Introduction
Vitamins and minerals are essential for normal body functions and are taken by many as nutritional supplements. Vitamins, minerals, herbs, and other supplements are being used by an increasing number of both females and males. In 1997, 60 million Americans stated they had used herbs in the previous year. It is interesting that many patients do not reveal their herbal use to their physicians and pharmacists. There is a potential for interaction between prescribed drugs and OTC (over-the-counter) supplements. Some supplements should not be used or are contraindicated in certain conditions such as pregnancy, diabetes, and depression (just to name a few). For these reasons, it is extremely important always to let your physicians know what prescribed drugs and OTC supplements you are taking. The information presented is not meant to be an authoritative reference. It is also important to realize that medical information changes on a frequent basis and that many aspects are controversial.
The most important source of nutrients in general is a healthy, well-balanced diet. This includes grains, vegetables, fruits, meat/poultry/fish/dry beans and/or nuts, milk and milk products, and limited fats/oils/sweets. Eliminate from your diet (or consume only in moderation): sugar including refined carbohydrates, caffeine, alcohol, salt, and white flour.
Supplements cannot take the place of healthy eating. Physicians recognize it may not be practical to get all of the appropriate nutrients from your diet and that you may benefit from careful supplementation. In addition to a healthy, well-balanced diet with appropriate supplementation, other aspects of a healthy style of living are just as important. Some of these include adequate water intake, regular exercise, sleep and relaxation, stress management, smoking cessation, limited alcohol use, and regular medical check-ups.
Who may benefit from taking supplements? Women who may benefit from supplements include: those with heavy menstrual bleeding, those who are pregnant or breast feeding, those who are menopausal, those who are on low-calorie diets, some vegetarians, those with limited milk intake and sunlight exposure, those with certain medical conditions (such as high blood pressure taking a water pill), and those who are unable or unwilling to consume a healthy diet. Again, it is important to realize supplements do not replace healthy eating!
Vitamins are chemical substances that regulate chemical reactions in the body. They often act as coenzymes, or partners with enzymes, the proteins that cause reactions to take place in your body. Minerals are found in many cells in the body (such as in the bone, teeth, and nails) and are also part of enzymes and may trigger enzymatic reactions.
Always check with your physician before taking any supplement, especially when taking more than the RDA (Recommended Dietary Allowance). RDAs are judged to be adequate to meet the known nutrient needs of most healthy persons. Some individuals may require higher amounts, or in certain situations lower amounts are appropriate. Some supplements do not have a RDA because science has not yet established this value. An AI (Adequate Intake) level or TUI (Tolerable Upper Intake) level may be reported if data is not adequate to give a RDA. The range of Estimated Safe and Adequate Daily Dietary Intake levels for supplements is also sometimes used. Some supplements may have no recommended dosage because this has not been established.

Vitamins are divided into two groups: water-soluble and fat-soluble. As the name implies, fat-soluble vitamins dissolve in fat. They are carried into your bloodstream and throughout your body attached to body chemicals made with lipids, or fat. That is the reason you need moderate amounts of fat in your food choices. Vitamins A, D, E, and K are fat-soluble. Your body stores fat-soluble vitamins in your body fat, so getting a fresh supply daily is not essential. In fact, consuming excess fat-soluble vitamins for too long, usually from supplements and not your diet, can be harmful. Water-soluble vitamins dissolve in water and include the B-complex vitamins and vitamin C. They are carried in your bloodstream and for the most part are not stored in large amounts in your body. Regular intake of water-soluble vitamins is necessary to avoid deficiencies. These vitamins are more easily destroyed in food preparation, processing, and storage than are fat-soluble vitamins. Excess amounts of water-soluble vitamins pass out of your body, but moderation in taking these vitamins is advisable since excess ingestion can cause extra work for your kidneys and may cause other harm.
Vitamin A (retinol and retinyl esters)

• Carotenoids – includes vitamin A, beta-carotene, lycopene, and lutein/zeaxanthin
• Fat soluble – stored in the liver
• RDA: 800 RE (retinol equivalents) per day = 2,700 IU vitamin A = 4,800 micro grams of beta-carotene
• Supplemental Dosage: 5-25,000 IU per day – see caution below regarding toxicity
• Pregnancy Dosage: do not exceed 5,000 IU per day during pregnancy or within three months of becoming pregnant
• Actions: antioxidant in the form of carotenoids and may reduce the risk for some cancers and other diseases of aging. Essential for normal reproduction, but excess amounts can be teratogenic (cause birth defects). Promotes the integrity and healing of epithelial tissues (skin, urinary tract, gastrointestinal tract, conjunctiva of the eyes, and respiratory system). May enhance immune function to treat and prevent infection (especially viral).
• Interactions:
  • neomycin can retard absorption of vitamin A
  • alcohol can cause hepatotoxicity (toxicity to the liver) resulting in vitamin A toxicity
  • tetracycline may cause high blood pressure
• Toxicity: high doses of vitamin may cause liver damage, pseudotumor cerebri (a condition mimicking a brain tumor), or death. Early warnings of toxicity include fatigue, headache, joint pain, muscle aches, bone pain, and dry skin. Ingestion of Beta-carotene may increase the risk of lung cancer in smokers (results of studies are controversial). Recent data (Journal of the American Medication Association, January 2, 2002) suggests there is an increased risk of hip fracture in postmenopausal women who take 3000 micro grams or more per day of retinol. 
• Food Sources: Approximate Retinol Equivalents (RE)
  • Beef liver, cooked (3 ounces) 9,085
  • Sweet potato mashed (1/2 cup) 2,800
  • Carrot, 1 medium 2,205
  • Turnip greens, cooked (1/2 cup) 395
  • Cantaloupe (1/2 cup) 260
  • Milk, skim (1 cup) 150
  • Egg, 1 large 95

Other Carotenoids

• Beta-carotene - precursor of vitamin A found in fruits and vegetables, but the conversion to vitamin A is limited
• Supplemental Dosage: up to 25,000 units (15 mg) per day
• Actions: antioxidant and enhances immune function
• Interactions: supplementation of beta-carotene may lower vitamin E, lycopene, and lutein/zeaxanthin levels
• Toxicity: amenorrhea (no menses) has been reported in women eating large amounts of carotenoid-containing vegetables. The skin may turn slightly orange with large amounts, but there is no evidence this is harmful. Vitamin A toxicity has not been reported in women taking large amounts of beta-carotene.
• Lycopene – potent antioxidant that may reduce the risk of certain cancers – best food source is tomatoes.
• Lutein/zeaxanthin – may reduce macular degeneration – best food sources are spinach, collard greens, and other dark green vegetables.

Vitamin D (calciferol)

• The "sunshine vitamin" - vitamin D is produced by your skin when exposed to sunlight (20-30 minutes of sunlight on face and hands two to three times per week) – the need for vitamin D increases with age (see below)
• RDA: 200 IU per day = 5 micro grams cholecalciferol through age 50 400 IU per day = 10 micro grams cholecalciferol age 51-70
  600 IU per day = 15 micro grams cholecalciferol over age 70
• TUI: tolerable upper intake level = 2,000 IU per day = 50 micro grams
• Actions: promotes the absorption of calcium and phosphorus and helps deposit these minerals in bones and teeth, making them stronger.
• Interactions:
  • cathartics (laxatives) retard absorption of vitamin D
  • digoxin can cause hypercalcemia and arrhythmias (irregular heart beat)
  • anticonvulsants interfere with vitamin D
  • prednisone interferes with the conversion of vitamin D to its active form by the kidneys
• Toxicity: kidney stones, kidney damage, muscle weakness, weak bones, excessive bleeding, and other problems. Large doses may increase the risk of atherosclerosis (hardening of the arteries)
• Food Sources: cheese, eggs, some fish, and fortified cereals are the best sources.
  • Milk most types (1 cup) 100 IU
  • Corn flakes (1 cup) 40 IU
  • Egg, large (1) 25 IU
  • Salmon, with bones 10 IU

Vitamin E (tocopherols and tocotrienols)

• RDA: 8 mg per day for females 11 and older 10 mg per day during pregnancy 11 mg per day while breast feeding
• Supplemental Dosage: alpha-tocopherol is the most widely used supplement form of Vitamin E - 400-800 IU per day taken in divided doses – with diabetes and rheumatic heart disease, start with low doses (100 IU/day) and build up slowly – use natural, not synthetic vitamin E, for supplementation but the best source for vitamin E may be from foods rather than supplements. Caution: Supplements are alpha-tocopherol and a major component of vitamin E from food is gamma-tocopherol. The gamma form may be more beneficial and may be displaced from the cells by the alpha form. Vitamin E with mixed tocopherols (alpha, beta, delta, and gamma) may be the best form to use as a supplement.
• Actions: antioxidant that can reduce the risk of heart disease and certain cancers. Vitamin E stabilizes cell membranes and inhibits platelet aggregation. At moderate doses it improves immune function (at high doses vitamin E may inhibit immune function). It can improve the symptoms of fibrocystic breast disease and may help the symptoms of PMS.
• Interactions:
  
  • coumadin enhances anticoagulant action (patients on blood thinners should not supplement vitamin E) – may increase the risk of bleeding including stroke
  • vitamin E and iron exert mutual inhibitory effects
  • supplementation with omega-3 and omega-6 fatty acids increases vitamin E requirements
  • vitamin B6 may enhance the effect of vitamin E
• Toxicity: see "Interactions." It is very important that vitamin E and gingko baloba supplements not be taken together when patients are on blood thinners. Excess vitamin E may increase retinal hemorrhage in diabetics. This may be avoided with adequate intake of vitamin K.
• Food Sources: Vegetable oils including soybean, corn, cottonseed, and safflower (note: heating oils to high temperatures as in frying destroys the vitamin E), nuts, seeds, wheat germ, and leafy-green vegetables are the best sources.
• Vitamin E ( gamma-tocopherol mg)
  • Almonds, dried (1 ounce) 6.5
  • Wheat germ (1/4 cup) 4.0
  • Peanut butter (2 tablespoons) 3.0
  • Corn oil (1 tablespoon) 2.0
  • Spinach, raw (1 cup) 1.0

Vitamin K

• Vitamin K is produced from certain bacteria in your intestine
• RDA: 65 micro grams
• Actions: makes proteins necessary to clot blood and some other proteins for your blood, bones, and kidneys
• Interactions: Coumadin is a blood thinner. Patients taking blood thinners should eat foods rich in vitamin K in moderation. Excess vitamin K can counteract the effects of coumadin.
• Toxicity: no toxicity is known.
• Food Sources: Vitamin K (micro grams)
  
  • Spinach, raw (1 cup) 145 Strawberries (1/2 cup) 10
  • Broccoli, raw (1/2 cup) 60 Orange, medium (1) 9
  • Egg, large (1) 25
  • Wheat bran (1 ounce) 25
  • Wheat germ (1 ounce) 10
  • Milk (1 cup) 10

Vitamin B1 (thiamin)

• RDA:  1 mg per day for females ages 14-18 1.1 mg ages 19 on
  1.4 mg during pregnancy
  1.5 mg while breast feeding
• Supplement Dosage: 10-100 mg per day
• Actions: helps produce energy from carbohydrates in all cells of your body and functioning of the nervous system.
• Deficiency: can result in fatigue, weak muscles, and nerve damage. Contrary to popular claims, extra amounts do not have any energy-boosting properties.
• Interactions:
  • alcohol consumption can cause thiamin deficiency
  • high doses may cause a deficiency of vitamin B6 or magnesium
• Toxicity: Any excess amounts consumed are excreted in the urine.
• Food Sources: whole grains and enriched-grain products such as fortified cereals provide much of the thiamin we eat.
  • Thiamin (mg)
  • Pork, lean, broiled (3 ounces) 0.9
  • Enriched rice, cooked (1/2 cup) 0.2
  • Whole grain bread (1 slice) 0.1

Vitamin B2 (Riboflavin)

• RDA: 1.1 mg per day for adult women 1.4 mg per day during pregnancy 1.6 mg per day while breast feeding Supplemental Dosage: 10-100 mg per day
• Actions: helps produce energy in all cells of your body. Also helps change the amino acid called tryptophan in your food into niacin. (Protein is made of many different amino acids.)
• Deficiency: Except when severely malnourished, people are not likely to have a deficiency. Deficiency can result in cataracts, dry and flaky skin, and a sore, red tongue. Deficiency does not cause hair loss.
• Interactions: riboflavin deficiency or poor utilization can result from taking adriamycin, phenothiazines, dilantin, imipramine, or amitriptyline.
• Toxicity: No known effects of excess consumption.
• Food Sources: Milk and other dairy products are major sources of riboflavin (sunlight destroys riboflavin; this is the reason milk is stored in opaque containers). Riboflavin is also found in enriched bread and other grain products, eggs, meat, and green-leafy vegetables.
  • Riboflavin (mg)
  • Yogurt, skin with dry milk solids (1 cup) 1.6
  • Milk, skim (1 cup) 0.4
  • Egg, large (1) 0.1
  • Whole-grain bread (1 slice) 0.1

Vitamin B3 (Niacin/niacinamide)

• Niacin is the acid form – niacinamide passes the blood-brain barrier more easily
• RDA: 14 mg NE (niacin equivalents) per day for adult women 18 mg NE (niacin equivalents) per day during pregnancy 17 mg NE (niacin equivalents) per day while breast feeding
• TUI (tolerable upper intake level): 35 mg per day for adults
• Supplemental Dosage: 25-1,000 mg per day
• Actions: helps your body use sugars and fatty acids. It also helps produce energy in the cells of your body and helps enzymes function normally. Niacin is involved in normal brain function, tryptophan metabolism, and serotonin metabolism (possible anti-anxiety and anti-depressive action). High dose niacin affects serum lipids, and niacin is a precursor to glucose tolerance factor; niacinamide does neither.
• Deficiency: is not likely in people who consume adequate amounts of protein-rich foods. Pellagra is caused by severe niacin deficiency and results in diarrhea, mental disorientation, and skin problems.
• Interactions: aspirin may reduce to metabolic clearance of niacin niacin may increase the effect of ganglionic blocking drugs and vasoactive drugs and cause postural hypotension (low blood pressure when you get up too quickly)
• Toxicity: Excess intake can result in flushed skin, rashes, or liver damage. It is sometimes given to lower cholesterol but should not be taken in doses in excess of what a physician prescribes. Niacin may reactivate healed stomach ulcers or increase serum uric acid levels
• Food Sources: Niacin is found in protein-rich foods such as poultry, fish, beef, peanut butter, and legumes; it is also added to many grain products.
  • Niacin (mg NE)
  • Turkey breast, roasted without skin (3 ounces) 4.5
  • Peanut butter (2 tablespoons) 4.0
  • Enriched spaghetti, cooked (1/2 cup) 2.5

Vitamin B6 (pyridoxine)

• RDA: 1.3 mg per day for adult women through age 50 1.5 mg per day over age 50 1.9 mg per day during pregnancy 2.0 mg per day while breast feeding
• TUI (tolerable upper intake level): 100 mg per day for adults
• Actions: energy metabolism, nervous system function, immune function, and homocysteine metabolism. Pyridoxine helps make non-essential amino acids necessary to make body cells. It helps change tryptophan into niacin and serotonin (a messenger in your brain). It also helps produce other body chemicals including insulin, hemoglobin, and antibodies that fight infection.
• Deficiency: can cause convulsions in infants, depression, nausea, or greasy, flaky skin. Deficiency can be caused by monamine-oxidase inhibitors, isoniazid, theophylline, oral contraceptives, hydralazine, tartrazine, tobacco smoke, and pesticides and other hydrazine chemicals.
• Interactions: Large doses may increase the need for magnesium, zinc, essential fatty acids, folic acid, and other B vitamins. Do not take vitamin B6 at the same time as B-complex vitamins.
• Toxicity: Large doses taken over time can cause nerve damage
• Food Sources: Chicken, fish, and pork are the best sources; it is also found in whole grains, nut and legumes.
  • Pyridoxine (mg)
  • Chicken, light meat, skinless, roasted (3 ounces) 0.5
  • Pork loin, roasted (3 ounces) 0.4
  • Peanut butter (2 tablespoons) 0.1
  • Black beans, boiled (1/2 cup) 0.1

Folic Acid (folate)

• RDA:400 m g (0.4 mg) per day for women through age 50 600 m g per day during pregnancy 500 m g per day while breast feeding
• TUI (tolerable upper intake level): 1,000 m g per day
• Supplemental Dosage: 0.4-5.0 mg per day
• Actions: helps produce DNA and RNA, therefore playing an essential role in making new body cells (needed to lower the risk of delivering a baby with neural tube defects). It also works with B12 to form hemoglobin in red blood cells and may help protect from heart disease. Deficiency: affects normal cell division and protein synthesis and can also result in anemia. Deficiency in pregnancy can cause neural tube defects and cleft palate in the newborn. Deficiency can occur with oral contraceptives, trimethoprim, sulfasalazine, and cigarette smoke.
• Interactions: may interfere with dilantin and methotrexate. Large doses of folic acid may promote a deficiency of zinc and B12. Large doses of B6, B12, and zinc may increase the requirement for folic acid.
• Toxicity: Excess intake can mask B12 deficiency and can interfere with certain medications and cause seizures in epileptics.
• Food Sources: include leafy vegetables, some fruits, legumes, yeast breads, wheat germ, and fortified cereals.
  • Folic acid (m g)
  • Spinach, boiled (1/2 cup) 130
  • Navy beans, boiled (1/2 cup) 125
  • Wheat germ (1/4 cup) 80
  • Orange, medium (1) 45
  • Bread, fortified with folate (1 slice) 40

Vitamin B12 (cobalamin)

• RDA: 2.4 m g per day for adults 2.6 m g per day during pregnancy 2.8 m g per day while breast feeding
• Supplemental Dosage: 1mg usually given by intramuscular injection. The hydroxycobalamin form is better than the cyanocobalamin form.
• Actions: works closely with folate to make new red blood cells. It is an essential part of many body chemicals and occurs in every body cell and also helps the body use fatty acids and some amino acids.
• Deficiency: can result in anemia, fatigue, nerve damage, a smooth tongue, and a very sensitive skin. Some people develop a deficiency because they cannot absorb B12 and must be treated with injections of the vitamin. Strict vegetarians and their infants are at risk for deficiency as are the elderly. Fortified foods or supplements can prevent B12 deficiency.
• Interactions: Extra folate can mask a deficiency of B12. Oral absorption of B12 can be impaired by antacids, histamine blockers, potassium citrate, potassium chloride, colchicine, and some oral diabetes medications.
• Toxicity: None known. Excess amounts to boost energy has no scientific basis.
• Food Sources: Animal products including meat, fish, poultry, and eggs are the major food sources of the vitamin.
  • Vitamin B12 (m g)
  • Salmon, cooked (3 ounces) 2.6
  • Beef tenderloin lean, broiled (3 ounces) 2.2
  • Shrimp, cooked (3 ounces) 1.3
  • Milk (1 cup) 0.5
  • Chicken, light meat, skinless, roasted (3 ounces) 0.3
  • Egg, large (1) 0.1
    

Biotin

• AI (Adequate Intake): 30 m g per day for women including during pregnancy 35 mg per day while breast feeding
• Actions: helps produce energy and metabolize (use) protein, fat, and carbohydrate from food.
• Deficiency: is rare with a healthy diet but could result in heart abnormalities, loss of appetite, fatigue, depression, or dry skin.
• Toxicity: None known.
• Food Sources: Eggs, liver, yeast breads, and cereals are the best sources.
  • Food Sources Biotin (m g) (cont’d)
  • Egg, large (1) 10
  • Wheat germ (1/4 cup) 6
  • Oatmeal, cooked (1/2 cup) 5
  • Shredded wheat cereal (1 ½ ounces) 4

Pantothenic Acid

• AI (Adequate Intake): 5 mg per day for adults 6 mg per day during pregnancy 7 mg per day while breast feeding
• Supplemental Dosage: 10-1,000 mg per day
• Actions: helps produce energy and metabolize (use) protein, fat, and carbohydrate from food. Deficiency is rare for healthy people who eat a healthy diet. It is a precursor of coenzyme A.
• Toxicity: Excess intake can result in occasional diarrhea and water retention.
• Food Sources: The best sources are meat, poultry, fish, whole-grain cereals, and legumes.
  • Pantothenic Acid (mg)
  • Salmon, cooked (3 ounces) 1.7
  • Chicken, light meat, skinless, roasted (3 ounces) 0.9
  • Sweet potato, mashed, cooked (1/2 cup) 0.9
  • Milk, skim (1 cup) 0.8

Vitamin C (ascorbic acid)

• RDA: 60 mg per day for adults 70 mg per day during pregnancy 90-95 mg per day while breast feeding 100 mg (at least) per day for smokers
• Supplemental Dosage: 500-2000 mg per day
• Actions: promotes tissue healing, immune function, and has antiviral and antibacterial effects. It helps produce collagen (connective tissue that holds muscles, bones and other tissues together. It also helps keep capillary walls and blood vessels firm, helps the body absorb iron from plant sources of food, promotes healthy gums, helps healing from cuts and wounds, and is necessary for a healthy immune system. Vitamin C is a water-soluble antioxidant (it attacks free radicals in body fluids, not in fat tissue).
• Deficiency: leads to a disease called scurvy resulting in lost teeth, excessive bleeding, swollen gums, and wounds that do not heal properly.
• Interactions: large doses may interfere with tests for occult blood in the stool and some urine tests for sugar aspirin and tobacco smoke may promote vitamin C deficiency absorption of iron is enhanced large doses of vitamin C may cause copper deficiency
• Toxicity: Very large doses may cause kidney stones and diarrhea. The effects of large doses over a long period of time are not known.
• Food Sources: Citrus fruits, berries, melons, peppers, many dark leafy vegetables, potatoes, and tomatoes are good sources for vitamin C.
  • Red bell pepper (1/2 cup) 95
  • Orange juice from frozen concentrate (6 ounces) 75
  • Broccoli, boiled (1/2 cup) 60
  • Grapefruit, white (1/2) 40
  • Potato, baked with skin (1) 25
  • Collard greens, frozen, boiled (1/2 cup) 25

Lipoic Acid

• Supplemental Dosage: 300-800 mg per day
• Actions: antioxidant – use in combination with other antioxidants. May reduce some effects of diabetes and help normalize elevated liver enzymes.

Para-Aminobenzoic Acid (PABA)

• Supplemental Dosage: 300-400 mg per day
• Actions: a factor in vitamin B complex and required for formation of folic acid. It neutralizes the bacteria-killing ability of sulfa drugs since it provides an essential growth factor for bacteria. It may suppress certain autoimmune diseases and fibrotic disorders and enhance the effects of corticosteroids and estrogen.
• Interactions: interferes with sulfanilmides
• Toxicity: high doses may cause rash, fever, hypoglycemia, and rarely death

Choline

• Water-soluble
• Supplemental Dosage: 1-4 g per day
• Actions: a factor in vitamin B complex. It is essential for transmission of nerve impulses
• Toxicity: large doses may cause depression or a fishy odor.

Minerals are inorganic substances (vitamins are organic substances) and are necessary to regulate body processes and to give your body structure. Unlike vitamins, minerals are not changed or destroyed by cooking or by the way they are stored (such as the effect of sunlight on vitamin D). Minerals are absorbed through your intestine and are transported and stored in your body in different ways. In general, a large dose of a single mineral may cause deficiencies of others. Excess amounts of some minerals pass out of the body through urine. Excess amounts of others are stored and can be harmful if high levels are consumed for long periods of time. All minerals are essential and are divided into two groups depending on how much your body needs: major minerals and trace minerals.
If your body needs more than 250 mg per day, this is categorized as a major mineral. Calcium, phosphorus, magnesium, and the electrolytes are in this category. Electrolytes include sodium, potassium, and chloride. Electrolytes are grouped because they work together to regulate fluids in and out of cells and to transmit nerve impulses.
The daily requirements of trace minerals are usually less than 20 mg per day. These include chromium, copper, fluoride, iodine, iron, manganese, molybdenum, selenium, and zinc. With adequate scientific research, some of the trace minerals have RDAs (iron, zinc, iodine, and selenium). The others are reported as an AI (Adequate Intake) level, TUI (Tolerable Upper Intake) level, or Estimated Safe and Adequate Daily Dietary Intake level. Tin, arsenic, silicon, vanadium, nickel, and boron are trace minerals in the body that we know little about and have not been assigned RDAs or other safe and adequate amount.

Calcium

• AI: 1,300 mg per day ages 9-18 1,000 mg per day for adults through 50 1,200 mg per day over the age of 50
• TUI: 2,500 mg per day
• Actions: builds bone and helps reduce the rate of bone loss as you age. Calcium is needed for muscle contraction and normal heart function. It is also necessary for normal nerve function and normal blood clotting. Calcium may also help reduce the risk of high blood pressure and, in some cases, colon cancer (calcium binds with bile salts which may be carcinogenic). Calcium works in partnership with phosphorus and vitamin D. Calcium citrate may be better absorbed than calcium carbonate, which is especially important with older women.
• Deficiency: can retard normal bone growth and increase the risk of osteoporosis (brittle bones that increase the chance of fractures of the spine, hips and other bones). In addition to adequate intake of calcium along with vitamin D, regular weight-bearing exercise, and adequate estrogen (or an estrogen substitute) are necessary for women to minimize the risk of osteoporosis. Also avoid smoking, excess alcohol (more than one drink per day regularly), and excess caffeine (more than one cup of coffee per day - if you must drink coffee or tea, drink it in between meals, not with meals), all of which interfere with bone health. Prolonged use of NSAIs can deplete copper and increase the risk of osteoporosis.
• Interactions: corticosteroids may cause calcium depletion tetracyclines inhibit calcium absorption and vice versa digoxin toxicity may be increased by calcium supplementation if no magnesium is given aluminum absorption is reduced by calcium supplementation – excessive aluminum can cause osteomalacia (soft bones). Aluminum is found in cookware, cans, tomatoes, bananas, baking soda, and many deodorants.
• Toxicity: large doses over a long period of time can cause kidney stones and poor kidney function. Also, excess amounts can interfere with the absorption of other minerals such as iron, magnesium, zinc, and others.
• Food Sources: Approximate Calcium (mg)
  • Milk, skim (1 cup) 300
  • Yogurt plain, nonfat (1 cup) 450
  • Orange juice, calcium fortified (6 ounces) 225
  • Cheddar cheese (1 ounce) 205
  • Salmon, canned with edible bones (3 ounces) 205
  • Turnip greens (1/2 cup) 100
  • Ice cream (1/2 cup) 85
  • Broccoli (1/2 cup) 45

Phosphorus

• RDA: 1,200 mg per day ages 9-18 700 mg per day for adults of all ages
• TUI: 4,000 mg per day ages 9-70 3,500 mg per day during pregnancy 3,000 mg per day after age 70
• Actions: helps generate energy in all cells of the body and acts as the main regulator of energy metabolism. Phosphorus is also a major component of bones and teeth. It is also a part of DNA and RNA that control cell growth and repair. Deficiency is unusual but can occur in people who take an antacid with aluminum hydroxide for a long time. Symptoms of deficiency include bone loss, weakness, loss of appetite, and pain.
• Toxicity: excess consumption can decrease the level of calcium.
• Food Sources: Phosphorus (mg)
  • Milk, whole (1 cup) 230
  • Beef, lean ground cooked (3 ounces) 60
  • Cheddar cheese (1 ounce) 145
  • Peanut butter (2 tablespoons) 105
  • Egg, large (1) 90

Magnesium

• RDA: 360 mg per day for teenage girls till age 18 310 mg per day for women through age 30 320 mg per day for women after age 30
• Supplemental Dosage: 250-600 mg per day
• Actions: is an important part of more than 300 body enzymes and is necessary to maintain nerve and muscle cells. Magnesium is also a major component of bone, is involved in energy metabolism, inhibits platelet aggregation, dilates blood vessels, enhances immune function, and has anti-spasmodic effects on smooth muscle.
• Deficiency: rare – deficiency can cause irregular heartbeat, nausea, weakness, and problems thinking
• Interactions – large doses of calcium or vitamin B6 may increase the requirements for magnesium Magnesium deficiency may be induced by: diuretics (water pills) except those that are potassium-sparing some antibiotics including gentamycin and carbenicillin cortisone digoxin – magnesium deficiency may increase the risk of digoxin toxicity some anti-asthmatic drugs chronic laxative use excess alcohol intake
• Toxicity: will not occur unless there is kidney disease preventing excretion of magnesium in the urine
• Food Sources: the best sources include nuts, whole grains, legumes, and green vegetables
  • Magnesium (mg)
  • Spinach, boiled (1/2 cup) 80
  • Peanut butter (2 tablespoons) 50
  • Black-eyed peas, boiled (1/2 cup) 45
  • Pecans, dried (1ounce) 35
  • Whole-wheat bread (1 slice) 25

Chloride

• AI: 750 mg per day
• Actions: helps regulate fluids in and out of body cells. Chloride is a component of stomach acid and aids in digestion and absorption of food; it is necessary for transmission of nerve impulses
• Deficiency: goes along with sodium loss causing similar symptoms
• Toxicity: approximately 1/3 of all adults are "salt-sensitive" and can develop swelling and high blood pressure
• Food Sources: salt is made of sodium and chloride. Salt and salty foods are the main sources of chloride. ¼ teaspoon of salt contains 750 mg of chloride

Potassium

• Minimum Daily Amount: 2,000 to 3,000 per day (some experts recommend 3,000 mg per day to protect against high blood pressure). The best place to get potassium is from food
• Supplemental Dosage: 300-600mg per day, although larger doses may be needed by patients taking potassium-depleting diuretics
• Actions: helps control fluid and mineral balance in and out of the cells and is necessary to maintain normal blood pressure. It is necessary for transmission of nerve impulses and for contraction of muscles
• Deficiency: rare in healthy people. Deficiency can be seen with prolonged vomiting, diarrhea, laxative use, and taking water pills (diuretics). Kidney disease can also cause deficiency. Deficiency symptoms can include weakness, loss of appetite, nausea, and fatigue.
• Interactions: some diuretics may deplete potassium whereas potassium-sparing diuretics and ACE inhibitors can increase potassium retention. Digitalis toxicity can be exacerbated by simultaneous potassium deficiency
• Toxicity: rare but can occur with kidney disease when excess potassium cannot be excreted. This can cause heart problems. Prescription-strength potassium can cause gastrointestinal ulceration
• Food Sources: commonly found in fruits, many vegetables, meat, poultry, and fish.
  • Potassium (mg)
  • Banana, medium (1) 450
  • Milk, whole (1 cup) 370
  • Turkey, roasted, skinless (3 ounces) 255
  • Orange, medium (1) 250
  • Tomato, raw (1) 135
  • Bell pepper (1/2 cup) 90

Sodium

• Minimum Daily Amount: 500 mg for healthy adults – the Daily Value used for food labeling is 2,400mg
• Actions: helps control fluid and mineral balance in and out of the cells and helps regulate blood pressure. It is necessary for transmission of nerve impulses. It also helps muscles relax, including your heart.
• Deficiency: prolonged diarrhea and vomiting or kidney disease can cause a deficiency. Symptoms of deficiency could include nausea, dizziness, and muscle cramps.
• Interactions: diuretics and lithium can cause sodium depletion; therefore be careful with low salt diets.
• Toxicity: can occur with kidney disease when excess sodium cannot be excreted. This can cause fluid retention, swelling, and high blood pressure in people who are "salt-sensitive." Excess sodium can also promote renal stones, osteoporosis, and congestive heart failure.
• Food Sources: processed foods account for about 80% of the sodium in food. The rest comes from table salt and the small amount that occurs naturally in food. ¼ teaspoon contains about 575 mg of sodium.
  • Sodium (mg)
  • Ham, cooked (3 ounces) 1,030
  • Chicken broth, canned (1 cup) 1,005
  • Dill pickle, medium (1) 835
  • Canned tuna (2 ounces) 310
  • Cheddar cheese (1 ounce) 175
  • Whole-wheat bread (1 slice) 160
  • Milk, whole (1 cup) 120

Chromium

• Safe and Adequate Intake: 50 to 200 m g per day
• Supplemental Dosage: 200-1000 m g per day
• Actions: works with insulin to help your body use glucose (sugar)
• Deficiency: can cause diabetes-like symptoms. Ingestion of large amounts of refined sugar may deplete chromium.
• Toxicity: none known
• Food Sources: meats, eggs, whole-grain products, and cheese are good sources.
  • Chromium (mg)
  • Shredded-wheat cereal (2 ounces) 65
  • Cheese, American (1 ounce) 48
  • Egg, cooked (1 large) 26

Copper

• Safe and Adequate Intake: 1.5 - 3.0 mg per day
• Supplemental Dosage: 2-4 mg per day
• Actions: helps make hemoglobin to carry oxygen in your blood, is found in many enzymes, and helps produce energy in body cells. Copper promotes healing and strengthens connective and elastic tissues and has anti-inflammatory activity
• Deficiency: most commonly occurs from genetic problems or excess consumption of zinc.
• Interactions: NSAI (non-steroidal anti-inflammatory) drugs and penicillamine can promote copper deficiency. Patients on NSAIs for a long time are at increased risk for osteoporosis because of copper depletion.
• Toxicity: from dietary sources is very rare in the United States
• Food Sources: organ meats (liver), seafood, nuts and seeds. Also, cooking in copper pots increases the amounts in food.
  • Copper (mg)
  • Beef liver, braised (3 ounces) 2.4
  • Salmon, cooked (3 ounces) 0.3
  • Sunflower seeds (1/4 cup) 0.6
  • Peanuts (1/4 cup) 0.5

Fluoride

• AI: 2.0 mg per day for children ages 9-13 3.0 mg per day for teenagers and female adults
• TUI: 10.0 mg from age 9 through adulthood
• Actions: harden tooth enamel to prevent tooth decay and assist in preventing osteoporosis
• Deficiency: tooth enamel can be weak and osteoporosis may be more likely
• Toxicity: excess consumption can cause brown stains of the teeth (although the teeth are healthy in all other ways)
• Food Sources: tea made with fluorinated water and fish with edible bones such as canned salmon. The major source is fluorinated water. Most bottled water is not fluorinated.

Iodine

• RDA: 150 m g per day for adults 175 m g per day during pregnancy 200 m g per day while breast feeding
• Supplemental Dosage: 1-8 drops per day of Lugol’s iodine (40-45 mg of iodine per drop)
• Actions: is found in thyroid hormone that regulates body metabolism
• Deficiency: results in inadequate production of thyroid hormone which causes the body metabolism to slow down and can result in weight gain, goiter (enlarged thyroid gland), and other signs and symptoms of hypothyroidism. Use of iodized salt usually prevents a deficiency.
• Toxicity: goiter can result from excessively high levels of iodine but this is rare in the United States from food sources. Can get allergic reactions, rash, runny nose, excess salivation, or poor or excessive thyroid function from supplementation.
• Food Sources: found in salt-water fish, foods that are grown near coastal areas and iodized salt. ¼ teaspoon iodized salt contains 100 m g of iodine.

Iron

• RDA: 15 mg per day for women through age 50 and while breast feeding 10 mg per day for women over age 50 30 mg per day during pregnancy
• Actions: is an essential part of hemoglobin that carries oxygen in the blood
• Deficiency: results in anemia that can cause fatigue and increase the risk of infections. Iron deficiency is more common in menstruating women. Polyphenols in coffee and tannins in tea inhibit absorption of plant-source iron. Soy products can inhibit iron absorption. Iron deficiency is a common cause for diffuse hair loss in women.
• Interactions: iron supplements may decrease absorption of ciproflaxacin and thyroxine vitamin E inhibits iron utilization and vice versa vitamin C enhances iron absorption iron supplements may reduce zinc absorption
• Toxicity: excess iron intake is especially dangerous for children and adults who have a genetic problem called hemochromotosis.
• Food Sources: found in both animal and plant food sources; iron is better absorbed from animal sources when vitamin C is consumed at the same meal.
  • Beef liver, braised (3 ounces) 5.8
  • Sirloin steak, broiled (3 ounces) 2.9
  • Chicken, skinless, white meat (3 ounces) 1.0
  • Bran (1/2 cup) 3.5
  • Spinach, boiled (1/2 cup) 3.2
  • Lima beans, cooked (1/2 cup) 2.5

Manganese

• AI: 2-5 mg per day for adults
• Supplemental Dosage: 10-50 mg per day
• Actions: is a part of many enzymes. Manganese is necessary to prevent osteoporosis, to enhance normal sugar metabolism, and to maintain cartilage integrity.
• Deficiency: rare since it is found in many foods
• Toxicity: consuming excess amounts from food is rare. Excess supplementation may cause a Parkinson-like syndrome
• Food Sources: whole-grain products and some fruits and vegetables are the best sources of manganese
  • Manganese (mg)
  • Pineapple, raw (1/2 cup) 1.3
  • Whole-wheat bread (1 slice) 0.6
  • Lentils, boiled (1/2 cup) 0.5
  • Strawberries (1/2 cup) 0.2

Molybdenum

• AI: 75-250 m g for adults
• Supplemental Dosage: 50-500 m g for adults
• Actions: is part of many enzymes and works with riboflavin to incorporate iron into hemoglobin
• Deficiency: rare with a normal diet
• Interactions: excess molybdenum may induce copper deficiency; take molybdenum and copper supplements at separate times of the day
• Toxicity: excess amounts may interfere with the body’s ability to use copper, but harmful levels are rare
• Food Sources: milk, breads, legumes, and grain products are the best sources.
  • Molybdenum (mg)
  • Lima beans, cooked (1/2 cup) 300
  • Liver, braised (3 ounces) 125
  • Wheat germ (1 ounce) 60

Selenium

• RDA: 55 m g per day for women 65 m g per day during pregnancy 75 m g per day while breast feeding
• Supplemental Dosage: 100-250 m g per day
• Actions: works as an antioxidant with vitamin E to protect cells from damage and aids in cellular growth. Selenium is necessary for normal thyroid function, enhances immune function, and has antiviral effects.
• Deficiency: uncertain but may affect heart muscle function. Deficiency can be caused by chronic alcohol abuse.
• Interactions: simultaneous supplementation with vitamin C and selenium on an empty stomach may inactivate the selenium (taken with food, vitamin C 1000mg does not cause this)
• Toxicity: high levels from supplements can be harmful
• Food Sources: seafood, liver, and kidney along with other meats are the richest source. Selenium is also found in grain products and seeds, but the amount depends on the content of selenium in the soil.
  • Selenium (mg)
  • Chicken, light meat, skinless (3 ounces) 26
  • Brown rice, cooked, (1/2 cup) 13
  • Egg, large (1) 12
  • Whole-wheat bread (1 slice) 11

Zinc

• RDA: 12 mg per day for women 15 mg per day during pregnancy 19 mg per day while breast feeding
• Supplemental Dosage: 15-90 mg per day
• Actions: promotes cell reproduction and repair. Zinc is an essential part of more than 70 enzymes and also assists in metabolism of carbohydrate, protein, and fat. Zinc promotes wound healing, enhances immune function, and is necessary for normal thyroid function and anti-inflammatory action.
• Deficiency: during childhood can retard growth and during pregnancy can cause birth defects. Zinc deficiency can cause loss of appetite, skin changes, and reduced ability to fight infection. Alcoholics are frequently zinc deficient.
• Interactions: some diuretics may increase zinc excretion and large doses of zinc over long periods of time may cause copper deficiency and promote folic acid deficiency
• Toxicity: excess consumption from supplements can hinder copper absorption.
• Food Sources: meats, seafood, and liver are good sources of zinc, and lesser amounts are found in eggs and milk.
  • Zinc (mg)
  • Beef, ground, lean (3 ounces) 4.5
  • Wheat germ (1/4 cup) 3.5
  • Black-eyed peas, frozen, boiled (1/2 cup) 1.0
  • Milk, whole (1 cup) 1.0
  • Egg, large (1) 0.5

Boron

• Supplemental Dosage: 1-3 mg per day
• Actions: Boron is a trace mineral that we know little about. May be necessary for bone health. Boron may increase the concentrations of estrogen and testosterone; the risk of supplementation should be weighed against the benefits in women who have or are at risk for hormone dependent cancers.

Silicon

• Supplemental Dosage: 1-2 mg per day
• Actions: may help prevent atherosclerosis, may help with prevention of osteoporosis, may strengthen nails and hair.
• Interactions: inhibits aluminum absorption