Mineral and trace element supplements

As with vitamins, it is considered to be best to obtain our mineral requirements from food. As with vitamins, if you wish to take supplements it is best not to exceed the recommended nutrient intake or recommended daily allowances – and care must be taken regarding the combinations taken as high doses of certain minerals can affect the absorption of others. Some further information is given below about some of the minerals and trace elements that are commonly seen as supplements.


There are some groups in the population who do not obtain enough iron in the diet. The main groups at risk of low iron intake are:

• Infants and children from the age of 6 months to 2 years
• Younger adolescents (especially girls)
• Women of child-bearing age
• Pregnant women
• Vegetarians

Iron deficiency results in a type of anemia where the red blood cells are smaller and paler than usual and are less able to carry oxygen to the body tissues. Symptoms include tiredness, weakness, pale skin, breathlessness on exertion, and sometimes palpitations. People with severe iron deficiency have impaired intellectual performance, poor work capacity, and poor immune and nerve function. In children low iron status may affect learning ability and behavior.

It is preferable to obtain the necessary iron from food sources but supplements may be useful in some situations. (Babies and toddlers should obtain all the iron they need without supplements provided that appropriate milk formula are used. Consult a Health professional or dietitian for advice about appropriate formula). Iron is toxic at doses of 40 mg or more per day in adults. Care should be taken as supplements are available that contain up to 50 mg. Iron supplements may be in liquid or tablet form. Liquid supplements should be diluted well and taken through a straw (to prevent discoloration of the teeth). Iron is best taken on an empty stomach to maximize absorption, but if taken with food there is less risk of stomach upsets.

Iron supplements may cause gastrointestinal irritation, nausea, and constipation, which can be a particular problem in the elderly. Routine iron supplementation is no longer the rule in pregnancy; iron status should be monitored and supplements taken only on advice from an appropriate health professional.

Absorption of iron may be affected by various drugs, including antacids, some antibiotics, and other nutrient supplements. Calcium supplements may reduce iron absorption; large doses of iron may reduce absorption of copper and zinc, and vice versa, and iron reduces absorption of manganese. Vitamin E requirements may be increased if large doses of iron supplements are taken, and vitamin E supplements may prevent adequate blood-forming responses in people with iron deficiency anemia.

For all the above reasons it is probably best to take advice form a health professional if you are contemplating taking iron supplements. This is always advisable in the case of infants and young children.

Solving the Calcium Conundrum

Every once in a while, new research findings seem to fly in the face of conventional nutrition wisdom, leaving health-conscious consumers scratching their heads or throwing up their hands. One of the most recent examples was a study published last July in the British Medical Journal that linked calcium supplementation with increased heart-attack risk.

Researchers analyzed 14 research trials in which subjects took either a placebo or at least 500 mg per day of supplemental calcium in studies lasting longer than a year, with a mean participant age greater than 40 years old. At follow-up a few years later, significantly more participants taking calcium supplements have had heart attacks than those taking placebo. The study authors concluded that calcium supplements (not taken with vitamin D) are associated with an increased risk of heart attack.

In light of the findings, consumers who’ve made a habit of taking supplemental calcium – around 43 percent of the U.S. population and nearly 70 percent of older women, according to findings published in the Journal of Nutrition – have been left to wonder: Do the potential risks of supplementation outweigh the mineral’s bone-supportive benefits?

The real key is that the calcium was taken without the needed vitamin D. there is research suggesting that when calcium is paired with vitamin D, there’s a reduction in the risk of heart disease.

In addition to potentially counteracting increased risk associated with supplemental calcium alone, vitamin D plays a vital role in bone and overall health. It aids in calcium absorption, helps form and maintain strong bones and may protect against osteoporosis. This vitamin has also shown promise in staving off high blood pressure, diabetes and other chronic diseases. And, there’s solid evidence that calcium and vitamin D taken together help prevent bone fractures. Recent research has even shown that improving calcium and vitamin D status substantially reduces all cancer risk in post-menopausal women – yet another motivation to aim for adequate amounts of both nutrients.

The recommendation is to use nutrient-rich and balanced food, such as skim milk and yogurt, as your natural sources of calcium and vitamin D. Other calcium-rich foods include leafy greens, sardines in oil, tofu made with calcium sulfate and enriched forms of orange juice, soy milk and cereals. Substantial sources of vitamin D include some types of fish, cod liver oil and fortified foods such as milk, cereals and juices. (Adequate intake is especially important for people with limited sun exposure, as UV-B rays stimulate the body’s own synthesis of vitamin D).

If you don’t like these foods, try a supplement intended for bone health that is a combination of calcium and vitamin D, along with vitamin K to provide the balance of nutrients needed for bone health. Look for citrate or malate forms of calcium, as those are the best-absorbed forms, and seek out the D3 form of vitamin D.

Before you head to the health-food store, read labels to take stock of how much calcium and vitamin D you’re already getting through food and drink. According to a report released last November (“Dietary Reference Intakes for Calcium and Vitamin D”), you may not be lacking as much as you think, if at all. (A simple blood test can help determine levels of vitamin D in the body, including that produced in response to sunlight). Above all, keep in mind that maintaining bone health isn’t as simple as just a pair of nutrients.

It’s like trying to solve a jigsaw puzzle with two pieces. Consider the lifestyle approach and include calcium, vitamin D, vitamin K and magnesium. Avoid excessive amounts of protein, and follow a sound exercise program. Think overall nutrition and not just nutrients.

(by Liz Robins)

Calcium Supplements for Pregnant Women

For moms who used more calcium supplements during their pregnancy, in particular, during the second trimester, that at 6 months of age, their babies had significantly lower blood pressure than children who are born to moms who used less calcium supplements during the second trimester.

Specifically, for children born to moms who used calcium supplements, the equivalent of about two tablets of calcium supplements a day, their blood pressure was several points lower than those of other children. This becomes important because a number of studies have suggested that blood pressures in children, as early as 6 months of age, often track who is likely to have higher blood pressure as an adult. So by looking at children’s blood pressures at 6 months of age, it gives us an opportunity to identify children who may be at elevated risk for higher blood pressures. As a result of that, over the past several years, children in this age range have blood pressures measured when they go to their pediatrician routinely. The ability to identify factors that may help decide whether a child’s blood pressure is going to be higher through their life or lower becomes a very important finding.

High blood pressure for adults is one of the leading causes of illness, of death, and of healthcare expense. One of the things that becomes so important is to be able to determine when a child or an adult first has high blood pressure because the longer somebody sits with high blood pressure, the more likely he is to have more permanent-lasting effects and damage to his body from the higher blood pressure. So being able to identify that for some individuals the origin or the onset of their high blood pressure begins with what happens in fetal life, gives us the opportunity to focus in at how we can develop ways to prevent high blood pressure from developing in the first place as opposed to having to treat it in older patients.There seems to potentially be the ability to adjust that up or down by some simple interventions such as how much calcium a mom is taking during those very important formative periods in fetal development.

Globally, there have been studies that have suggested during pregnancy, many women have insufficient calcium intake. That is problematic for them in many other ways, including the amount of calcium in their bones and how their hormone systems are functioning, how their kidneys are working, and a variety of other areas. The importance of calcium for moms’ health during her pregnancy is now not only important for the mom, but may also ultimately turn out to be important for her baby’s long-term health.

Calcium Functions

Calcium is a major mineral that plays several important roles in the body. It’s more abundant in the body than any other mineral: most of it in bones and teeth and a very small amount in the blood and soft tissues.

Here are some of calcium’s key functions:
• Helps form and maintain strong bones and teeth (with vitamin D and phosphorus)
• Helps muscles contract
• Helps blood vessels relax and constrict
• Transmits nerve impulses
• Helps blood clot
• Supports the functions of proteins (including enzymes and hormones)
• Helps regulate blood pressure

Although calcium is found in high amounts in a variety of foods including dairy products, fish with bones, and leafy green vegetables, the amount you absorb depends on several factors. Absorption is higher when you consume less and when your needs are higher (as in infancy and pregnancy). Absorption is lower when your vitamin D intake is low. Substances such as phytates (found in nuts, seeds, and grains) or oxalates (found in spinach) can also lower your absorption of calcium, as can consuming too much wheat bran. Women might absorb less calcium after menopause because of low estrogen levels. High intakes of supplemental phosphorus or magnesium can also inhibit the absorption of calcium from foods.

Calcium is found naturally in a variety of foods. The most absorbable calcium is found in dairy foods such as milk, yogurt, and cheese. Other good or excellent sources of highly absorbable calcium are canned fish with bones; vegetables such as kohlrabi, Brussels sprouts, kale, and broccoli; and tofu and soy milk make with calcium.

Calcium is also added to some foods and beverages like orange juice, ready-to-eat cereals, breads, and yogurt products. The amount of calcium that can be absorbed from such products varies considerably.

Too little dietary calcium can contribute to bone or tooth loss and muscle cramps. Chronic low intakes can lead to osteoporosis and increase the risk of high blood pressure, colon cancer, and preeclampsia during pregnancy.
Those with kidney failure, parathyroid disorders, or vitamin D deficiency or those who use certain diuretic medications can develop hypocalcemia with symptoms such as muscle spasms or cramps, convulsions, and lethargy (although some symptoms can be due to their illness and not because of the calcium deficiency).

At risk for getting too little dietary calcium include

• Women after menopause who produce less estrogen (a hormone), lose more bone, and absorb less calcium from dietary sources
• Women of childbearing age who do not get their periods because of eating disorders and/or excessive physical activity
• Those with lactose intolerance or lactose maldigestion who consume few or no dairy foods

Excess intakes of calcium, especially from supplements, can cause bloating, constipation, and kidney problems (such as kidney stones). It can also decrease your body’s absorption of the minerals iron, magnesium, and zinc. Although it’s rare, hypercalcemia can be caused by cancer, overproduction of parathyroid hormone (PTH) by the parathyroid gland, or excess vitamin D from supplements. Symptoms can include fatigue, confusion, decreased appetite, constipation, and impaired organ function.

Preeclampsia is a condition that can occur during pregnancy; symptoms include high blood pressure and protein in the urine.

Parathyroid disorders involve parathyroid glands that rest on the thyroid calcium and phosphorus. Hyperparathyroidism is caused by secretion of excess PTH (and elevates blood calcium levels); hypoparathyroidism is caused by secretion of too little PTH (and lowers calcium levels and elevates phosphorus levels). Hypocalcemia is a condition in which blood levels of calcium are lower than normal.

Hypercalcemia is a condition in which blood levels of calcium are higher than normal.

Vitamin D for Pregnancy and Newborns

Consult Your Doctor BEFORE taking any recommended Vitamin D on your own.

What are the recommendations for vitamin D during pregnancy?

It is recommended that all pregnant women take the prenatal vitamins that contain 400 IU of vitamin D a day along with a vitamin D supplement of 1,000 IU a day. Their calcium supplements may also contain 400 IU of vitamin D a day, and 2,000 IU of vitamin D day is fine, especially for obese women. They should have a blood level of vitamin D between 30 and 100 nanograms per milliliter.

What are the recommendations for dispensing vitamin D to breastfeeding infants?

The American Academy of Pediatrics recently came out with the recommendation that all infants, including breastfed infants, should receive 400 IU of vitamin D a day. This is the bare minimum. Remember, 2,000 IU a day during the first year of life can decrease a child’s risk of diabetes by nearly 80 percent. Thus, giving infants 1,000 IU a day may be more beneficial to their health.

If a woman is already taking 400 IU of vitamin D in a prenatal vitamin, how much more is needed ruing pregnancy and breastfeeding?

All pregnant and lactating women should take the prenatal vitamin containing 400 IU of vitamin D a day along with an additional 1,000 IU vitamin D supplement, for a total of at least 1,400 IU of vitamin D a day. They should also take calcium supplements (1,000 milligrams a day, which can be split into two servings of 500 milligrams each). Or they can obtain their calcium by drinking three to four glasses of skim milk or calcium-fortified orange juice, which will likely be fortified with vitamin D, too.  Pregnant and lactating women can easily take 2,000 IU of vitamin D a day without causing any toxicity. They should maintain a blood level of vitamin D between 30 and 100 nanograms per milliliter.

We used to think too much Vitamin D in pregnant women would cause the fetus’s head growth to be stunted. Is that a myth?

Yes, it is a myth. Taking the recommended 1,400 to 2,000 IU of vitamin D a day will not stunt the fetus’s head growth. Vitamin D deficiency in utero, however, can.

Why are infants only to receive 400 IU? How about premature infants?

Infants appear to satisfy most of their vitamin D requirement for bone health by receiving 400 IU of vitamin D a day. This is the recommendation made by the American Academy of Pediatrics and the Canadian Pediatric Society. There is some evidence that premature infants may not be able to metabolize vitamin D as efficiently, but there are no data to suggest that giving a premature infant more than 400 IU of vitamin D a day has any additional benefit. Thus, infants, including premature infants, receive at least 400 IU of vitamin D a day, and that up to 1,000 IU of vitamin D a day is safe for them.

I am in the third trimester and have been supplementing with 1,400 IU of vitamin D3 a day. My doctor wants me to stop supplementing because my levels of activated vitamin D are twice normal and my vitamin D is normal. She’s worried about toxicity. Should I be?

Absolutely not. Activated vitamin D goes up during the second and third trimester; this is in response to your body’s making more vitamin D-binding protein and your need to increase your efficiency of absorbing dietary supplemental calcium for fetal mineralization. You are perfectly fine and should continue to take your vitamin D. you and your baby will benefit.

The Benefits of Boosting Calcium: All the Way to Weight Loss

An estimated 44 percent to 87 percent of Americans don’t get enough calcium, including children, who are falling severely short on this mineral critical for proper growth and development. Unfortunately, there are not usually any obvious symptoms of a calcium deficiency, and people can go for years in a calcium-deficient state before any noticeable problems occur. Most of the symptoms that might occur due to a calcium deficiency would be seen only if calcium levels are low in the blood. Because the body is very good at keeping the blood calcium levels steady (often at the expense of bone strength), most people will never experience any symptoms of a deficiency until their bones are significantly weakened and fracture.

The benefits of boosting calcium go far beyond the obvious reasons of helping to normalize calcium levels and ensure healthy physiological processing. Several recent studies have shown links between increased calcium intake and specific health benefits in any array of conditions.

Premenstrual syndrome. It is found that a 50 percent decrease in PMS symptoms for women given calcium supplementation, compared to a 30 percent decrease for the placebo group. No other drug addresses all these symptoms as effectively. Another report, based on an epidemiological study of more than two thousand women, found a strong link between calcium and vitamin D intake and the risk of PMS. A high intake of calcium and vitamin D may reduce the risk of PMS.

Weight loss. Other studies have demonstrated links between increased calcium intake and weight loss. One of the researchers reported that calcium plays a key role in metabolic disorders linked to obesity, and also that high calcium diets lead to the release of a hormone that leads to the body’s fat cells losing weight. This is the basis on which the milk industry claims its product helps cinch a waistline, bolstering the “it does a body good” mantra.

High blood pressure. Clinical trials have also linked how calcium levels with high blood pressure. Argentinean research showed that women who take calcium during pregnancy may lower their children’s future risk of blood-pressure problems. Studies done at Rockefeller University showed that calcium supplements were of general benefit to both mother and baby during pregnancy.

Colon cancer. Researchers have linked calcium with the prevention of colon cancer.

Stroke. Harvard scientists reported on a link between increased calcium and the prevention of stroke.

Cholesterol. Researchers have shown that increased calcium can lower LDL (bad) cholesterol.

The Ex Factor

You know you can’t get through a health book without a mention of the “ex” factor, or exercise. Physical activity directly ties in to the conversation about bone and muscle health. Physical exercise, especially the weight-bearing kind, puts healthy stress on your bones to keep them strong and force them to be even stronger. It also works the muscles that keep you nimble and quick on your feet.

Young women and men who exercise regularly generally achieve greater peak bone mass than those who do not. Exercising allows us to maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis. The exercise you choose needn’t be complicated, boring, or overly challenging or demanding. The best exercise for your bones is the kind that forces you to work against gravity, even if its’ simply by working against your own body weight, as is the case for modern forms of yoga, mat Pilates, and the use of a resistance band. Other examples include weight training, hiking, jogging, climbing stairs, tennis, dancing, and of course, walking. It’s the constant pounding on the ground that translates to better muscle strength in the hips and lower back, maintaining or increasing bone density. These are the two places that are at highest risk for fracture.