Do you really need mineral supplements?
By
Dr. Leow Chee Seng
MBA (UPM), DBA (UBI), FBIH (UK), MMIM (Mal), MIHRM (Mal), MIM-CPT (Mal),CAHRP (Consultant) Mal), Certified E-Commerce Professional (Mal),Certified Professional Trainer (MIM, PSNB),Certified Stress Management (IACT, USA),Certificate Qualitative Research (Georgia, USA), Certificate in Homeopathy Medicine (Mal)
Practising Cognitive, Behavioural Therapist
Practicing Nutrition Therapist
When we walk into a pharmacy, the sale executive introduces different supplement to us. They explain the functions and benefits of each supplement. However, have we ever thought if the supplement needs by our body?
Practicing Nutrition Therapist
When we walk into a pharmacy, the sale executive introduces different supplement to us. They explain the functions and benefits of each supplement. However, have we ever thought if the supplement needs by our body?
For a healthy people, supplements help us to
· Prevent vitamin and mineral deficiencies when the diet does not provide adequate nutriens of all necessary nutrients.
· Supply amounts of nutrients larger than the diet can provide
· Protect against future disease
However, different individual takes supplement for various reasons. Recent nutrition surveys in United States has identified the deficiency supplement among their citizen includes calcium, iron, zinc, magnesium, copper and manganese. In general, there are few groups of people need special concern on nutrition, early people premenopausal women, athletes and special care patients. Besides, weight-loss, pure vegetarian, macrobiotic, and several other diets can also place some people at risk of deficiencies that vary with the type of diet. Dietary deficiencies increase the risk for diseases.
Tips
Elderly people always stay at home. They would face deficiency of vitamin D, vitamin A, vitamin E, calcium, vitamin B1, vitamin B2, and zinc.
Premenopausal women have found have low amount of consumption on calcium, iron, Vitamin A and Vitamin C.
Scientific prove on different vitamins
a) Vitamin A and beta-carotene.
A lot of people assume beta-carotene and vitamin A are the same. In fact, beta-carotene is a precursor to vitamin A. However, beta-carotene and vitamin A have different role in human health. When we shop in a pharmacy, it is not easy for us to buy vitamin A. Most of the supplement for vitamin A is sold in the form of beta-carotene. Deficiency of vitamin A is uncommon among healthy people except for older age groups. Several researches have proven that vitamin A is important for building our immune system but vitamin A supplementation did not help prevent infections in elderly people living in nursing homes. Bare in mind that never take vitamin A in the form of retinol more than 10,000 IU because it leads to birth defects and bone loss.
Beta-carotene increases the number of white blood cells and enhance-fighting immune functions in healthy people who take 25,000 to 100,000 IU per day. In contrast, there are some research that was conducted among smokers reported that supplements of synthetic beta-carotene increases the risk of both heart disease and lung cancer. However, a few of trials found that there is no positive and negative relationship between synthetic beta-carotene and other diseases including cancer, diabetes, angina pectoris, age-related eye disease, and intermittent claudicating. In practical, I always encourage people to take natural food as the source of beta-carotene instead of synthetic. Research has found that synthetic beta-carotene even is similar to synthetic beta carotene but only natural beta-carotene is able to reverse precancerous changes, which synthetic beta carotene does not. No studies have done to investigate if natural beta carotene could be more effective than synthetic form in preventing other diseases, but the potential harm for taking synthetic beta-carotene it should avoided by smokers.
b) Vitamins B
Vitamin B is subcategories into B1 (thiamine ), B2 (riboflavin) , B3(niacin) , B5(pantothenic acids ) B6(pyridoxine), B12(cobalamin). Western diet has adequate supply of vitamin B except vitamin B5 and B6 because the nutrition is added to white flour products and other food. There is a study shows that 49% of a group of male and female adolescents were found deficiency of vitamin B5. Vitamin B6 deficiency is common among geriatric population in western. Vitamin B12 deficiency is not common among healthy young people except vegans who also avoid daily and eggs. In US, there is about 15% of population face deficiency problem of this vitamin. One of the possibility of deficiency of vitamin B12 is due to people who take acid-blocking drugs or antacids for a long period of time. For old people, the deficiency of vitamin B12 is often related to degenerative that causing malabsorption of vitamin B12 from food among them. Another vitamin, biotin is produced by intestinal bacteria in amount that, along the typical dietary biotin intake, to prevent deficiency of nutrients.
There is no scientific research has done if vitamin B prevent disease. However, nutritionist believe that vitamin B6 is able to prevent heart disease by regulate blood homocysteine level in blood. However, there is no other research on preventive effect of vitamin B6 supplement on health. Vitamin B12 is important for control of homocysterine level in blood. Elevated homocysterine levels are associated with heart disease, stroke, Alzheimer’s disease and osteoporosis, and some, even not all, research suggests that homocysteine has a direct role in causing those diseases.
In practice, 100 mcg per day of vitamin B12 was adequate to reverse vitamin B12 deficiency in healthy elderly people. Besides, daily supplementation with 400 mcg of folic acids, 10mg of vitamin B6 and 50mcg of vitamin B12 lowers elevated homocysteine levels in most people. Some research have shown that supplementing with one or more of these vitamins helps preventing or reverse hardening of arteries and may reduce the risk of bone fracture.
c) Folic Acids
Folic acids deficiency is quite common throughout the world. In United States, about 11% of healthy people are affected by deficiency of folic acids. Hence, the US Food and Drug Administration (FDA) mandated that some grain products provide supplemental folic acids to reduce the prevalence of deficiency of folic acids. However, this increase of folic acids in food does not have effect on preventive measures for heart disease and birth defects.
The usage of folic acids in Obstetrics and gynecology clinic is common because requirement of folic acids double during pregnancy. The insufficient intake of folic acid has been associated to the low birth weight and increase in incidence of neural tube defects in newborns. Specialist would usually provide 400mcg per day of folic acid prior to and short conception to overcome of neural tube defects in newborns.
d) Ascorbic acids / vitamin C
Deficiency of vitamin C is rare in Asia but for those who consume Western diets, but insufficiency is found 6% of healthy adults especially among college students and smokers. For preventive purposes, a person is encouraged to take at least 90 to 100mg per day. Excessive concentration of vitamin C does not have any effect on concentration of vitamin C in the blood. Hence, a small amount of vitamin C is needed for prevention of disease.
e) Vitamin D
God provides us with free vitamin D everyday when exposing to sunlight, but sources can be insufficient especially for old people who seldom go out. Besides, deficiency of vitamin D also faces by vegans during winter month. In United States, there is 6% - 14% of population of healthy adult who has problem with deficiency of vitamin D. Vitamin D insufficiency is associated with bone loss and fractures in older people. In a double blind study, supplement of 800 IU per day of vitamin D prevented bone loss more effectively than 200 IU per day in postmenopausal women. Remember, vitamin D is known to be toxic in very high amounts, up to 2 000 IU per day is considered safe.
f) Vitamin E
It is reported that 27% of the US population had low blood levels of vitamin E. Research has found that 400 to 800 IY of vitamin E per day lowered risk of nonfatal heart attacks, but no fatal ones. Besides, there is another double blind trial found no beneficial effect from 400 IU per day of vitamin E supplementation on risk of nonfatal heart attacks, while another research found that 50 IU per day had no effect on heart attack. However, some double blind research has found that 50 IU per day of vitamin E is association with the reduction of risk of prostate cancer among smokers. Another recent research found that large amount of vitamin E (400IU per day or more) may result in a small increase in all-cause mortality, which another shows that there is an increase of heart failure. From all the research, some doctors are advising people not to take large amount of vitamin E.
In nutrition industries, mixed tocopherols, as opposed to the more w widely used alpha-tocopherols, may be safer and beneficial on heart-disease prevention. Supplementing of 100 IU per day of vitamin E is associated with lowered risk of heart disease
g) Vitamin K
Vitamin K is believed to help in blood clotting. Deficiency of vitamin K can cause bleeding problem but it is rare among healthy people. Besides blood clot, low vitamin K in blood is always associated to osteoporosis. In nutrition point of view, at least 1mg per day of vitamin K is used to reduce bone loss among women.
h) Calcium
Deficiency of calcium is more obvious among women. Good calcium nutrition throughout life is essential for achieving peak bone mass and preventing deficiency-related bone loss. Besides, scientific research has proven that high calcium level I the blood could reduce the possibility of bone fractures. However, very few researches conclude the effect of calcium on the protection of bones.
The needs of supplementing calcium for postmenapausal women, 800 to 1000mg is generally added to dies that commonly between 500mg to 700mg of calcium per day.
i) Phosphorus
Phosphorus plays essential roles in maintaining our health. However, our diets no matter the West or the East have adequate in this mineral. Some organisation proposed that the high level of phosphorus is hazardous to calcium and affects the metabolism of the bones. In general population, we do not need to take supplement of calcium. Hence, most multivitamins in the supplements do not add phosphorus as one of the element. However, for elderly there might be an exception because phosphorus level is associated to calcium level in our body. Hence, older person who is taking calcium supplement could be benefited when taking phosphorus supplement to increase absorption of the nutrients.
j) Magnesium
Magnesium deficiency is more commonly seen among elderly people. As the rule of thumb, at least 250mg per day may help preventing of bone lose.
k) Potassium
Modern diets have lower potassium level as compared to primitive diets. However, true deficiencies are uncommon. Some research has identified the role of potassium on preventing high blood pressure. Other research proposed that higher potassium level in diets can prevent stroke. Unfortunately, supplemental potassium allowed in each pill is only 99mg which is far below the recommended amount (2 400mg per day). However, multiple of potassium pills are recommended because it could cause stomach upset. Hence, in order to increase potassium level in the blood, the best method is to increase the frequency of taking fruits, vegetables or their juices.
l) iron
Deficiency of iron is more commonly among vegetarians, menstruating girls and women, pregnant women, female and adolescent athletes. Iron plays important roles in synthesis red blood cells (erythrocytes) in our body. Excessive of iron increases the risk factors for heart diseases, some cancers, diabetes, rate of infection and exacerbation of rheumatoid. In practice, iron supplements should be avoided unless they have been diagnosed with having, or being high risk of iron deficiency.
m) Iodine
Iodine deficiency is a major problem in many developing countries. Western countries have taken initiation to introduce iodized salt and the iodine is added to many foods. However, iodine intake has decrease in recent years. The deficiency is higher among countries where iodized salt is not available. Most people do not have problem regards to iodine unless they are avoiding seafood and sea vegetables. Patients with thyroid disease should check their doctor before using the iodine supplements.
n) Zinc
Zinc deficiency is not common but it has higher prevalence among countries with low incomes. Zink supplements (10mg per day) have prevented growth impairment in deficient American and Canadian children. Research has shown that 25mg to 150mg of zinc per day increases immune function among healthy people. Extreme level of zinc supplement impare the function of immune function and some healthcare professional recommend no more than 30mg to 50mg per day. There is a significant relationship between zinc level in blood and absorption of copper. Hence, when a person is taking zinc supplement, we would recommend them to take copper supplement to avoid zinc-induced copper deficiency.
o) Copper
The average dietary copper intake in the States has been found to below the accepted standards. Copper supplement helps to prevent bone loss. Since zinc can interfere with copper absorption, copper should be taken whenever zinc supplement are used for more than a few weeks.
p) Manganese
Although the content of manganese is low in processed food, but the dietary intake of the nutrient is adequate. Manganese deficiency has been associated with osteoporosis in unpublished studies. A double-blind trial found that a combination of mineral supplements including manganese prevented bone loss in postmenopausal women. Iron can reduce manganese absorption and cause lower body levels of manganese. So, manganese may be important to include when iron is supplemented. However, there is no other studies have studied the effect of manganese supplement to health.
q) Chromium
There is a disagreement about the extent of chromium deficiency in Western society because chromium nutrition has been difficult to study because of technical problems in analyzing foods and human body fluids for chromium content. Chromium deficiency has been associated with blood sugar and cholesterol abnormalities. A common observation is that the level of chromium in our body reduces during aging. Therefore, chromium supplements have not been tested of their ability to prevent diabetes and cardiovascular diseases. Healthcare professionals recommend the supplement of chromium as a reasonable precaution because a few single case report have described possible side effects in people taking large amounts of chromium, from 600 to 2 400mcg per day, although it is not clear whether chromium was responsible for these reactions.
r) Selenium
Selenium deficiency is rare among US Citizen. According to Recommended Dietary Allowance (FDA), 70mcg per day of selenium is recommended in the diet. However, a double blind studies found that people with 200mcg of yeast based selenium per day for four and a half years had a 50% drop in the cancer death rate over seven years compared with the placebo group. For healthy people, higher amount of selenium has been used for the cancer preventive effect. The upper end of safe long-term selenium intake has been estimated to 350 – 400 mcg per day.
s) Molybdenum
Molybdenum is an essential mineral with low potential of toxicity. The deficiencies of Molybdenum is rare, estimated requirement are based on what a person usually received in their diets. A study was conducted in China found that there is no benefit for a supplement containing vitamin C and molybdenum for cancer and cardiovascular disease. There is no other study has been conducted on investigating disease prevention with molybdenum supplements.
Elderly people always stay at home. They would face deficiency of vitamin D, vitamin A, vitamin E, calcium, vitamin B1, vitamin B2, and zinc.
Premenopausal women have found have low amount of consumption on calcium, iron, Vitamin A and Vitamin C.
Scientific prove on different vitamins
a) Vitamin A and beta-carotene.
A lot of people assume beta-carotene and vitamin A are the same. In fact, beta-carotene is a precursor to vitamin A. However, beta-carotene and vitamin A have different role in human health. When we shop in a pharmacy, it is not easy for us to buy vitamin A. Most of the supplement for vitamin A is sold in the form of beta-carotene. Deficiency of vitamin A is uncommon among healthy people except for older age groups. Several researches have proven that vitamin A is important for building our immune system but vitamin A supplementation did not help prevent infections in elderly people living in nursing homes. Bare in mind that never take vitamin A in the form of retinol more than 10,000 IU because it leads to birth defects and bone loss.
Beta-carotene increases the number of white blood cells and enhance-fighting immune functions in healthy people who take 25,000 to 100,000 IU per day. In contrast, there are some research that was conducted among smokers reported that supplements of synthetic beta-carotene increases the risk of both heart disease and lung cancer. However, a few of trials found that there is no positive and negative relationship between synthetic beta-carotene and other diseases including cancer, diabetes, angina pectoris, age-related eye disease, and intermittent claudicating. In practical, I always encourage people to take natural food as the source of beta-carotene instead of synthetic. Research has found that synthetic beta-carotene even is similar to synthetic beta carotene but only natural beta-carotene is able to reverse precancerous changes, which synthetic beta carotene does not. No studies have done to investigate if natural beta carotene could be more effective than synthetic form in preventing other diseases, but the potential harm for taking synthetic beta-carotene it should avoided by smokers.
b) Vitamins B
Vitamin B is subcategories into B1 (thiamine ), B2 (riboflavin) , B3(niacin) , B5(pantothenic acids ) B6(pyridoxine), B12(cobalamin). Western diet has adequate supply of vitamin B except vitamin B5 and B6 because the nutrition is added to white flour products and other food. There is a study shows that 49% of a group of male and female adolescents were found deficiency of vitamin B5. Vitamin B6 deficiency is common among geriatric population in western. Vitamin B12 deficiency is not common among healthy young people except vegans who also avoid daily and eggs. In US, there is about 15% of population face deficiency problem of this vitamin. One of the possibility of deficiency of vitamin B12 is due to people who take acid-blocking drugs or antacids for a long period of time. For old people, the deficiency of vitamin B12 is often related to degenerative that causing malabsorption of vitamin B12 from food among them. Another vitamin, biotin is produced by intestinal bacteria in amount that, along the typical dietary biotin intake, to prevent deficiency of nutrients.
There is no scientific research has done if vitamin B prevent disease. However, nutritionist believe that vitamin B6 is able to prevent heart disease by regulate blood homocysteine level in blood. However, there is no other research on preventive effect of vitamin B6 supplement on health. Vitamin B12 is important for control of homocysterine level in blood. Elevated homocysterine levels are associated with heart disease, stroke, Alzheimer’s disease and osteoporosis, and some, even not all, research suggests that homocysteine has a direct role in causing those diseases.
In practice, 100 mcg per day of vitamin B12 was adequate to reverse vitamin B12 deficiency in healthy elderly people. Besides, daily supplementation with 400 mcg of folic acids, 10mg of vitamin B6 and 50mcg of vitamin B12 lowers elevated homocysteine levels in most people. Some research have shown that supplementing with one or more of these vitamins helps preventing or reverse hardening of arteries and may reduce the risk of bone fracture.
c) Folic Acids
Folic acids deficiency is quite common throughout the world. In United States, about 11% of healthy people are affected by deficiency of folic acids. Hence, the US Food and Drug Administration (FDA) mandated that some grain products provide supplemental folic acids to reduce the prevalence of deficiency of folic acids. However, this increase of folic acids in food does not have effect on preventive measures for heart disease and birth defects.
The usage of folic acids in Obstetrics and gynecology clinic is common because requirement of folic acids double during pregnancy. The insufficient intake of folic acid has been associated to the low birth weight and increase in incidence of neural tube defects in newborns. Specialist would usually provide 400mcg per day of folic acid prior to and short conception to overcome of neural tube defects in newborns.
d) Ascorbic acids / vitamin C
Deficiency of vitamin C is rare in Asia but for those who consume Western diets, but insufficiency is found 6% of healthy adults especially among college students and smokers. For preventive purposes, a person is encouraged to take at least 90 to 100mg per day. Excessive concentration of vitamin C does not have any effect on concentration of vitamin C in the blood. Hence, a small amount of vitamin C is needed for prevention of disease.
e) Vitamin D
God provides us with free vitamin D everyday when exposing to sunlight, but sources can be insufficient especially for old people who seldom go out. Besides, deficiency of vitamin D also faces by vegans during winter month. In United States, there is 6% - 14% of population of healthy adult who has problem with deficiency of vitamin D. Vitamin D insufficiency is associated with bone loss and fractures in older people. In a double blind study, supplement of 800 IU per day of vitamin D prevented bone loss more effectively than 200 IU per day in postmenopausal women. Remember, vitamin D is known to be toxic in very high amounts, up to 2 000 IU per day is considered safe.
f) Vitamin E
It is reported that 27% of the US population had low blood levels of vitamin E. Research has found that 400 to 800 IY of vitamin E per day lowered risk of nonfatal heart attacks, but no fatal ones. Besides, there is another double blind trial found no beneficial effect from 400 IU per day of vitamin E supplementation on risk of nonfatal heart attacks, while another research found that 50 IU per day had no effect on heart attack. However, some double blind research has found that 50 IU per day of vitamin E is association with the reduction of risk of prostate cancer among smokers. Another recent research found that large amount of vitamin E (400IU per day or more) may result in a small increase in all-cause mortality, which another shows that there is an increase of heart failure. From all the research, some doctors are advising people not to take large amount of vitamin E.
In nutrition industries, mixed tocopherols, as opposed to the more w widely used alpha-tocopherols, may be safer and beneficial on heart-disease prevention. Supplementing of 100 IU per day of vitamin E is associated with lowered risk of heart disease
g) Vitamin K
Vitamin K is believed to help in blood clotting. Deficiency of vitamin K can cause bleeding problem but it is rare among healthy people. Besides blood clot, low vitamin K in blood is always associated to osteoporosis. In nutrition point of view, at least 1mg per day of vitamin K is used to reduce bone loss among women.
h) Calcium
Deficiency of calcium is more obvious among women. Good calcium nutrition throughout life is essential for achieving peak bone mass and preventing deficiency-related bone loss. Besides, scientific research has proven that high calcium level I the blood could reduce the possibility of bone fractures. However, very few researches conclude the effect of calcium on the protection of bones.
The needs of supplementing calcium for postmenapausal women, 800 to 1000mg is generally added to dies that commonly between 500mg to 700mg of calcium per day.
i) Phosphorus
Phosphorus plays essential roles in maintaining our health. However, our diets no matter the West or the East have adequate in this mineral. Some organisation proposed that the high level of phosphorus is hazardous to calcium and affects the metabolism of the bones. In general population, we do not need to take supplement of calcium. Hence, most multivitamins in the supplements do not add phosphorus as one of the element. However, for elderly there might be an exception because phosphorus level is associated to calcium level in our body. Hence, older person who is taking calcium supplement could be benefited when taking phosphorus supplement to increase absorption of the nutrients.
j) Magnesium
Magnesium deficiency is more commonly seen among elderly people. As the rule of thumb, at least 250mg per day may help preventing of bone lose.
k) Potassium
Modern diets have lower potassium level as compared to primitive diets. However, true deficiencies are uncommon. Some research has identified the role of potassium on preventing high blood pressure. Other research proposed that higher potassium level in diets can prevent stroke. Unfortunately, supplemental potassium allowed in each pill is only 99mg which is far below the recommended amount (2 400mg per day). However, multiple of potassium pills are recommended because it could cause stomach upset. Hence, in order to increase potassium level in the blood, the best method is to increase the frequency of taking fruits, vegetables or their juices.
l) iron
Deficiency of iron is more commonly among vegetarians, menstruating girls and women, pregnant women, female and adolescent athletes. Iron plays important roles in synthesis red blood cells (erythrocytes) in our body. Excessive of iron increases the risk factors for heart diseases, some cancers, diabetes, rate of infection and exacerbation of rheumatoid. In practice, iron supplements should be avoided unless they have been diagnosed with having, or being high risk of iron deficiency.
m) Iodine
Iodine deficiency is a major problem in many developing countries. Western countries have taken initiation to introduce iodized salt and the iodine is added to many foods. However, iodine intake has decrease in recent years. The deficiency is higher among countries where iodized salt is not available. Most people do not have problem regards to iodine unless they are avoiding seafood and sea vegetables. Patients with thyroid disease should check their doctor before using the iodine supplements.
n) Zinc
Zinc deficiency is not common but it has higher prevalence among countries with low incomes. Zink supplements (10mg per day) have prevented growth impairment in deficient American and Canadian children. Research has shown that 25mg to 150mg of zinc per day increases immune function among healthy people. Extreme level of zinc supplement impare the function of immune function and some healthcare professional recommend no more than 30mg to 50mg per day. There is a significant relationship between zinc level in blood and absorption of copper. Hence, when a person is taking zinc supplement, we would recommend them to take copper supplement to avoid zinc-induced copper deficiency.
o) Copper
The average dietary copper intake in the States has been found to below the accepted standards. Copper supplement helps to prevent bone loss. Since zinc can interfere with copper absorption, copper should be taken whenever zinc supplement are used for more than a few weeks.
p) Manganese
Although the content of manganese is low in processed food, but the dietary intake of the nutrient is adequate. Manganese deficiency has been associated with osteoporosis in unpublished studies. A double-blind trial found that a combination of mineral supplements including manganese prevented bone loss in postmenopausal women. Iron can reduce manganese absorption and cause lower body levels of manganese. So, manganese may be important to include when iron is supplemented. However, there is no other studies have studied the effect of manganese supplement to health.
q) Chromium
There is a disagreement about the extent of chromium deficiency in Western society because chromium nutrition has been difficult to study because of technical problems in analyzing foods and human body fluids for chromium content. Chromium deficiency has been associated with blood sugar and cholesterol abnormalities. A common observation is that the level of chromium in our body reduces during aging. Therefore, chromium supplements have not been tested of their ability to prevent diabetes and cardiovascular diseases. Healthcare professionals recommend the supplement of chromium as a reasonable precaution because a few single case report have described possible side effects in people taking large amounts of chromium, from 600 to 2 400mcg per day, although it is not clear whether chromium was responsible for these reactions.
r) Selenium
Selenium deficiency is rare among US Citizen. According to Recommended Dietary Allowance (FDA), 70mcg per day of selenium is recommended in the diet. However, a double blind studies found that people with 200mcg of yeast based selenium per day for four and a half years had a 50% drop in the cancer death rate over seven years compared with the placebo group. For healthy people, higher amount of selenium has been used for the cancer preventive effect. The upper end of safe long-term selenium intake has been estimated to 350 – 400 mcg per day.
s) Molybdenum
Molybdenum is an essential mineral with low potential of toxicity. The deficiencies of Molybdenum is rare, estimated requirement are based on what a person usually received in their diets. A study was conducted in China found that there is no benefit for a supplement containing vitamin C and molybdenum for cancer and cardiovascular disease. There is no other study has been conducted on investigating disease prevention with molybdenum supplements.
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