. Muscles need it to move, for example, nerves need it to carry messages between the brain and every body part and the immune system needs vitamin D to fight off invading bacteria and viruses. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Vitamin D is found in cells throughout the body. How much vitamin D do I need? The amount of vitamin D you need each day depends on your age. Average daily recommended amounts from the Food and Nutrition Board for different ages are listed here in International Units (IU):


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Birth to 12 months 400 IU

Children 1–13 years 600 IU

Teens 14–18 years 600 IU

Adults 19–70 years 600 IU

Adults 71 years and older 800 IU

Pregnant and breastfeeding women 600 IU



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Vitamin D What foods provide vitamin D? Very few foods naturally have vitamin D. Fortified foods provide most of the vitamin D in American diets. Fatty fish such as salmon, tuna and mackerel are among the best sources. Beef liver, cheese and egg yolks provide small amounts. Mushrooms provide some vitamin D. In some mushrooms that are newly available in stores,

the vitamin D content is being boosted by exposing these mushrooms to ultraviolet light. Almost all of the U.S. milk supply is fortified with 400 IU of vitamin D per quart. But foods

made from milk, like cheese and ice cream, are usually not fortified. Vitamin D is added to many breakfast cereals and to some brands of orange juice, yogurt,

margarine and soy beverages; check the labels.




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Vitamin D Can I get vitamin D from the sun? The body makes vitamin D when skin is directly exposed to the sun and most people meet at least some of their vitamin D needs this way. Skin exposed to sunshine indoors through a window will not produce vitamin D. Cloudy days, shade and having dark-colored skin also cut down on the amount of vitamin D the skin makes. However, despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight in order to lower the risk for skin cancer. When out in the sun for more than a few minutes, wear protective clothing and apply sunscreen with an SPF (sun protection factor) of 8 or more. Tanning beds also cause the skin to make vitamin D, but pose similar risks for skin cancer.

People who avoid the sun or who cover their bodies with sunscreen or clothing should include good sources of vitamin D in their diets or take a supplement. Recommended intakes of vitamin D are set on the assumption of little sun exposure.




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Vitamin D What kinds of vitamin D dietary supplements are available? Vitamin D is found in supplements (and fortified foods) in two different forms: D2 (ergocalciferol) and D3(cholecalciferol). Both increase vitamin D in the blood. Am I getting enough vitamin D? Because vitamin D can come from sun, food and supplements, the best measure of one's vitamin D status is blood levels of a form known as 25-hydroxyvitamin D. Levels are described in either nanomoles per liter (nmol/L) or nanograms per milliliter (ng/mL), where 1 nmol/L = 0.4 ng/mL. In general, levels below 30 nmol/L (12 ng/mL) are too low for bone or overall health, and levels above 125 nmol/L (50 ng/mL) are probably too high. Levels of 50 nmol/L or above (20 ng/mL or above) are sufficient for most people. By these measures, some Americans are vitamin D deficient and almost no one has levels that are too high. In general, young people have higher blood levels of 25-hydroxyvitamin D than older people and males have higher levels than females. By race, non-Hispanic blacks tend to have the lowest levels and non-Hispanic whites the highest. The majority of Americans have blood levels lower than 75 nmol/L (30 ng/mL).




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Vitamin D Certain other groups may not get enough vitamin D: Breastfed infants, since human milk is a poor source of the nutrient. Breastfed infants should

be given a supplement of 400 IU of vitamin D each day. Older adults, since their skin doesn't make vitamin D when exposed to sunlight as efficiently

as when they were young and their kidneys are less able to convert vitamin D to its active form.

People with dark skin, because their skin has less ability to produce vitamin D from the sun. People with disorders such as Crohn's disease or celiac disease who don't handle fat

properly, because vitamin D needs fat to be absorbed. Obese people, because their body fat binds to some vitamin D and prevents it from getting

into the blood. What happens if I don't get enough vitamin D? People can become deficient in vitamin D because they don't consume or absorb enough from food, their exposure to sunlight is limited, or their kidneys cannot convert vitamin D to its active form in the body. In children, vitamin D deficiency causes rickets, where the bones become soft and bend. It's a rare disease but still occurs, especially among African American infants and children.




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Vitamin D What are some effects of vitamin D on health? Vitamin D is being studied for its possible connections to several diseases and medical problems, including diabetes, hypertension, and autoimmune conditions such as multiple sclerosis. Two of them discussed below are bone disorders and some types of cancer. Bone disorders

As they get older, millions of people (mostly women, but men too) develop, or are at risk of, osteoporosis, where bones become fragile and may fracture if one falls. It is one consequence of not getting enough calcium and vitamin D over the long term. Supplements of both vitamin D3 (at 700–800 IU/day) and calcium (500–1,200 mg/day) have been shown to reduce the risk of bone loss and fractures in elderly people aged 62–85 years. Men and women should talk with their health care providers about their needs for vitamin D (and calcium) as part of an overall plan to prevent or treat osteoporosis.

Cancer Some studies suggest that vitamin D may protect against colon cancer and perhaps even cancers of the prostate and breast. But higher levels of vitamin D in the blood have also been linked to higher rates of pancreatic cancer. At this time, it's too early to say whether low vitamin D status increases cancer risk and whether higher levels protect or even increase risk in some people.




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Vitamin D Can vitamin D be harmful? Yes, when amounts in the blood become too high, it can lead to toxicity. Signs of toxicity include nausea vomiting poor appetite constipation weakness weight loss By raising blood levels of calcium, too much vitamin D can cause confusion, disorientation and problems with heart rhythm. Excess vitamin D can also damage the kidneys. The safe upper limit for vitamin D is 1,000 to 1,500 IU/day for infants, 2,500 to 3,000 IU/day for children 1-8 years, and 4,000 IU/day for children 9 years and older, adults and pregnant and lactating teens and women. Vitamin D toxicity almost always occurs from overuse of supplements. Excessive sun exposure doesn't cause vitamin D poisoning because the body limits the amount of this vitamin it produces.




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Vitamin D Vitamins & Supplements

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Food IUs per serving Percent Daily Value

Cod liver oil, 1 tablespoon 1,360 340

Swordfish, cooked, 3 ounces 566 142

Salmon (sockeye), cooked, 3 ounces 447 112

Tuna fish, canned in water, drained, 3 ounces 154 39

Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies)

137 34

Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup 115-124 29-31

Yogurt, fortified with 20% of the daily value for vitamin D, 6 ounces (more heavily fortified yogurts provide more of the daily value)

80 20

Margarine, fortified, 1 tablespoon 60 15

Sardines, canned in oil, drained, 2 sardines 46 12

Liver, beef, cooked, 3 ounces 42 11

Egg, 1 large (vitamin D is found in yolk) 41 10

Ready-to-eat cereal, fortified with 10% of the daily value for vitamin D, 0.75-1 cup (more heavily fortified cereals might provide more of the daily value)

40 10

Cheese, Swiss, 1 ounce 6 2



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Vitamin D Getting the vitamin D your body needs: The two main ways to get vitamin D are by exposing your bare skin to sunlight and by taking vitamin D supplements. You can’t get the right amount of vitamin D your body needs from food. Exposing your body to sunlight: Your body is designed to get the vitamin D it needs by producing it when your bare skin is exposed to sunlight. The part of the sun’s rays that is important is ultraviolet B (UVB). This is the most natural way to get vitamin D. Large amounts of vitamin D3 (cholecalciferol) are made in your skin when you expose all of your body to summer sun. This happens very quickly; around half the time it takes for your skin to turn pink and begin to burn. This could be just 15 minutes for a very fair skinned person or a couple of hours or more for a dark skinned person.


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Vitamin D You don’t need to tan or to burn your skin in order to get the vitamin D you need. Exposing your skin for a short time will make all the vitamin D your body can produce in one day. In fact, your body can produce 10,000 to 25,000 IU of vitamin D in just a little under the time it takes for your skin to turn pink. You make the most vitamin D when you expose a large area of your skin, such as your back, rather than a small area such as your face or arms. There are a number of factors that affect how much vitamin D your body produces when your skin is exposed to sunlight. The amount of vitamin D you get from exposing your bare skin to the sun depends on: The time of day – more vitamin D is produced if your skin is exposed during the middle of the

day. Where you live – the closer to the equator you live, the easier it is for you to produce vitamin

D from sunlight all year round. The color of your skin – pale skins make vitamin D more quickly than darker skins. The amount of skin you expose – the more skin your expose the more vitamin D your body

will produce.




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Vitamin D Exposing your skin to UVB and risk of cancer: Exposing your skin to the sun for too long, so that your skin starts to burn can be dangerous. This is because it can increase your risk of developing skin cancers. Research to date shows that moderate but frequent sun exposure is healthy but overexposure and intense exposure can increase your risk of skin cancer. After you have exposed your skin for half the time it takes for you to turn pink, cover up with clothing and go into the shade. Using sunscreen is not as recommended as using shade and clothing to protect your skin, because it hasn’t consistently been shown to prevent all types of skin cancers. But if you do want to use sunscreen, use a sunscreen that blocks both UVA light and UVB light. Vitamin D supplements: In the 21st century, it’s hard to get daily full body sun exposure. On the days that you can’t get enough sun exposure, taking a supplement is an effective way to get the vitamin D your body needs. It‘s also a good way to get vitamin D if you’re worried about exposing your skin to the sun.




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Vitamin D How much vitamin D do I need to take? Different organizations recommend different daily intakes. Here are the recommendations from some organizations in the United States: The Food and Nutrition Board recommended daily intakes are the official recommendations by the United States government. Why are the recommendations so different? Some researchers believe that there isn’t enough evidence to support taking higher amounts of vitamin D yet. On the other hand, some researchers believe that research is proving, or will prove, that taking lower amounts isn’t enough.


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Recommended daily intakes from various organizations: Vitamin D Council Endocrine Society Food and Nutrition Board

Infants 1,000 IU/day 400-1,000 IU/day 400 IU/day

Children 1,000 IU/day per 25lbs of body weight 600-1,000 IU/day 600 IU/day

Adults 5,000 IU/day 1,500-2,000 IU/day 600 IU/day, 800 IU/day for seniors

Vitamin D Council


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Vitamin D Types and usage of vitamin D: The Vitamin D Council recommends taking vitamin D3 rather than vitamin D2. Vitamin D3 is the type of vitamin D your body produces in response to sun exposure, while vitamin D2 is not. In the United States, most over-the-counter vitamin D supplements are D3, but check to make sure. Vitamin D2 is sometimes prescribed by doctors because that is what pharmacies have available. If your doctor prescribes you D2, ask them if you can take vitamin D3 instead. Vitamin D3 supplements aren’t vegetarian and some part of the production in making them occur outside the United States. If you have ethical concerns with taking vitamin D3, then sun exposure is a good option and vitamin D2 can be an alternative. Other than that, it doesn’t matter what form of vitamin D you take, whether it’s in a capsule, tablet or liquid drop. For most people, vitamin D is easily absorbed in the body and you don’t need to worry about what time of day you take it or whether you take it with meals. Cod liver oil contains vitamin D. However, the Vitamin D Council recommends against it because it has a high amount of vitamin A. Vitamin A is also a fat-soluble vitamin, so your body has a hard time getting rid of it and too much vitamin A can be harmful.




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Vitamin D Can anyone take vitamin D supplements? Most people can take vitamin D supplements with no problems. However, care is needed in a few situations. These situations include: If you’re taking certain other medicines: digoxin for an irregular heartbeat (atrial fibrillation) or

thiazide diuretics such as hydrochlorothiazide or bendroflumethiazide (commonly used to treat high blood pressure). In this situation, don’t take high doses of vitamin D. You should also have your digoxin level monitored more closely if you’re taking vitamin D.

If you have one of these medical conditions: primary hyperparathyroidism, Hodgkin’s or non-Hodgkin’s lymphoma, a granulomatous disease, kidney stones, some types of kidney disease, liver disease or hormonal disease, you should get advice from a specialist.

Don’t take vitamin D if you have high blood calcium levels, unless under the care of your physician.

You may need more than the usual dose of vitamin D if you’re taking certain medicines which interfere with vitamin D. These include carbamazepine, phenytoin, primidone, barbiturates and some medicines used for the treatment of HIV infection.

-Source: Vitamin D Council




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Vitamin D Vitamin D and diet: There are small amounts of vitamin D in a few foods, which makes it nearly impossible to get what you need from food. However, these foods include: Fatty fish Beef liver Egg yolks Fortified milk and orange juice Fortified cereals Infant formula The Vitamin D Council believes that trying to get enough vitamin D from your diet is unlikely to give you the vitamin D you need.




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Vitamin E What is vitamin E and what does it do? Vitamin E is a fat-soluble nutrient found in many foods. In the body, it acts as an antioxidant, helping to protect cells from the damage caused by free radicals. Free radicals are compounds formed when our bodies convert the food we eat into energy. People are also exposed to free radicals in the environment from cigarette smoke, air pollution and ultraviolet light from the sun. The body also needs vitamin E to boost its immune system so that it can fight off invading bacteria and viruses. It helps to widen blood vessels and keep blood from clotting within them. In addition, cells use vitamin E to interact with each other and to carry out many important functions. How much vitamin E do I need? The amount of vitamin E you need each day depends on your age. Average daily recommended intakes are listed here in milligrams (mg) and in International Units (IU). Package labels list the amount of vitamin E in foods and dietary supplements in IU.


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Birth to 6 months 4 mg (6 IU)

Infants 7-12 months 5 mg (7.5 IU)

Children 1-3 years 6 mg (9 IU)

Children 4-8 years 7 mg (10.4 IU)

Children 9-13 years 11 mg (16.4 IU)

Teens 14-18 years 15 mg (22.4 IU)

Adults 15 mg (22.4 IU)

Pregnant teens and women 15 mg (22.4 IU)

Breastfeeding teens and women 19 mg (28.4 IU)



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Vitamin E What foods provide vitamin E? Vitamin E is found naturally in foods and is added to some fortified foods. You can get recommended amounts of vitamin E by eating a variety of foods including the following: Vegetable oils like wheat germ, sunflower and safflower oils. Corn and soybean oils also

provide some vitamin E. Nuts (such as peanuts, hazelnuts, and, especially, almonds) and seeds (like sunflower

seeds). Green vegetables, such as spinach and broccoli. Food companies add vitamin E to some breakfast cereals, fruit juices, margarines and spreads and other foods. To find out which ones have vitamin E, check the product labels.




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Vitamin E What kinds of vitamin E dietary supplements are available? Vitamin E supplements come in different amounts and forms. Two main things to consider when choosing a vitamin E supplement are: 1. The amount of vitamin E: Most once-daily multivitamin-mineral supplements provide about

30 IU of vitamin E, whereas vitamin E-only supplements usually contain 100 to 1,000 IU per pill. The doses in vitamin E-only supplements are much higher than the recommended amounts. Some people take large doses because they believe or hope that doing so will keep them healthy or lower their risk of certain diseases.

2. The form of vitamin E: Although vitamin E sounds like a single substance, it is actually the name of eight related compounds in food, including alpha-tocopherol. Each form has a different potency, or level of activity in the body.

Vitamin E from natural (food) sources is listed as "d-alpha-tocopherol" on food packaging and supplement labels. Synthetic (laboratory-made) vitamin E is listed as "dl-alpha-tocopherol." The natural form is more potent. For example, 100 IU of natural vitamin E is equal to about 150 IU of the synthetic form. Some vitamin E supplements provide other forms of the vitamin, such as gamma-tocopherol, tocotrienols, and mixed tocopherols. Scientists do not know if any of these forms are superior to alpha-tocopherol in supplements.




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Vitamin E Am I getting enough vitamin E? The diets of most Americans provide less than the recommended amounts of vitamin E. Nevertheless, healthy people rarely show any clear signs that they are not getting enough vitamin E (see next question for information on the signs of vitamin E deficiency). What happens if I don't get enough vitamin E? Vitamin E deficiency is very rare in healthy people. It is almost always linked to certain diseases where fat is not properly digested or absorbed. Examples include Crohn's disease, cystic fibrosis and certain rare genetic diseases such as abetalipoproteinemia and ataxia with vitamin E deficiency (AVED). Vitamin E needs some fat for the digestive system to absorb it. Vitamin E deficiency can cause nerve and muscle damage that results in loss of feeling in the arms and legs, loss of body movement control, muscle weakness, and vision problems. Another sign of deficiency is a weakened immune system.




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Vitamin E What are some effects of vitamin E on health? Scientists are studying vitamin E to understand how it affects health. Here are several examples of what this research has shown. Heart disease

Some studies link higher intakes of vitamin E from supplements to lower chances of developing heart disease. But the best research finds no benefit. People in these studies are randomly assigned to take vitamin E or a placebo and they don't know which they are taking. Vitamin E supplements do not seem to prevent heart disease, reduce its severity, or affect the risk of death from this disease. Scientists do not know whether high intakes of vitamin E might protect the heart in younger, healthier people who do not have a high risk of heart disease.

Eye disorders Age-Related Macular Degeneration (AMD), or the loss of central vision in older people, and cataracts are among the most common causes of vision loss in older people. The results of research on whether vitamin E can help prevent these conditions are inconsistent. Among people with early-stage AMD, a supplement containing large doses of vitamin E combined with other antioxidants, zinc and copper showed promise for slowing down the rate of vision loss.




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Vitamin E Cancer

Most research indicates that vitamin E does not help prevent cancer and may be harmful in some cases. Large doses of vitamin E have not consistently reduced the risk of colon and breast cancer in studies, for example. A large study found that taking vitamin E supplements (400 IU/day) for several years increased the risk of developing prostate cancer in men. Two studies that followed middle-aged men and women for 7 or more years found that extra vitamin E (300–400 IU/day, on average) did not protect them from any form of cancer. However, one study found a link between the use of vitamin E supplements for 10 years or more and a lower risk of death from bladder cancer. Vitamin E dietary supplements and other antioxidants might interact with chemotherapy and radiation therapy. People undergoing these treatments should talk with their doctor or oncologist before taking vitamin E or other antioxidant supplements, especially in high doses.

Mental function Several studies have investigated whether vitamin E supplements might help older adults remain mentally alert and active as well as prevent or slow the decline of mental function and Alzheimer's disease. So far, the research provides little evidence that taking vitamin E supplements can help healthy people or people with mild mental functioning problems to maintain brain health.




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Vitamin E Can vitamin E be harmful? Eating vitamin E in foods is not risky or harmful. In supplement form, high doses of vitamin E might increase the risk of bleeding (by reducing the blood's ability to form clots after a cut or injury) and of serious bleeding in the brain (known as hemorrhagic stroke). The highest safe level of intake from supplements for adults is 1,500 IU/day for natural forms of vitamin E and 1,100 IU/day for the synthetic form. The highest safe levels for children are lower than for adults. Some recent research suggests that intakes of vitamin E below these upper safe levels could increase the risk of prostate cancer in men. Vitamin E might also increase the risk of death in some adults with chronic health conditions, but this does not seem to be the case in healthy people. Recommended Dietary Allowances (RDAs) for Vitamin E


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Age Males Females Pregnancy Lactation

0–6 months* 4 mg (6 IU) 4 mg (6 IU)

7–12 months* 5 mg (7.5 IU) 5 mg (7.5 IU)

1–3 years 6 mg (9 IU) 6 mg (9 IU)

4–8 years 7 mg (10.4 IU) 7 mg (10.4 IU)

9–13 years 11 mg (16.4 IU) 11 mg (16.4 IU)

14+ years 15 mg (22.4 IU) 15 mg (22.4 IU) 15 mg (22.4 IU) 19 mg (28.4 IU)



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Vitamin E Food sources of vitamin E


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Food (mg) per serving Percent Daily Value

Wheat germ oil, 1 tablespoon 20.3 100 Sunflower seeds, dry roasted, 1 ounce 7.4 37 Almonds, dry roasted, 1 ounce 6.8 34 Sunflower oil, 1 tablespoon 5.6 28 Safflower oil, 1 tablespoon 4.6 25 Hazelnuts, dry roasted, 1 ounce 4.3 22 Peanut butter, 2 tablespoons 2.9 15 Peanuts, dry roasted, 1 ounce 2.2 11 Corn oil, 1 tablespoon 1.9 10 Spinach, boiled, ½ cup 1.9 10 Broccoli, chopped, boiled, ½ cup 1.2 6 Soybean oil, 1 tablespoon 1.1 6 Kiwifruit, 1 medium 1.1 6 Mango, sliced, ½ cup 0.7 4 Tomato, raw, 1 medium 0.7 4 Spinach, raw, 1 cup 0.6 3



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Folate What is folate and what does it do? Folate is a B-vitamin that is naturally present in many foods. A form of folate, called folic acid, is used in dietary supplements and fortified foods. Our bodies need folate to make DNA and other genetic material. Folate is also needed for the body's cells to divide. How much folate do I need? The amount of folate you need depends on your age. Average daily recommended amounts are listed below in micrograms (mcg) of dietary folate equivalents (DFEs). All women and teen girls who could become pregnant should consume 400 mcg of folic acid daily from supplements, fortified foods, or both in addition to the folate they get naturally from foods.


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Birth to 6 months 65 mcg DFE

Infants 7–12 months 80 mcg DFE

Children 1–3 years 150 mcg DFE



Teens 14–18 years 400 mcg DFE

Adults 19+ 400 mcg DFE

Pregnant teens and women 600 mcg DFE

Breastfeeding teens and women 500 mcg DFE



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Folate What foods provide folate? Folate is naturally present in many foods and food companies add folic acid to other foods, including bread, cereal and pasta. You can get recommended amounts by eating a variety of foods, including the following: Vegetables (especially asparagus, brussel sprouts and dark green leafy vegetables such as

spinach and mustard greens). Fruits and fruit juices (especially oranges and orange juice). Nuts, beans and peas (such as peanuts, black-eyed peas and kidney beans). Grains (including whole grains, fortified cold cereals, enriched flour products such as bread, bagels, cornmeal and pasta and rice). Folic acid is added to many grain-based products. To find out whether folic acid has been added to a food, check the product label. Beef liver is high in folate but is also high in cholesterol, so limit the amount you eat. Only small amounts of folate are found in other animal foods like meats, poultry, seafood, eggs and dairy products.




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Folate What kinds of folic acid dietary supplements are available? Folic acid is available in multivitamins and prenatal vitamins. It is also available in B-complex dietary supplements and supplements containing only folic acid. Am I getting enough folate? Most people in the United States get enough folate. However, certain groups of people are more likely than others to have trouble getting enough folate: Teen girls and women aged 14–30 years (especially before and during pregnancy). Non-Hispanic black women. People with disorders that lower nutrient absorption (such as celiac disease and inflammatory

bowel disease). People with alcoholism.




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Folate What happens if I don't get enough folate? Folate deficiency is rare in the United States, but some people get barely enough. Getting too little folate can result in megaloblastic anemia, which causes weakness, fatigue, trouble concentrating, irritability, headache, heart palpitations and shortness of breath. Folate deficiency can also cause open sores on the tongue and inside the mouth as well as changes in the color of the skin, hair or fingernails. Women who don't get enough folate are at risk of having babies with neural tube defects, such as spina bifida. Folate deficiency can also increase the likelihood of having a premature or low birth weight baby.




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Folate What are some effects of folate on health? Scientists are studying folate to understand how it affects health. Here are several examples of what this research has shown. Neural tube defects

Taking folic acid regularly before becoming pregnant and during early pregnancy helps prevent neural tube defects in babies. About half of all pregnancies are unplanned, therefore, all women and teen girls who could become pregnant should consume 400 mcg of folic acid daily from supplements, fortified foods or both in addition to the folate they get naturally from foods.

Since 1998, the U.S. Food and Drug Administration has required food companies to add folic acid to enriched bread, cereal, flour, cornmeal, pasta, rice and other grain products sold. Because most people in the United States eat these foods on a regular basis, folic acid intakes have increased and the number of babies born with neural tube defects has decreased since 1998.

Preterm birth, congenital heart defects and other birth defects Taking folic acid might reduce the risk of having a premature baby and prevent birth defects, such as congenital heart problems. But more research is needed to understand how folic acid affects the risk of these conditions.




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Folate Cancer

Folate that is found naturally in food may decrease the risk of several forms of cancer. But folate might have different effects depending on how much is taken and when. Modest amounts of folic acid taken before cancer develops might decrease cancer risk, but high doses taken after cancer (especially colorectal cancer) begins might speed up its progression. For this reason, high doses of folic acid supplements (more than the safe upper limit of 1,000 mcg) should be taken with caution, especially by people who have a history of colorectal adenomas (which sometimes turn into cancer). More research is needed to understand the roles of dietary folate and folic acid supplements in cancer risk.

Heart disease and stroke Some scientists used to think that folic acid and other B-vitamins might reduce heart disease risk by lowering levels of homocysteine, an amino acid in the blood. But although folic acid supplements do lower blood homocysteine levels, they don't decrease the risk of heart disease. Some studies have shown that a combination of folic acid with other B-vitamins, however, helps prevent stroke.




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Folate Dementia, cognitive function and Alzheimer's disease

Folic acid supplements with or without other B-vitamins do not seem to improve cognitive function, but more research on this topic is needed.

Depression People with low blood levels of folate might be more likely to suffer from depression and might not respond as well to treatment with antidepressants as people with normal folate levels. Folic acid supplements might make antidepressant medications more effective. But it is not clear whether these supplements help people with both normal folate levels and those with folate deficiency. More research is needed to learn about the role of folate in depression and whether folic acid supplements are helpful when used in combination with standard treatment.




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Folate Can folate be harmful? Folate that is naturally present in food is not harmful. Folic acid in supplements and fortified foods, however, should not be consumed in amounts above the safe upper limit, unless recommended by a health care provider. Taking large amounts of folic acid might hide a vitamin B12 deficiency. Folic acid can correct the anemia but not the nerve damage caused by vitamin B12 deficiency. This can lead to permanent damage of the brain, spinal cord and nerves. High doses of folic acid might also increase the risk of colorectal cancer and possibly other cancers in some people. The safe upper limits for folic acid are listed here.


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Ages Safe Upper Limit


Infants 7–12 months Not established

Children 1–3 years 300 mcg



Teens 14–18 years 800 mcg

Adults 1,000 mcg



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Folate


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Food mcg DFE per serving Percent Daily Value

Beef liver, braised, 3 ounces 215 54 Spinach, boiled, ½ cup 131 33 Black-eyed peas (cowpeas), boiled, ½ cup 105 26 Breakfast cereals, fortified with 25% of the daily value 100 25 Rice, white, medium-grain, cooked, ½ cup 90 23 Asparagus, boiled, 4 spears 89 22 Spaghetti, cooked, enriched, ½ cup 83 21 Brussels sprouts, frozen, boiled, ½ cup 78 20 Lettuce, romaine, shredded, 1 cup 64 16 Avocado, raw, sliced, ½ cup 59 15 Spinach, raw, 1 cup 58 15 Broccoli, chopped, frozen, cooked, ½ cup 52 13 Mustard greens, chopped, frozen, boiled, ½ cup 52 13 Green peas, frozen, boiled, ½ cup 47 12 Kidney beans, canned, ½ cup 46 12



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Folate


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Food mcg DFE per serving Percent Daily Value

Bread, white, 1 slice 43 11 Peanuts, dry roasted, 1 ounce 41 10 Wheat germ, 2 tablespoons 40 10 Tomato juice, canned, ¾ cup 36 9 Crab, Dungeness, 3 ounces 36 9 Orange juice, ¾ cup 35 9 Turnip greens, frozen, boiled, ½ cup 32 8 Orange, fresh, 1 small 29 7 Papaya, raw, cubed, ½ cup 27 7 Banana, 1 medium 24 6 Yeast, baker’s, ¼ teaspoon 23 6 Egg, whole, hard-boiled, 1 large 22 6 Vegetarian baked beans, canned, ½ cup 15 4 Cantaloupe, raw, 1 wedge 14 4 Fish, halibut, cooked, 3 ounces 12 3 Milk, 1% fat, 1 cup 12 3 Ground beef, 85% lean, cooked, 3 ounces 7 2 Chicken breast, roasted, ½ breast 3 1



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Iodine What is iodine and what does it do? Iodine is a mineral found in some foods. The body needs iodine to make thyroid hormones. These hormones control the body's metabolism and many other important functions. The body also needs thyroid hormones for proper bone and brain development during pregnancy and infancy. Getting enough iodine is important for everyone, especially infants and women who are pregnant. How much iodine do I need? The amount of iodine you need each day depends on your age. Average daily recommended amounts are listed here in micrograms (mcg).


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Birth to 6 months 110 mcg

Infants 7–12 months 130 mcg



Teens 14–18 years 150 mcg

Adults 150 mcg

Pregnant teens and women 220 mcg

Breastfeeding teens and women 290 mcg



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Iodine What foods provide iodine? Iodine is found naturally in some foods and is also added to salt that is labeled as "iodized". You can get recommended amounts of iodine by eating a variety of foods, including the following:

Fish (such as cod and tuna), seaweed, shrimp and other seafood. Dairy products (such as milk, yogurt and cheese) and products made from grains (like

breads and cereals). Fruits and vegetables, which contain iodine, although the amount depends on the iodine

in the soil where they grew and in any fertilizer that was used. Iodized salt. Processed foods, however, such as canned soups, almost never contain

iodized salt.

What kinds of iodine dietary supplements are available? Iodine is available in dietary supplements, usually in the form of potassium iodide or sodium iodide. Many multivitamin-mineral supplements contain iodine. Dietary supplements of iodine containing kelp (a seaweed) are also available.




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Iodine Am I getting enough iodine? Most people in the United States get enough iodine from foods and beverages. However, certain groups of people are more likely than others to have trouble getting enough iodine: People who do not use iodized salt. Adding iodine to salt is the most widely used strategy to

control iodine deficiency. Currently, about 70% of households worldwide use iodized salt. Pregnant women. Women who are pregnant need about 50% more iodine than other women

to provide enough iodine for their baby. Surveys show that many pregnant women in the United States may not get quite enough iodine, although experts do not know whether this affects their babies.

People living in regions with iodine-deficient soils who eat mostly local foods. These soils produce crops that have low iodine levels. Among the regions with the most iodine-poor soil are mountainous areas, such as the Himalayas, the Alps, and the Andes regions, as well as river valleys in South and Southeast Asia.

People who get marginal amounts of iodine and who also eat foods containing goitrogens. Goitrogens are substances that interfere with the way the body uses iodine. They are present in some plant foods including soy and cruciferous vegetables such as cabbage, broccoli, cauliflower and brussel sprouts.




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Iodine What happens if I don't get enough iodine? Iodine deficiency is uncommon in the United States and Canada. People who don't get enough iodine cannot make sufficient amounts of thyroid hormone. This can cause many problems. In pregnant women, severe iodine deficiency can permanently harm the fetus by causing stunted growth, mental retardation and delayed sexual development. Less severe iodine deficiency can cause lower-than-average IQ in infants and children and decrease adults' ability to work and think clearly. Goiter, an enlarged thyroid gland, is often the first visible sign of iodine deficiency. What are some effects of iodine on health? Scientists are studying iodine to understand how it affects health. Here are some examples of what this research has shown. Fetal and infant development

Women who are pregnant or breastfeeding need to get enough iodine for their babies to grow and develop properly. Breastfed infants get iodine from breast milk. However, the iodine content of breast milk depends on how much iodine the mother gets. To make adequate amounts of iodine available for proper fetal and infant development, several national and international groups recommend that pregnant and breastfeeding women and infants take iodine supplements.




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Iodine Cognitive function during childhood

Severe iodine deficiency during childhood has harmful effects on the development of the brain and nervous system. The effects of mild iodine deficiency during childhood are more difficult to measure, but mild iodine deficiency might cause subtle problems with neurological development. Giving iodine supplements to children with mild iodine deficiency improves their reasoning abilities and overall cognitive function. In children living in iodine-deficient areas, iodine supplements seem to improve both physical and mental development. More study is needed to fully understand the effects of mild iodine deficiency and of iodine supplements on cognitive function.

Fibrocystic breast disease Although not harmful, fibrocystic breast disease causes lumpy, painful breasts. It mainly affects women of reproductive age but can also occur during menopause. Very high doses of iodine supplements might reduce the pain and other symptoms of fibrocystic breast disease, but more study is necessary to confirm this. Check with your health care provider before taking iodine for this condition, especially because iodine can be unsafe at high doses.




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Iodine Radiation-induced thyroid cancer

Nuclear accidents can release radioactive iodine into the environment, increasing the risk of thyroid cancer in people who are exposed to the radioactive iodine, especially children. People with iodine deficiency who are exposed to radioactive iodine are especially at risk of developing thyroid cancer. The U.S. Food and Drug Administration has approved potassium iodide as a thyroid-blocking agent to reduce the risk of thyroid cancer in radiation emergencies.

Are there any interactions with iodine that I should know about? Yes, they can interact or interfere with medicines that you take. Here are several examples: Iodine supplements might interact with anti-thyroid medications such as methimazole

(Tapazole®). Taking high doses of iodine with anti-thyroid medications could cause your body to produce too little thyroid hormone.

Taking potassium iodide with medicines for high blood pressure (ACE inhibitors including benazepril (Lotensin®), lisinopril (Prinivil® and Zestril®) and fosinopril (Monopril®) could raise the amount of potassium in your blood to an unsafe level.

The amount of potassium in your blood can also get too high if you take potassium iodide with potassium-sparing diuretics such as spironolactone (Aldactone®) and amiloride (Midamor®).




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Iodine Can iodine be harmful? Yes, if you get too much. Getting high levels of iodine can cause some of the same symptoms as iodine deficiency, including goiter (an enlarged thyroid gland). High iodine intakes can also cause thyroid gland inflammation and thyroid cancer. Getting a very large dose of iodine (several grams, for example) can cause burning of the mouth, throat, and stomach, fever, stomach pain, nausea, vomiting, diarrhea, weak pulse and coma. The safe upper limits for iodine are listed here. These levels do not apply to people who are taking iodine for medical reasons under the care of a doctor.


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Birth to 12 months: Not established

Children 1–3 years: 200 mcg



Teens 14–18 years: 900 mcg

Adults: 1,100 mcg



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Iodine Vitamins & Supplements

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Food Approximate Micrograms (mcg) per serving Percent Daily Value

Seaweed, whole or sheet, 1 g 16 to 2,984 11% to 1,989% Cod, baked, 3 ounces 99 66% Yogurt, plain, low-fat, 1 cup 75 50% Iodized salt, 1.5 g (approx. 1/4 teaspoon) 71 47%

Milk, reduced fat, 1 cup 56 37% Fish sticks, 3 ounces 54 36% Bread, white, enriched, 2 slices 45 30% Fruit cocktail in heavy syrup, canned, 1/2 cup 42 28%

Shrimp, 3 ounces 35 23% Ice cream, chocolate, 1/2 cup 30 20% Macaroni, enriched, boiled, 1 cup 27 18%



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Iodine Vitamins & Supplements

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Food Approximate Micrograms (mcg) per serving Percent Daily Value

Egg, 1 large 24 16% Tuna, canned in oil, drained, 3 ounces 17 11%

Corn, cream style, canned, 1/2 cup 14 9% Prunes, dried, 5 prunes 13 9% Cheese, cheddar, 1 ounce 12 8% Raisin bran cereal, 1 cup 11 7% Lima beans, mature, boiled, 1/2 cup 8 5% Apple juice, 1 cup 7 5% Green peas, frozen, boiled, 1/2 cup 3 2% Banana, 1 medium 3 2%



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Iron Iron: what is it? Iron, one of the most abundant metals on Earth, is essential to most life forms and to normal human physiology. Iron is an integral part of many proteins and enzymes that maintain good health. In humans, iron is an essential component of proteins involved in oxygen transport. It is also essential for the regulation of cell growth and differentiation. A deficiency of iron limits oxygen delivery to cells, resulting in fatigue, poor work performance and decreased immunity. On the other hand, excess amounts of iron can result in toxicity and even death. Almost two-thirds of iron in the body is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues. Smaller amounts of iron are found in myoglobin, a protein that helps supply oxygen to muscle, and in enzymes that assist biochemical reactions. Iron is also found in proteins that store iron for future needs and that transport iron in blood. Iron stores are regulated by intestinal iron absorption.




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Iron Vitamins & Supplements

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What foods provide iron? There are two forms of dietary iron: heme and nonheme. Heme iron is derived from hemoglobin, the protein in red blood cells that delivers oxygen to cells. Heme iron is found in animal foods that originally contained hemoglobin, such as red meats, fish and poultry. Iron in plant foods such as lentils and beans is arranged in a chemical structure called nonheme iron. This is the form of iron added to iron-enriched and iron-fortified foods. Heme iron is absorbed better than nonheme iron, but most dietary iron is nonheme iron.



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Iron Vitamins & Supplements

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Food mg per serving

% Daily Value

Chicken liver, pan-fried, 3 ounces 11.0 61

Oysters, canned, 3 ounces 5.7 32

Beef liver, pan-fried, 3 ounces 5.2 29

Beef, chuck, blade roast, lean only, braised, 3 ounces 3.1 17

Turkey, dark meat, roasted, 3 ounces 2.0 11

Beef, ground, 85% lean, patty, broiled, 3 ounces 2.2 12

Beef, top sirloin, steak, lean only, broiled, 3 ounces 1.6 9

Tuna, light, canned in water, 3 ounces 1.3 7

Turkey, light meat, roasted, 3 ounces 1.1 6

Chicken, dark meat, meat only, roasted, 3 ounces 1.1 6

Chicken, light meat, meat only, roasted, 3 ounces 0.9 5

Tuna, fresh, yellow fin, cooked, dry heat, 3 ounces 0.8 4

Crab, Alaskan king, cooked, moist heat, 3 ounces 0.7 4

Pork, loin chop, broiled, 3 ounces 0.7 4

Shrimp, mixed species, cooked, moist heat, 4 large 0.3 2

Halibut, cooked, dry heat, 3 ounces 0.2 1

Sources of heme iron: Sources of nonheme iron:

Food mg per serving

% Daily Value

Ready-to-eat cereal, 100% iron fortified, ¾ cup 18.0 100

Oatmeal, instant, fortified, prepared with water, 1 packet 11.0 61

Soybeans, mature, boiled, 1 cup 8.8 48

Lentils, boiled, 1 cup 6.6 37

Beans, kidney, mature, boiled, 1 cup 5.2 29

Beans, lima, large, mature, boiled, 1 cup 4.5 25

Ready-to-eat cereal, 25% iron fortified, ¾ cup 4.5 25

Blackeye peas, (cowpeas), mature, boiled, 1 cup 4.3 24

Beans, navy, mature, boiled, 1 cup 4.3 24

Beans, black, mature, boiled, 1 cup 3.6 20

Beans, pinto, mature, boiled, 1 cup 3.6 21

Tofu, raw, firm, ½ cup 3.4 19

Spinach, fresh, boiled, drained, ½ cup 3.2 18

Spinach, canned, drained solids ½ cup 2.5 14

Spinach, frozen, chopped or leaf, boiled ½ cup 1.9 11

Raisins, seedless, packed, ½ cup 1.6 9

Grits, white, enriched, quick, prepared with water, 1 cup 1.5 8

Molasses, 1 tablespoon 0.9 5

Bread, white, commercially prepared, 1 slice 0.9 5

Bread, whole-wheat, commercially prepared, 1 slice 0.7 4



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Iron What affects iron absorption? Iron absorption refers to the amount of dietary iron that the body obtains and uses from food. Healthy adults absorb about 10% to 15% of dietary iron, but individual absorption is influenced by several factors. Storage levels of iron have the greatest influence on iron absorption. Iron absorption increases when body stores are low. When iron stores are high, absorption decreases to help protect against toxic effects of iron overload. Iron absorption is also influenced by the type of dietary iron consumed. Absorption of heme iron from meat proteins is efficient. Absorption of heme iron ranges from 15% to 35%, and is not significantly affected by diet. In contrast, 2% to 20% of nonheme iron in plant foods such as rice, maize, black beans, soybeans and wheat is absorbed. Nonheme iron absorption is significantly influenced by various food components. Meat proteins and vitamin C will improve the absorption of nonheme iron. Tannins (found in tea), calcium, polyphenols and phytates (found in legumes and whole grains) can decrease absorption of nonheme iron. Some proteins found in soybeans also inhibit nonheme iron absorption. It is most important to include foods that enhance nonheme iron absorption when daily iron intake is less than recommended, when iron losses are high (which may occur with heavy menstrual losses), when iron requirements are high (as in pregnancy) and when only vegetarian nonheme sources of iron are consumed.




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Iron What is the recommended intake for iron? Recommendations for iron are provided in the Dietary Reference Intakes (DRIs) developed by the Institute of Medicine of the National Academy of Sciences. Dietary Reference Intakes is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people. Three important types of reference values included in the DRIs are Recommended Dietary Allowances (RDA), Adequate Intakes (AI) and Tolerable Upper Intake Levels (UL). The RDA recommends the average daily intake that is sufficient to meet the nutrient requirements of nearly all (97–98%) healthy individuals in each age and gender group. An AI is set when there is insufficient scientific data available to establish a RDA. AIs meet or exceed the amount needed to maintain a nutritional state of adequacy in nearly all members of a specific age and gender group. The UL, on the other hand, is the maximum daily intake unlikely to result in adverse health effects.




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Iron

When can iron deficiency occur? The World Health Organization considers iron deficiency the number one nutritional disorder in the world. As many as 80% of the world's population may be iron deficient, while 30% may have iron deficiency anemia. Iron deficiency develops gradually and usually begins with a negative iron balance, when iron intake does not meet the daily need for dietary iron. This negative balance initially depletes the storage form of iron while the blood hemoglobin level, a marker of iron status, remains normal. Iron deficiency anemia is an advanced stage of iron depletion. It occurs when storage sites of iron are deficient and blood levels of iron cannot meet daily needs. Blood hemoglobin levels are below normal with iron deficiency anemia.


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Recommended Dietary Allowances for Iron for Infants (7 to 12 months), Children and Adults

Age Males (mg/day) Females (mg/day) Pregnancy (mg/day) Lactation (mg/day)

7 to 12 months 11 11 N/A N/A

1 to 3 years 7 7 N/A N/A



14 to 18 years 11 15 27 10

19 to 50 years 8 18 27 9

51+ years 8 8 N/A N/A



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Iron Iron deficiency anemia can be associated with low dietary intake of iron, inadequate absorption of iron or excessive blood loss. Women of childbearing age, pregnant women, preterm and low birth weight infants, older infants and toddlers and teenage girls are at greatest risk of developing iron deficiency anemia because they have the greatest need for iron. Women with heavy menstrual losses can lose a significant amount of iron and are at considerable risk for iron deficiency. Adult men and post-menopausal women lose very little iron and have a low risk of iron deficiency. Individuals with kidney failure, especially those being treated with dialysis, are at high risk for developing iron deficiency anemia. This is because their kidneys cannot create enough erythropoietin, a hormone needed to make red blood cells. Both iron and erythropoietin can be lost during kidney dialysis. Individuals who receive routine dialysis treatments usually need extra iron and synthetic erythropoietin to prevent iron deficiency. Vitamin A helps mobilize iron from its storage sites, so a deficiency of vitamin A limits the body's ability to use stored iron. This results in an apparent iron deficiency because hemoglobin levels are low even though the body can maintain normal amounts of stored iron. While uncommon in the U.S., this problem is seen in developing countries where vitamin A deficiency often occurs.




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Iron Chronic malabsorption can contribute to iron depletion and deficiency by limiting dietary iron absorption or by contributing to intestinal blood loss. Most iron is absorbed in the small intestines. Gastrointestinal disorders that result in inflammation of the small intestine may result in diarrhea, poor absorption of dietary iron and iron depletion. Signs of iron deficiency anemia include:

feeling tired and weak decreased work and school performance slow cognitive and social development during childhood difficulty maintaining body temperature decreased immune function, which increases susceptibility to infection glossitis (an inflamed tongue)




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Iron Eating nonnutritive substances such as dirt and clay, often referred to as pica or geophagia, is sometimes seen in persons with iron deficiency. There is disagreement about the cause of this association. Some researchers believe that these eating abnormalities may result in an iron deficiency. Other researchers believe that iron deficiency may somehow increase the likelihood of these eating problems. People with chronic infectious, inflammatory or malignant disorders such as arthritis and cancer may become anemic. However, the anemia that occurs with inflammatory disorders differs from iron deficiency anemia and may not respond to iron supplements. Research suggests that inflammation may over-activate a protein involved in iron metabolism. This protein may inhibit iron absorption and reduce the amount of iron circulating in blood, resulting in anemia.




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Iron Who may need extra iron to prevent a deficiency? Three groups of people are most likely to benefit from iron supplements: people with a greater need for iron, individuals who tend to lose more iron and people who do not absorb iron normally. These individuals include:

pregnant women preterm and low birth weight infants older infants and toddlers teenage girls women of childbearing age, especially those with heavy menstrual losses people with renal failure, especially those undergoing routine dialysis people with gastrointestinal disorders who do not absorb iron normally

Celiac Disease and Crohn's Syndrome are associated with gastrointestinal malabsorption and may impair iron absorption. Iron supplementation may be needed if these conditions result in iron deficiency anemia. Women taking oral contraceptives may experience less bleeding during their periods and have a lower risk of developing an iron deficiency. Women who use an intrauterine device (IUD) to prevent pregnancy may experience more bleeding and have a greater risk of developing an iron deficiency. If laboratory tests indicate iron deficiency anemia, iron supplements may be recommended.




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Iron Total dietary iron intake in vegetarian diets may meet recommended levels; however that iron is less available for absorption than in diets that include meat. Vegetarians who exclude all animal products from their diet may need almost twice as much dietary iron each day as non-vegetarians because of the lower intestinal absorption of nonheme iron in plant foods. Vegetarians should consider consuming nonheme iron sources together with a good source of vitamin C, such as citrus fruits, to improve the absorption of nonheme iron. There are many causes of anemia, including iron deficiency. There are also several potential causes of iron deficiency. After a thorough evaluation, physicians can diagnose the cause of anemia and prescribe the appropriate treatment.




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Iron Does pregnancy increase the need for iron? Nutrient requirements increase during pregnancy to support fetal growth and maternal health. Iron requirements of pregnant women are approximately double that of non-pregnant women because of increased blood volume during pregnancy, increased needs of the fetus and blood losses that occur during delivery. If iron intake does not meet increased requirements, iron deficiency anemia can occur. Iron deficiency anemia of pregnancy is responsible for significant morbidity, such as premature deliveries and giving birth to infants with low birth weight. Low levels of hemoglobin and hematocrit may indicate iron deficiency. Hemoglobin is the protein in red blood cells that carries oxygen to tissues. Hematocrit is the proportion of whole blood that is made up of red blood cells. Nutritionists estimate that over half of pregnant women in the world may have hemoglobin levels consistent with iron deficiency. In the U.S., the Centers for Disease Control (CDC) estimated that 12% of all women age 12 to 49 years were iron deficient in 1999–2000. When broken down by groups, 10% of non-Hispanic white women, 22% of Mexican-American women and 19% of non-Hispanic black women were iron deficient. Prevalence of iron deficiency anemia among lower income pregnant women has remained the same, at about 30%, since the 1980s.




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Iron The RDA for iron for pregnant women increases to 27 mg per day. Unfortunately, data from the 1988–94 NHANES survey suggested that the median iron intake among pregnant women was approximately 15 mg per day. When median iron intake is less than the RDA, more than half of the group consumes less iron than is recommended each day. Several major health organizations recommend iron supplementation during pregnancy to help pregnant women meet their iron requirements. The CDC recommends routine low-dose iron supplementation (30 mg/day) for all pregnant women, beginning at the first prenatal visit. When a low hemoglobin or hematocrit is confirmed by repeat testing, the CDC recommends larger doses of supplemental iron. The Institute of Medicine of the National Academy of Sciences also supports iron supplementation during pregnancy. Obstetricians often monitor the need for iron supplementation during pregnancy and provide individualized recommendations to pregnant women.




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Vitamin K Vitamin K is a vitamin found in leafy green vegetables, broccoli, and brussel sprouts. The name vitamin K comes from the German word “Koagulationsvitamin.” Several forms of vitamin K are used around the world as medicine. But in the U.S., the only form available is vitamin K1 (phytonadione). Vitamin K1 is generally the preferred form of vitamin K because it is less toxic, works faster, is stronger, and works better for certain conditions. In the body, vitamin K plays a major role in blood clotting. It is used to reverse the effects of blood thinning medications when too much is given; to prevent clotting problems in newborns who don’t have enough vitamin K; and to treat bleeding caused by medications including salicylates, sulfonamides, quinine, quinidine or antibiotics. Vitamin K is also given to treat and prevent vitamin K deficiency. It is also used to prevent and treat weak bones (osteoporosis) and relieve itching that often accompanies a liver disease called biliary cirrhosis. People apply vitamin K to the skin to remove spider veins, bruises, scars, stretch marks and burns. It is also used topically to treat rosacea, a skin condition that causes redness and pimples on the face. After surgery, vitamin K is used to speed up skin healing and reduce bruising and swelling.


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Vitamin K Healthcare providers also give vitamin K by injection to treat clotting problems. An increased understanding of the role of vitamin K in the body beyond blood clotting led some researchers to suggest that the recommended amounts for dietary intake of vitamin K be increased. In 2001, the National Institute of Medicine Food and Nutrition Board increased their recommended amounts of vitamin K slightly, but refused to make larger increases. They explained there wasn’t enough scientific evidence to make larger increases in the recommended amount of vitamin K. Vitamin K is effective for: Treating and preventing vitamin K deficiency. Preventing certain bleeding or blood clotting problems. Reversing the effects of too much warfarin used to prevent blood clotting.


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Vitamin K Insufficient evidence for: More evidence is needed to rate vitamin K for these uses. Weak bones (osteoporosis) So far, research results on the effects of vitamin K on bone

strength and fracture risk in people with osteoporosis don’t agree. Cystic fibrosis Heart disease High cholesterol Spider veins Bruises Scars Stretch marks Burns Swelling Other conditions


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Vitamin K Safety: Vitamin K is safe for most people. Most people do not experience any side effects when taking in the recommended amount each day. Special Precautions & Warnings: Pregnancy and breast-feeding: When taken in the recommended amount each day, vitamin K

is considered safe for pregnant and breast-feeding women, but don't use higher amounts without the advice of your healthcare professional.

Kidney disease: Too much vitamin K can be harmful if you are receiving dialysis treatments due to kidney disease.

Liver disease: Vitamin K is not effective for treating clotting problems caused by severe liver disease. In fact, high doses of vitamin K can make clotting problems worse in these people.

Interactions: Warfarin (Coumadin) interacts with VITAMIN K. Vitamin K is used by the body to help blood clot. Warfarin is used to slow blood clotting. By helping the blood clot, vitamin K might decrease the effectiveness of warfarin. Be sure to have your blood checked regularly. The dose of your warfarin might need to be changed.


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Vitamin K Dosage: The following doses have been studied in scientific research: By mouth: For bleeding disorders such as hypoprothrombinemia: 2.5-25 mg of vitamin K1 (phytonadione). For counteracting bleeding that can occur when too much of the anticoagulant warfarin is given: 1-5 mg of vitamin K is typically used; however, the exact dose needed is determined by a lab test called the INR. There isn't enough scientific information to determine recommended dietary allowances (RDAs) for vitamin K, so daily adequate intake (AI) recommendations have been formed instead: The AIs are: infants 0-6 months, 2 mcg; infants 6-12 months, 2.5 mcg; children 1-3 years, 30 mcg; children 4-8 years, 55 mcg; children 9-13 years, 60 mcg; adolescents 14-18 years (including those who are pregnant or breast-feeding), 75 mcg; men over 19 years, 120 mcg; women over 19 years (including those who are pregnant and breast-feeding), 90 mcg.


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Magnesium Magnesium, an abundant mineral in the body, is naturally present in many foods, added to other food products, available as a dietary supplement and present in some medicines (such as antacids and laxatives). Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control and blood pressure regulation. Magnesium is required for energy production, oxidative phosphorylation and glycolysis. It contributes to the structural development of bone and is required for the synthesis of DNA, RNA and the antioxidant glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction and normal heart rhythm. An adult body contains approximately 25g magnesium, with 50% to 60% present in the bones and most of the rest in soft tissues. Less than 1% of total magnesium is in blood serum, and these levels are kept under tight control. Normal serum magnesium concentrations range between 0.75 and 0.95 millimoles (mmol)/L. Hypomagnesemia is defined as a serum magnesium level less than 0.75 mmol/L. Magnesium homeostasis is largely controlled by the kidney, which typically excretes about 120 mg magnesium into the urine each day. Urinary excretion is reduced when magnesium status is low.




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Magnesium Assessing magnesium status is difficult because most magnesium is inside cells or in bone. The most commonly used and readily available method for assessing magnesium status is measurement of serum magnesium concentration, even though serum levels have little correlation with total body magnesium levels or concentrations in specific tissues. Other methods for assessing magnesium status include measuring magnesium concentrations in erythrocytes, saliva, and urine; measuring ionized magnesium concentrations in blood, plasma, or serum; and conducting a magnesium-loading (or "tolerance") test. No single method is considered satisfactory. Some experts but not others consider the tolerance test (in which urinary magnesium is measured after parenteral infusion of a dose of magnesium) to be the best method to assess magnesium status in adults. To comprehensively evaluate magnesium status, both laboratory tests and a clinical assessment might be required.




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Magnesium Recommended Dietary Allowances for Magnesium:


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Age Male Female Pregnancy Lactation

Birth to 6 months 30 mg* 30 mg*

7–12 months 75 mg* 75 mg*

1–3 years 80 mg 80 mg

4–8 years 130 mg 130 mg

9–13 years 240 mg 240 mg

14–18 years 410 mg 360 mg 400 mg 360 mg

19–30 years 400 mg 310 mg 350 mg 310 mg

31–50+ years 420 mg 320 mg 360 mg 320 mg



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Magnesium Sources of magnesium: Food Magnesium is widely distributed in plant and animal foods and in beverages. Green leafy vegetables, such as spinach, legumes, nuts, seeds and whole grains, are good sources. In general, foods containing dietary fiber provide magnesium. Magnesium is also added to some breakfast cereals and other fortified foods. Some types of food processing, such as refining grains in ways that remove the nutrient-rich germ and bran, lower magnesium content substantially. Tap, mineral, and bottled waters can also be sources of magnesium, but the amount of magnesium in water varies by source and brand (ranging from 1 mg/L to more than 120 mg/L). Approximately 30% to 40% of the dietary magnesium consumed is typically absorbed by the body.




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Magnesium Vitamins & Supplements

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Percent Daily Value

Almonds, dry roasted, 1 ounce 80 20 Spinach, boiled, ½ cup 78 20 Cashews, dry roasted, 1 ounce 74 19 Peanuts, oil roasted, ¼ cup 63 16 Cereal, shredded wheat, 2 large biscuits 61 15 Soymilk, plain or vanilla, 1 cup 61 15 Black beans, cooked, ½ cup 60 15 Edamame, shelled, cooked, ½ cup 50 13 Peanut butter, smooth, 2 tablespoons 49 12 Bread, whole wheat, 2 slices 46 12 Avocado, cubed, 1 cup 44 15 Potato, baked with skin, 3.5 ounces 43 11 Rice, brown, cooked, ½ cup 42 11 Yogurt, plain, low fat, 8 ounces 42 11 Breakfast cereals, fortified with 10% of the Daily Value for magnesium 40 10



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Magnesium Vitamins & Supplements

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Percent Daily Value

Oatmeal, instant, 1 packet 36 9 Kidney beans, canned, ½ cup 35 9 Banana, 1 medium 32 8 Salmon, Atlantic, farmed, cooked, 3 ounces 26 7 Milk, 1 cup 24–27 6–7 Halibut, cooked, 3 ounces 24 6 Raisins, ½ cup 23 6 Chicken breast, roasted, 3 ounces 22 6 Beef, ground, 90% lean, pan broiled, 3 ounces 20 5 Broccoli, chopped and cooked, ½ cup 12 3 Rice, white, cooked, ½ cup 10 3 Apple, 1 medium 9 2 Carrot, raw, 1 medium 7 2



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Magnesium Sources of magnesium: Dietary supplements

Magnesium supplements are available in a variety of forms, including magnesium oxide, citrate and chloride. The Supplement Facts panel on a dietary supplement label declares the amount of elemental magnesium in the product, not the weight of the entire magnesium-containing compound. Absorption of magnesium from different kinds of magnesium supplements varies. Forms of magnesium that dissolve well in liquid are more completely absorbed in the gut than less soluble forms. Small studies have found that magnesium in the aspartate, citrate, lactate and chloride forms is absorbed more completely and is more bioavailable than magnesium oxide and magnesium sulfate. One study found that very high doses of zinc from supplements (142 mg/day) can interfere with magnesium absorption and disrupt the magnesium balance in the body.

Medicines Magnesium is a primary ingredient in some laxatives. Phillips' Milk of Magnesia®, for example, provides 500 mg elemental magnesium (as magnesium hydroxide) per tablespoon. Magnesium is also included in some remedies for heartburn and upset stomach due to acid indigestion. Extra-strength Rolaids®, for example, provides 55 mg elemental magnesium (as magnesium hydroxide) per tablet, although Tums® is magnesium free.




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Magnesium Magnesium intakes and status: Dietary surveys of people in the United States consistently show that intakes of magnesium are lower than recommended amounts. An analysis of data from the National Health and Nutrition Examination Survey (NHANES) of 2005–2006 found that a majority of Americans of all ages ingest less magnesium from food than their respective EARs; adult men aged 71 years and older and adolescent females are most likely to have low intakes. In a study using data from NHANES 2003–2006 to assess mineral intakes among adults, average intakes of magnesium from food alone were higher among users of dietary supplements (350 mg for men and 267 mg for women, equal to or slightly exceeding their respective EARs) than among nonusers (268 mg for men and 234 for women). When supplements were included, average total intakes of magnesium were 449 mg for men and 387 mg for women, well above EAR levels.




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Magnesium Magnesium deficiency: Symptomatic magnesium deficiency due to low dietary intake in otherwise-healthy people is uncommon because the kidneys limit urinary excretion of this mineral. However, habitually low intakes or excessive losses of magnesium due to certain health conditions, chronic alcoholism and/or the use of certain medications can lead to magnesium deficiency. Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms and coronary spasms can occur. Severe magnesium deficiency can result in hypocalcemia or hypokalemia (low serum calcium or potassium levels, respectively) because mineral homeostasis is disrupted. Groups at risk of magnesium inadequacy: Magnesium inadequacy can occur when intakes fall below the RDA but are above the amount required to prevent overt deficiency. The following groups are more likely than others to be at risk of magnesium inadequacy because they typically consume insufficient amounts or they have medical conditions (or take medications) that reduce magnesium absorption from the gut or increase losses from the body.




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Magnesium People with gastrointestinal diseases

The chronic diarrhea and fat malabsorption resulting from Crohn's disease, celiac disease and regional enteritis can lead to magnesium depletion over time. Resection or bypass of the small intestine, especially the ileum, typically leads to malabsorption and magnesium loss.

People with type 2 diabetes Magnesium deficits and increased urinary magnesium excretion can occur in people with insulin resistance and/or type 2 diabetes. The magnesium loss appears to be secondary to higher concentrations of glucose in the kidney that increase urine output.

People with alcohol dependence Poor dietary intake and nutritional status; gastrointestinal problems, including vomiting, diarrhea and fatty stools resulting from pancreatitis; renal dysfunction with excess excretion of magnesium into the urine; phosphate depletion; vitamin D deficiency; acute alcoholic ketoacidosis; and hyperaldosteronism secondary to liver disease may contribute to decreased magnesium status.

Older adults Magnesium absorption from the gut decreases and renal magnesium excretion increases with age. Older adults are also more likely to have chronic diseases or take medications that alter magnesium status, which can increase their risk of magnesium depletion.




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Zinc What is zinc and what does it do? Zinc is a nutrient that people need to stay healthy. Zinc is found in cells throughout the body. It helps the immune system fight off invading bacteria and viruses. The body also needs zinc to make proteins and DNA, the genetic material in all cells. During pregnancy, infancy and childhood, the body needs zinc to grow and develop properly. Zinc also helps wounds heal and is important for proper senses of taste and smell. How much zinc do I need? The amount of zinc you need each day depends on your age. Average daily recommended amounts for different ages are listed here in milligrams (mg):


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Teens 14–18 years (boys) 11 mg

Teens 14–18 years (girls) 9 mg

Adults (men) 11 mg

Adults (women) 8 mg

Pregnant teens 12 mg

Pregnant women 11 mg

Breastfeeding teens 13 mg

Breastfeeding women 12 mg



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Zinc What foods provide zinc? Zinc is found in a wide variety of foods. You can get recommended amounts of zinc by eating a variety of foods including the following: Oysters, which are the best source of zinc. Red meat, poultry, seafood such as crab and lobsters and fortified breakfast cereals. Beans, nuts, whole grains and dairy products. What kinds of zinc dietary supplements are available? Zinc is present in almost all multivitamin/mineral dietary supplements. It is also available alone or combined with calcium, magnesium or other ingredients in dietary supplements. Dietary supplements can have several different forms of zinc including zinc gluconate, zinc sulfate and zinc acetate. Zinc is also found in some oral over-the-counter products, including those labeled as homeopathic medications for colds. Use of nasal sprays and gels that contain zinc has been associated with the loss of the sense of smell, in some cases long-lasting or permanent. Currently, these safety concerns have not been found to be associated with oral products containing zinc, such as cold lozenges. Zinc is also present in some denture adhesive creams. Using large amounts of these products, beyond recommended levels, could lead to excessive zinc intake and copper deficiency causing neurological problems (numbness and weakness in the arms and legs).




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Zinc

Am I getting enough zinc? Most people in the United States get enough zinc from the foods they eat. However, certain groups of people are more likely than others to have trouble getting enough zinc: People who have had gastrointestinal surgery, such as weight loss surgery, or who have

digestive disorders, such as ulcerative colitis or Crohn's disease. These conditions can both decrease the amount of zinc that the body absorbs and increase the amount lost in the urine.

Vegetarians because they do not eat meat, which is a good source of zinc. Also, the beans and grains they typically eat have compounds that keep zinc from being fully absorbed by the body. For this reason, vegetarians might need to eat as much as 50% more zinc than the recommended amounts.

Older infants who are breastfed because breast milk does not have enough zinc for infants over 6 months of age. Older infants who do not take formula should be given foods that have zinc such as pureed meats. Formula-fed infants get enough zinc from infant formula.

Alcoholics because alcoholic beverages decrease the amount of zinc that the body absorbs and increase the amount lost in the urine. Also, many alcoholics eat a limited amount and variety of food, so they may not get enough zinc.

People with sickle cell disease because they might need more zinc.




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Zinc

What happens if I don't get enough zinc? Zinc deficiency is rare in North America. It causes slow growth in infants and children, delayed sexual development in adolescents and impotence in men. Zinc deficiency also causes hair loss, diarrhea, eye and skin sores and loss of appetite. Weight loss, problems with wound healing, decreased ability to taste food and lower alertness levels can also occur. Many of these symptoms can be signs of problems other than zinc deficiency. If you have these symptoms, your doctor can help determine whether you might have a zinc deficiency.




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Zinc What are some effects of zinc on health? Scientists are studying zinc to learn about its effects on the immune system (the body's defense system against bacteria, viruses, and other foreign invaders). Scientists are also researching possible connections between zinc and the health problems discussed below. Immune system and wound healing

The body's immune system needs zinc to do its job. Older people and children in developing countries who have low levels of zinc might have a higher risk of getting pneumonia and other infections. Zinc also helps the skin stay healthy. Some people who have skin ulcers might benefit from zinc dietary supplements, but only if they have low levels of zinc.

Diarrhea Children in developing countries often die from diarrhea. Studies show that zinc dietary supplements help reduce the symptoms and duration of diarrhea in these children, many of whom are zinc deficient or otherwise malnourished. The World Health Organization and UNICEF recommend that children with diarrhea take zinc for 10–14 days (20 mg/day, or 10 mg/day for infants under 6 months). It is not clear whether zinc dietary supplements can help treat diarrhea in children who get enough zinc, such as most children in the United States.




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Zinc The common cold

Some studies suggest that zinc lozenges or syrup (but not zinc dietary supplements in pill form) help speed recovery from the common cold and reduce its symptoms if taken within 24 hours of coming down with a cold. However, more study is needed to determine the best dose and form of zinc, as well as how long it should be taken before zinc can be recommended as a treatment for the common cold.

Age-Related Macular Degeneration (AMD) AMD is an eye disease that gradually causes vision loss. Research suggests that zinc might help keep early AMD from worsening into advanced AMD. In a large study, older people with AMD who took a daily dietary supplement with 80 mg zinc, 500 mg vitamin C, 400 IU vitamin E, 15 mg beta-carotene and 2 mg copper for about 6 years had a lower chance of developing advanced AMD and less vision loss than those who did not take the dietary supplement.

In the same study, people at high risk of the disease who took dietary supplements containing only zinc also had a lower risk of getting advanced AMD than those who did not take zinc dietary supplements. More research is needed before doctors can recommend zinc dietary supplements for patients with AMD. However, people who have or are developing the disease might want to talk with their doctor about taking dietary supplements.




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Zinc Can zinc be harmful? Yes, if you get too much. Signs of too much zinc include nausea, vomiting, loss of appetite, stomach cramps, diarrhea and headaches. When people take too much zinc for a long time, they sometimes have problems such as low copper levels, lower immunity, and low levels of HDL cholesterol (the "good" cholesterol). The safe upper limits for zinc are listed here. These levels do not apply to people who are taking zinc for medical reasons under the care of a doctor:


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Teens 14–18 years 34 mg

Adults 40 mg



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Zinc Are there any interactions with zinc that I should know about? Yes. Zinc dietary supplements can interact or interfere with medicines that you take and, in some cases, medicines can lower zinc levels in the body. Here are several examples: Taking a zinc dietary supplement along with quinolone or tetracycline antibiotics (such as

Cipro®, Achromycin®, and Sumycin®) reduces the amount of both zinc and the antibiotic that the body absorbs. Taking the antibiotic at least 2 hours before or 4–6 hours after taking a zinc dietary supplement helps minimize this effect.

Zinc dietary supplements can reduce the amount of penicillamine (a drug used to treat rheumatoid arthritis) that the body absorbs. They also make penicillamine work less well. Taking zinc dietary supplements at least 2 hours before or after taking penicillamine helps minimize this effect.

Thiazide diuretics, such as chlorthalidone (brand name Hygroton®) and hydrochlorothiazide (brand names Esidrix® and HydroDIURIL®) increase the amount of zinc lost in the urine. Taking thiazide diuretics for a long time could decrease the amount of zinc in the body.

Tell your doctor, pharmacist or other health care providers about any dietary supplements or medicines you take, they can tell you if those dietary supplements might interact or interfere with your medication or how your body absorbs, uses or breaks down nutrients.




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Zinc


Percent Daily Value

Oysters, cooked, breaded and fried, 3 ounces 74.0 493 Beef chuck roast, braised, 3 ounces 7.0 47 Crab, Alaska king, cooked, 3 ounces 6.5 43 Beef patty, broiled, 3 ounces 5.3 35 Breakfast cereal, fortified with 25% of the Daily Value for zinc, ¾ cup serving 3.8 25

Lobster, cooked, 3 ounces 3.4 23 Pork chop, loin, cooked, 3 ounces 2.9 19 Baked beans, canned, plain or vegetarian, ½ cup 2.9 19 Chicken, dark meat, cooked, 3 ounces 2.4 16 Yogurt, fruit, low fat, 8 ounces 1.7 11




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Zinc


Percent Daily Value

Cashews, dry roasted, 1 ounce 1.6 11 Chickpeas, cooked, ½ cup 1.3 9 Cheese, Swiss, 1 ounce 1.2 8 Oatmeal, instant, plain, prepared with water, 1 packet 1.1 7 Milk, low-fat or non fat, 1 cup 1.0 7 Almonds, dry roasted, 1 ounce 0.9 6 Kidney beans, cooked, ½ cup 0.9 6 Chicken breast, roasted, skin removed, ½ breast 0.9 6 Cheese, cheddar or mozzarella, 1 ounce 0.9 6 Peas, green, frozen, cooked, ½ cup 0.5 3 Flounder or sole, cooked, 3 ounces 0.3 2




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Multi-Vitamins What are multivitamin/mineral (MVM) dietary supplements? Multivitamin/mineral (MVM) supplements contain a combination of vitamins and minerals and sometimes other ingredients as well. They go by many names, including multis and multiples or simply vitamins. The vitamins and minerals in MVMs have unique roles in the body. What kinds of MVM supplements are available? There are many types of MVMs in the marketplace. Manufacturers choose which vitamins, minerals and other ingredients, as well as their amounts, to include in their products. Among the most common MVMs are basic, once-daily products containing all or most vitamins and minerals, with the majority in amounts that are close to recommended amounts. Higher-potency MVMs often come in packs of two or more pills to take each day. Manufacturers promote other MVMs for special purposes, such as better performance or energy, weight control or improved immunity. These products usually contain herbal and other ingredients (such as echinacea and glucosamine) in addition to vitamins and minerals.




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Multi-Vitamins The recommended amounts of nutrients people should get vary by age and gender and are known as Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs). One value for each nutrient, known as the Daily Value (DV), is selected for the labels of dietary supplements and foods. A DV is often, but not always, similar to one's RDA or AI for that nutrient. The label provides the %DV so that you can see how much (what percentage) a serving of the product contributes to reaching the DV. What are some effects of MVMs on health? People take MVMs for many reasons. Here are some examples of what research has shown about using them to increase nutrient intakes, promote health and reduce the risk of disease.




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Multi-Vitamins Increase nutrient intakes

Taking an MVM increases nutrient intakes and helps people get the recommended amounts of vitamins and minerals when they cannot or do not meet these needs from food alone. But taking an MVM can also raise the chances of getting too much of some nutrients, like iron, vitamin A, zinc, niacin, and folic acid, especially when a person uses more than a basic, once-daily product. Some people take an MVM as a form of dietary or nutritional "insurance." Ironically, people who take MVMs tend to consume more vitamins and minerals from food than those who don't. Also, the people least likely to get enough nutrients from diet alone who might benefit from MVMs are the least likely to take them.

Health promotion and chronic disease prevention For people with certain health problems, specific MVMs might be helpful. For example, a study showed that a particular high-dose formula of several vitamins and minerals slowed vision loss in some people with age-related macular degeneration. Although a few studies show that MVMs might reduce the overall risk of cancer in certain men, most research shows that healthy people who take an MVM do not have a lower chance of getting cancer, heart disease, or diabetes. Based on current research, it's not possible to recommend for or against the use of MVMs to stay healthier longer.




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Multi-Vitamins One reason we know so little about whether MVMs have health benefits is that studies often use different products, making it hard to compare their results to find patterns. Many MVMs are available and manufacturers can change their composition at will. It is therefore difficult for researchers to study whether a specific combination of vitamins and minerals affects health. Also, people with healthier diets and lifestyles are more likely to take dietary supplements, making it hard to identify any benefits from the MVMs. Can MVMs be harmful? Taking a basic MVM is unlikely to pose any risks to health. But if you consume fortified foods and drinks or take other dietary supplements, make sure that the MVM you take doesn't cause your intake of any vitamin or mineral to go above the upper safe levels. Pay particular attention to the amounts of vitamin A, beta-carotene and iron in the MVM.




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Multi-Vitamins

Should I take an MVM? MVMs cannot take the place of eating a variety of foods that are important to a healthy diet. Foods provide more than vitamins and minerals, they also have fiber and other ingredients that may have positive health effects. People who don't get enough vitamins and minerals from food alone, are on low-calorie diets, have a poor appetite, or avoid certain foods might consider taking an MVM. Some people might benefit from taking certain nutrients found in MVMs. For example: Women who might become pregnant should get 400 mcg/day of folic acid from fortified foods

and/or dietary supplements to reduce the risk of birth defects in their newborn babies. Pregnant women should take an iron supplement as recommended by their health care

provider. A prenatal MVM is likely to provide iron. Breastfed and partially breastfed infants should receive vitamin D supplements of 400 IU/day,

as should non-breastfed infants who drink less than about 1 quart per day of vitamin D-fortified formula or milk.

In postmenopausal women, calcium and vitamin D supplements may increase bone strength and reduce the risk of fractures.

People over 50 should get recommended amounts of vitamin B12 from fortified foods and/or dietary supplements as they might not absorb enough of the B12 naturally found in food.




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Multi-Vitamins Women who get too much vitamin A during pregnancy can increase the risk of birth defects in their babies. This risk does not apply to beta-carotene, however. Smokers and perhaps former smokers, should avoid MVMs with large amounts of beta-carotene and vitamin A because these ingredients might increase the risk of developing lung cancer. Adult men and postmenopausal women should avoid taking MVMs that contain 18 mg or more of iron unless their doctor has told them that they have iron deficiency or inadequacy. When the body takes in much more iron than it can eliminate, the iron can collect in body tissues and organs, such as the liver and heart and damage them. Iron supplements are a leading cause of poisoning in children under age 6, so keep any products containing iron (such as children's chewable MVMs or adults' iron supplements) out of children's reach.




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Multi-Vitamins Are there any interactions with MVMs that I should know about? MVMs with recommended intake levels of nutrients don't usually interact with medications, with one important exception. If you take medicine to reduce blood clotting, such as warfarin (Coumadin® and other brand names), talk to your health care provider before taking any MVM or dietary supplement with vitamin K. Vitamin K lowers the drug's effectiveness and doctors base the medicine dose partly on the amount of vitamin K you usually consume in foods and supplements. Which kind of MVM should I choose? Talk to a health care provider to help you figure out whether you should take an MVM and, if so, which one is best for you. Consider basic MVMs whose amounts of most or all vitamins and minerals do not go above the DVs. These MVMs usually have low amounts of calcium and magnesium, so some people might need to take one or both minerals separately. Make sure that the product does not have too much vitamin A and iron. Also consider choosing an MVM designed for your age, sex, and other factors (like pregnancy). MVMs for men often contain little or no iron, for example. MVMs for seniors usually provide more calcium and vitamins D and B12 and less iron than MVMs for younger adults. Prenatal MVMs for pregnant women often provide vitamin A as beta-carotene.




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Works Cited MayoClinic, 2013. http://www.mayoclinic.org/ Office of Dietary Supplements, National Institutes of Health. 2013. http://ods.od.nih.gov/ Vitamin D Council. 2013. http://www.vitamindcouncil.org/ WebMD. 2013. http://www.webmd.com/


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http://www.mayoclinic.org/

http://ods.od.nih.gov/

http://www.vitamindcouncil.org/

http://www.vitamindcouncil.org/

http://www.webmd.com/



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