VITAMINS

G. Douglas Andersen, DC, DACBSP, CCN

Vitamin

Major Functions

Deficiency Signs and Symptoms

Toxicity Signs and Symptoms

Top Food Sources

Comments

Vitamin A
(retinol)

USRDA 5000 IU
1 IU = .3 mcg retinol
1 IU = .344 mcg retinyl acetate

1 IU = .55 mcg retinyl palmitate

Affects both cell and antibody-mediated immune response; required for normal vision, healthy epithelial membranes and skin; high doses have been used for acne and to prevent immune compromise during radiation and chemotherapy

Night blindness, Bitot's spots, frequent infections, impaired wound healing, follicular hyperkeratosis (rough, dry, scaly skin),birth defects; deficiencies may result from low dietary intake, malabsorption or depletion caused by infection

Birth defects, abortion, dry, itchy, flakey skin, headaches, malaise, loss of appetite/weight, hair loss, bone/joint pain, eye irritation

Liver, egg yolks, butter, cream, cod liver oil

Oral contraceptives increase plasma levels of vitamin A.  Deficiency is the leading cause of nonaccidental blindness in children.  Hypervitaminosis A is the most common vitamin excess.  During pregnancy both deficiency and excess can cause birth defects.

Beta carotene

No RDA

3 mg = 5000 IU (First conversion system)

Converted to vitamin A by the liver; diabetics have a decreased ability to make this conversion; although not technically a vitamin, it is the only source of vitamin A in many multi formulas

Low dietary levels are associated with higher rates of several types of cancer

Orange skin (palms, soles, nasolabial folds) are seen with high levels of ingestion but pose no health risks; large supplemental amounts in heavy smokers can increase lung cancer rates

Red peppers, yams, mangoes, carrots, apricots, spinach, dark greens

Beta carotene is not technically a vitamin but is included in many supplements since it is converted to vitamin A by the body. There are 2 systems of measuring conversions which leads to confusion. The first system: 2 mcg of beta carotene = 1 mcg of retinol = 3.33 IU. The second system: 6 mcg beta carotene = 1 mcg retinol = 5 IU = 1 retinol equivalent (RE).

Vitamin D (cholecalciferol)

USRDA 400 IU
RDA over age 70- 600 IU

Aids in calcium, phosphorus, and magnesium absorption, thus, critical for healthy bones; inhibits proliferation of several types of cancer; may slow the progression of multiple sclerosis

Rickets in children, osteomalacia, osteopenia, osteoporosis

Excessive thirst, loss of appetite, nausea, vomiting, weakness, headache, constipation, hypercalcuria (which can lead to decreased kidney function and calcium deposits)

Fortified milk products, seafood, sunflower seeds, cod liver oil

Not technically a vitamin. Made in the body from sun exposure.  Sun production is inhibited or can be stopped due to seasonal (fall, winter) and geographic (northern latitudes) factors.  Production from sunlight is also inhibited with persons with darker skin, older age, and lack of exposure, either from excessive clothing or staying indoors.  Geriatrics are especially prone to deficiency.  Low serum levels are associated with increased incidence of osteoarthritis, osteoporosis, and fracture. 40 IU = 1 mcg.

Vitamin E (tocopherols)
"d" natural form
"dl" synthetic form

RDA 22.4 IU (15 mg) for d alpha tocopherol

Lipid-soluble antioxidant; protects red blood cells, neurological and lung tissue; the new RDA is set for the natural form only; to convert from mg to IU, multiply mg by 1.49

Rare; peripheral neuropathy, increased RBC fragility (hemolytic anemia), ataxia, muscle weakness

Generally quite safe; can cause fatigue, breast tenderness, GI and emotional problems; may increase blood pressure in hypertensives; may augment anticoagulant activity in persons with clotting disorders; Women with heart disease on hormone-replacement therapy should avoid high doses.

Nuts, seeds, wheat germ, vegetable oil

Enhances immunity, age-related eye disease; may help reduce nocturnal leg cramps and PMS.  To convert IU to mg, multiply IU in "d" forms by 0.67 and "dl" forms by 0.45. Gram doses may decrease beta carotene to vitamin A conversion, reduce vitamin K absorption, and interfere with vitamin D bone mineralization

Vitamin K (phylloquinone)

RDA males 80 mcg
females 65 mcg

Critical for blood clotting;  activates proteins required for bone mineralization and calcium binding.

Easy bruising, GI bleeding, nose bleeds, heavy periods

Natural forms are safe; persons on warfarin should avoid supplements

Green, leafy vegetables, broccoli, cabbage, spinach

Deficiency may be dietary, malabsorption, or loss of storage sites (liver disease)

Vitamin B1
(thiamin)

USRDA 1.5 mg

Energy production from carbohydrates; required for healthy nervous tissue and brain cells

Fatigue, depression, neuropathy, loss of appetite; moderate deficiency is seen in Wernicke-Korsakoff syndrome, which in addition to the above symptoms include emotional changes, ataxia, and mental derangement; severe deficiency is known as beriberi-edema, muscular atrophy and weakness, cardiac failure

Very rare

Nuts, beans, oats, wheat germ, bran, pork, sunflower seeds

97 percent is lost milling whole wheat to white flour.  B1 is depleted by alcohol.

Vitamin B2 (riboflavin)

USRDA 1.7 mg

Energy production from carbohydrates, fats, and protein; a component of the energy-producing enzymes flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN); antioxidant effects by regeneration of glutathione

Usually not seen alone; cheilosis (chapped, swollen, fissured lips), angular stomatitis (sores at the corner of the mouth), glossitis (swollen, fissured, sore tongue), photophobia, seborrheic dermatitis (crusty, scaly skin) especially around nasolabial folds, scrotum, and labia

Very rare; high doses over long periods may cause diarrhea; harmless coloring of urine (orange/ yellow) appears a few hours following ingestion

Liver, almonds, wild rice, mushrooms, egg yolks

Due to involvement in the metabolism of B3, B6, K, and folic acid, deficiencies can cause a wide range of problems. 400 mg in divided doses appears to be an effective prophylactic treatment for migraine sufferers. Riboflavin is destroyed by light.

Vitamin B3
Niacin, niacinamide (nicotinic acid and nicotinamide)

USRDA 20 mg

Involved with over 200 reactions in the body; a component of enzymes nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which are involved in energy production from carbohydrates, fats, and proteins; fatty acid, steroid, and DNA synthesis. 60 mg of tryptophan can synthesize 1 mg of niacin in the body.

Dermatitis, diarrhea, inflamed tongue and mouth, psychiatric changes; pellagra includes the above symptoms with irreversible dementia and is seen with acute deficiency

Transient flushing (with large doses or the hypersensitive) which may be accompanied by itching, dizziness, palpitations, and sweating; time release forms can cause liver damage; very high doses may also cause elevated blood glucose, peptic ulcers

Rice bran, wheat bran, peanuts, white meat turkey and chicken, rabbit, peanut butter

Niacinamide form does not lower lipids but may help signs and symptoms of osteoarthritis. Inositol nicotinate (no-flush niacin) can lower LDL cholesterol, triglycerides, lipoprotein A, fibrinogen, and increase HDL cholesterol like niacin can without the side effects. Inositol nicotinate may also help reduce the symptoms of Raynaud's disease and intermittent claudication. 80 percent is retained after cooking.

Vitamin B5 (pantothenic acid, pantothenate)

USRDA 10 mg

A component of coenzyme A, it is used for energy production from carbohydrates, protein, and fat; it is also involved in the synthesis of acetyl choline, adrenal hormones, heme, and cholesterol

Deficiency is rare.

Numbness and tingling of the hands and feet, muscle cramps of the arms and legs, headache, GI disturbances, fatigue, depression, irritability

No reports of toxicity; megadoses10,000 mg or moremay cause diarrhea

Beef, pork, chicken, fish, nuts, mushrooms

High dose 500 mg q.i.d. helps reduce RA pain.  Pantethine (an intermediate of B5) can lower total cholesterol, LDL, triglycerides Apoliprotein B and raise HDL and Apoliprotein A1.

Vitamin B6 (pyridoxine, pyridoxal)

USRDA 2 mg

Protein and amino acid metabolism; it is involved in over 100 enzyme reactions including the synthesis of sphingolipids and the neurotransmitters serotonin, dopamine, GABA, and norepinephrine; converts homocysteine to cysteine

Cheilosis, glossitis, stomach irritability, depression, anemia

Peripheral neuropathy (often when patients take 200 mg or more); insomnia

Fish, beans, walnuts, bananas, sunflower seeds

May help a variety of conditions including carpal tunnel syndrome, PMS, and kidney stones. Cooking destroys up to 50 percent. Food color FD&C yellow #5 may reduce absorption.

Folic acid
(folate, folacin)

USRDA 400 mcg
RDA pregnancy 600 mcg

Purine and pyrimidine synthesis, heme production converts homocysteine to methionine and helps in the formation of tyrosine, serine, and glutamic acid; deficiency while pregnant can cause neural tube defects

Fatigue, weakness, headache, glossitis, irritability, depression, restless leg syndrome; hematological effects (macrocytic anemia) are similar to that of vitamin B12 and include increased MCV, MCH, and MCHC

Safe unless there is a B12 deficiency; high doses will correct the hematological symptom complex, thus masking inadequate B12 which will result in neurological damage

Black-eyed peas, wheat germ, bran, beans, green, leafy vegetables, nuts

Low dietary levels are associated with various cancers. Ten percent of the population have defective folate enzyme which causes elevated homocysteine (it cannot bind to FAD which is a cofactor in reducing homocysteine to methionine). Supplementation can correct this problem which is a major cause of heart disease. Easily destroyed by cooking.

Vitamin B12 (cobalamins, cyanocobalamin)

USRDA 6 mcg

Red blood cell production; healthy myelin; DNA and RNA synthesis; converts homocysteine to methionine

Fatigue, shortness of breath, pallor; neuropathy, especially over age 60; hematological signs are very similar to folic acid; age-related loss of hearing, memory, and concentration; loss of bladder, bowel control; impotence, glossitis, weight loss, insomnia

Toxicity is very unusual. Urticaria, rash, and pruritus have been reported

Only animal products; meats, dairy, clams, oysters, egg yolks, sardine, liver

The most complex molecule of all vitamins, it has special uptake needs. Loss of stomach acidity reduces secretion of intrinsic factor which reduces absorption. Traditional laboratory tests are not accurate for subclinical deficiencies. Plants do not synthesize; thus, vegetarians should supplement. Intrinsic factor declines with age.

Biotin

USRDA 300 mcg

Energy production, fatty acid synthesis, healthy hair and nails

Dermatitis around orifices (mouth, nose, ears, eyes, perianal), hair loss, depression, gray skin

No reports of toxicity

Soy, liver, egg yolk, peanuts, walnuts

The food availability of biotin varies.  For example, 100 percent of the biotin in corn is absorbed but none of the biotin in wheat is absorbed.  Uncooked eggs have a protein, avidin, that binds biotin and prevent its absorption. Cooking will denature this protein, allowing absorption.

Vitamin C
(ascorbic acid, ascorbyl palmitate, ascorbate)

RDA males 90 mg
females 75 mg

Most important water-soluble antioxidant in the body; reduces several species of free radicals; regenerates vitamin E; involved in the formation of collagen, elastin, proteoglycans, bone matrix, and collagen gene expression; involved in the synthesis of the neurotransmitters dopamine, epinephrine, and norepinephrine; needed for synthesis of carnitine; may reduce the toxicity and improve effectiveness of chemotherapy and radiation of cancer patients

Fatigue, gum disease, easy bruising, slow wound healing, frequent infections; scurvy is the classic deficiency disease which has the above symptoms along with weakness, pain, depression, anemia, hemorrhage; all systems of the body may be affected by scurvy

Rare; high amounts can cause diarrhea, nausea, bloating

Acerola cherries, rose hips, red peppers, all citrus, guavas, greens (kale, collard, parsley, turnip, mustard), kiwis, strawberries

High dietary amounts in 54 of 75 epidemiological studies showed a decreased risk of several types of cancer. High dietary levels are also associated with a decrease in cataracts. Beneficial for asthma, pneumonia, bronchitis.  A  majority of studies have shown a reduction in the duration and intensity of the common cold.  Stress (psychological, illness and injury) increase excretion of vitamin C which is easily destroyed in food processing, storage, and cooking.

Some oncologists feel high doses during radiation and/or chemotherapy may protect the cancer.  Human studies are needed to resolve this issue.

Adaptations

1. Wildman, R.E., Medeiros, D.M. Advanced Human Nutrition. 2000. CRC Press: Boca Raton, FL.
2. Ensminger, A.H., Ensminger, M.E., Konlande, J.E., Robson, J.R. Encyclopedia of Foods and Nutrition. 1995. CRC Press: Boca Raton, FL.
3. Medical Economics. PDR for Nutritional Supplements, First Ed. 2001. Medical Economics: Montvale, NJ.
4. Bland, J., et al. Clinical Nutrition: A Functional Approach. 1999. Institute for Functional Medicine: Gig Harbor, WA.
5. Bucci, L. Roles, Functions, Deficiency Symptoms, and Dietary Sources of Vitamins In Wolinsky, I., Driskell, J.A., Ed. Sports Nutrition: Vitamins and Trace Elements. 1997. CRC Press: Boca Raton, FL.

Vitamin and mineral requirements for adults were derived from the Nutritional PDR. When more than 1 value was listed, preference was given to the United States Recommended Dietary Allowances (USRDA) which are the values used for nutritional supplement and food labeling. Recommended Dietary Allowances (RDA) are the dietary levels of nutrients required to meet the needs of 98 percent of healthy people based on the estimated average requirement. Estimated Safe and Adequate Dietary Intake (ESSADI) is set by the United States National Academy of Science, Food, and Nutrition Board when there is insufficient data for an RDA. Daily Value (DV) are standards used for food labels. Estimated Minimum Requirements (EMR) will be used in this case for electrolytes. Recommended values differ slightly for children, teenagers, women during pregnancy and lactation, and senior citizens.

MINERALS

Mineral

Major Functions

Deficiency Signs and Symptoms

Toxicity Signs and Symptoms

Top Food Sources

Comments

Calcium

RDA 1000 mg
Teens 1300 mg
Over age 50 and pregnancy 1200 mg

Healthy bones (in 50 of 52 trials osteoporosis was reduced) and teeth, muscle contraction, nerve impulse stimulation, blood clotting, enzyme activation, ion transport in cell membranes, cardiac rhythm, hormone secretion

Nocturnal cramps; chronic deficiency results in rickets, osteomalacia, osteopenia, osteoporosis.

 Excess dietary fiber, fat, vitamin A, caffeine along with high stress and low activity reduce the absorption and/or increase the excretion of calcium.

Epidemiological association between low intake and obesity

Constipation; may reduce absorption of biphosphate drugs; hypercalcemia which may lead to nephrocalcinosis and milk-alkali syndrome

Cheese (except cottage cheese), milk, yogurt, bran, almonds, sesame seeds, corn tortillas (with lime added), tofu

Absorption declines with age.  Best absorbed with food, vitamin D, stomach acid (secreted with food) and in doses of 500 mg or less.  Analysis of 15 trials shows citrate/citrate-maleate forms absorbed 25 percent better than the carbonate form. Carbonate contains 40 percent elemental calcium; citrate 24 percent. Adequate dietary intake also reduces the risk of colorectal cancer. PMS and hypertension may be helped with supplementation.

Magnesium

RDA males 420 mg females 320 mg

Part of over 300 enzymatic reactions including muscle contractions, nerve impulse relaxation, cardiac rhythm, ATP phosphate transfer, vascular tone, glycolysis, protein and fatty acid synthesis; essential for healthy teeth and bones

Muscle spasticity, cramping, fasciculations, tremors, twitches, weakness, arrhythmias; cerebral vasospasm, confusion, irritability, insomnia, decreased appetite, osteoporosis

Diarrhea, nausea, abdominal cramping; persons with renal failure should avoid large doses

Whole grains, nuts, green, leafy vegetables; processed foods are low in magnesium

Nature's calcium channel blocker.  Because it is involved in so many enzymatic reactions, some of the conditions that may improve with supplementation include angina, asthma, arrhythmia, diabetes, fatigue, fibromyalgia, hypertension, glaucoma, kidney stones, migraine headaches, osteoporosis, PMS, stroke.

Phosphorus

RDA adults 700 mg
Teens 1250 mg

Components of bone, teeth, and energy molecules, ATP, ADP, AMP, and creatine phosphate; required for phospholipid synthesis; regulates extracellular pH

Rare; loss of appetite, weight, and strength, and bone demineralization

Diarrhea, hypocalcemia, vomiting, nausea, abdominal pain

Dairy, soft drinks, fast food, grains, beef, chicken, beans

Deficiencies may be caused by excess antacid use, calcium intake, or inadequate vitamin D. The calcium to phosphorus ratio ranges from 2:1 to 1:2 (1:1 is preferred). It is rarely used in nutritional supplements because it is so plentiful in the diet.

Sodium

DV 2400 mg
EMR 500 mg

Involved in muscle contraction, nerve function, carbohydrate absorption, and fluid balance as the principle extracellular ion

Most often seen in athletics during competition in the heat; symptoms include muscle cramps, dehydration, heat exhaustion, and heat stroke caused by excessive sweat losses w/insufficient replacement

Hypertension and increase in urinary calcium excretion

Processed foods including canned, frozen, fast, chips, cheeses; sauces, condiments, and restaurant foods

The average U.S. intake is 4000 mg daily which is greater than the recommended 1800 to 2400 mg.

Potassium

DV 3500 mg
EMR 2000 mg

Muscle contraction, nerve transmission, acid base balance as the principle intracellular ion

Rapid and/or irregular heart beat, abnormal EKG

Hyperkalemia which may lead to life-threatening cardiac dysfunction

Almost all fruits and vegetables

Low dietary levels are associated with elevated rates of hypertension.  Conversely, hypertension can be reduced when dietary potassium is increased

Chloride

EMR 750
mg

pH balance, hydrochloric acid production

Vomiting and diarrhea may cause deficiency-shallow breathing, cramps, convulsion

Rare with healthy kidney function

Table salt, seafood

Table salt (sodium chloride) is 40 percent sodium and 60 percent chloride

Iron

RDA males 10 mg
females 15 mg
over age 50 10 mg
pregnancy 30 mg

A component of both hemoglobin and myoglobin, it is involved in oxygen transportation; required for collagen synthesis, and immune function; also a component of cytochrome enzymes which are involved in electron transport chain reactions, and detoxification of drugs, alcohol, and carcinogens

Microcytic anemia, fatigue, shortness of breath, pallor, angular stomatitis, decreased cold tolerance (esp. hands and feet)

Restless legs Syndrome

1 percent of people of European descent have hemochromatosis, a genetic error that causes excessive iron absorption which can lead to liver disease and coma; a frequent cause of poisoning in children who mistakenly take their parent's supplements

Red meat, oysters, beans, raisins, egg yolks, molasses, sunflower seeds

Iron is the most common mineral deficiency in the U.S. 20 percent of women are deficient which may be elevated in pregnancy. Deficiencies are also seen in infants, children, adolescents and even males. Heme iron from animal sources is absorbed better than nonheme vegetable sources. Oxalates in tea, chocolate, berries, and spinach along with phytates in grains and the preservative EDTA all bind iron and reduce absorption which is enhanced by taking vitamin C.

Zinc

RDA males 15 mg
females 12 mg

Involved in over 200 various enzymatic reactions; important for growth, development, wound healing, and immune response; antioxidant activity as a component of Zn/Cu SOD

Poor wound healing, frequent infections, decreased libido, stunted growth in children, white spots on nails, multiple dermatological problems (eczema, acne, skin ulcer, rashes, seborrhea)

Metallic taste, headaches, nausea, vomiting, GI pain, and copper deficiency which then causes anemia

Red meat, lamb, crab, nuts, seeds, beans, oysters, egg yolks, dark meat poultry

Mild deficiencies, which may be diet related or conditional (increased need during injuries/wounds/immune stress) can have profound negative health effects which are reversed by repletion. When no deficiency is present there is no evidence that extra zinc is beneficial. Studies using zinc lozenges to reduce the signs and symptoms of the common cold are divided.

Selenium

RDA males 70 mcg females 55 mcg

A component of glutathione peroxidase, a powerful antioxidant; required for thyroid hormone conversion (T₄ to T₃); works synergistically with vitamin E

Low dietary levels are associated with increased risk of heart disease and several types of cancer including prostate and colorectal

Doses over 1000 mcg may in time cause brittle hair, brittle nails with white horizontal streaks, skin rash, and garlic breath

Wheat (germ, bran, and unprocessed flour), butter, scallops, lobster, shrimp, crab

The amount in food depends on soil levels where crops were grown and the water and feed levels where livestock grazed. Selenium can reduce elevated levels of mercury, cadmium, and arsenic.

Copper

ESSADI
1.5-3.0 mg

A component of enzymes required for collagen cross linking, melanin, hemoglobin, phospholipids, and norepinephrine synthesis; has antioxidant activity (Zn/Cu SOD)

Elevated cholesterol, triglyceride, and glucose levels; depigmentation of skin and hair; anemia and osteoporosis

Nausea, vomiting, diarrhea, GI pain; persons with liver and kidney disease should use with extreme caution; Wilson's disease is a genetic disorder which results in excessive copper accumulation

Oysters, soy lecithin, potatoes w/skin, beans, almonds, walnuts, sunflower seeds, brazil nuts, pecans, split peas

Excess zinc, fructose, fiber, calcium, vitamin C and iron all reduce copper absorption. The amino acid histidine helps absorption.  Excess copper can promote pro-oxidant activity in damaged DNA.

Chromium

ESSADI 50-200 mcg

Helps control blood glucose by activating insulin membrane receptors enabling insulin to promote glucose, amino acid, and triglyceride uptake by cells

Glucose intolerance, hypoglycemia, craving for simple carbohydrates, fatigue, and irritability

Most data indicates chromium is safe even in high doses; there have been a few reports where the picolinate form was taken in large amounts by people who developed renal failure, however, there was no proof chromium picolinate was the cause

Brewer's yeast, beef, whole wheat, chili, potatoes, wheat bran and wheat germ

Small studies demonstrating weight loss and muscle gain were not confirmed in larger follow-up studies. Chromium is beneficial for blood sugar control in diabetic patients.

Iodine

RDA 150 mcg

Synthesis of thyroid hormones are involved in basal metabolic rate, heart rate, endocrine secretion, respiration, digestion, carbohydrate and fat metabolism

Causes reduced levels of T₃ and T₄ which cause increases in thyroid stimulating hormone (TSH); this results in goiter, hypothyroidism, and myxedema

Paresthesias, arrhythmias, rashes, acne, hyperthyroidism, nervousness and anxiety

Iodized salt, kelp, seafood

Cabbage, cauliflower, casaba, broccoli, soybeans, and millet contain phytochemicals which reduce iodine entry into the thyroid gland. They are destroyed by cooking.

Manganese

ESSADI 2-5 mg

Cofactor for enzymes used to synthesize glycosaminoglycans (needed for healthy cartilage and bone); antioxidant function as a component of intramitochondrial SOD  (Mn SOD)

Poor growth of hair and nails, both demineralization which may lead to fracture and osteoporosis

Persons with liver failure may accumulate high levels in the basal ganglia which leads to Parkinsonlike symptoms

Nuts, especially pecans, brazil, and almonds; barley, rye, buckwheat, wheat, and split peas

There is no evidence that manganese supplements will promote cartilage synthesis if no deficiency exists. Manganese competes with iron for absorption.

Boron

No established value, see comments

Appears to influence intracellular and extracellular calcium transport; helps the kidney in the synthesis of the active form of vitamin D

Increased urinary losses of calcium and magnesium, bone demineralization, osteoarthritis

Huge doses (100 mg plus) may cause nausea, diarrhea, abdominal pain, appetite and weight loss

Most fruits and vegetables

Epidemiological reports find where dietary levels are above 3 mg a day, osteoarthritis rates are considerably lower in populations who consume less than 1 mg a day. Supplemental doses of 6 mg daily helped OA symptoms in 50 percent (versus 10 percent placebo group). Boron's ability to slightly raise testosterone in geriatric women has not been replicated in males who lift weights.

Molybdenum

USRDA 75 mcg

Component of enzymes used to detoxify alcohol, sulfites, and uric acid

Headache, tachycardia (caused by sulfate buildup)

Goutlike symptoms

Lentils, peas, brown rice

Can be used with zinc to lower copper levels. May reduce incidence of esophageal cancer.