Vitamins and Minerals

Hi, my name is Abbie Boo Bolts, and I'm a registered dietitian here at Holy Family. Today, we're going to talk about micronutrients, which means vitamins and minerals.

Normally, we focus on the macronutrients: carbohydrates, proteins, and fats. But sometimes we don't focus on those smaller components of our foods, and they are very important to our health. So we're going to focus on some of them today. There are many, and we're not going to focus on all of them, but we'll focus on some key ones today.

So, as I mentioned before, macronutrients are things like carbohydrates, protein, and lipids or fats. Micronutrients are things such as vitamins and minerals. So today, we'll focus on the micronutrients. Let's give a definition to these first.

Vitamins are considered a group of micronutrients. In order to be a vitamin, there are a few key things. The first one is that they are a distinct compound that is different from carbs, protein, and fat. They are natural components of food, so food does include vitamins in varying amounts and types. They're not made by the body in adequate amounts to meet our needs, so we do need to get them from foods. And then they're essential for normal body functions. So we need vitamins for our body to perform certain functions that are essential for us. And then if we don't have enough of these, we can have specific vitamin deficiencies, which we'll talk a little bit about later.

Minerals are also essential for human function. There are two categories: macro minerals, which we need more than 100 milligrams per day, and micro minerals, which are those components that we need less than 15 milligrams per day—so a much smaller amount. So we're going to take a look at those two different types next.

Vitamins are also broken into different categories based on how they move around inside our body. So there are fat-soluble vitamins. These are the vitamins that are transported with fat in our body, so things such as vitamin A, D, E, and K. It's a little easier to have a toxicity, or to have too much of these, because they're not necessarily excreted through our urine, and so they can build up in our body if we have too much. But usually, it takes quite large amounts of these to have a toxicity. And then we have the water-soluble vitamins. So these are most of the B vitamins, vitamin C, things like folate, and these are, if we have too much of them, excreted in our urine. So not as common to have toxicity with these, but still possible.

And then there are other nutrients that have vitamin characteristics. So they're similar to vitamins. These are things like choline, lecithin, and things like bioflavonoids that you may have heard of. Some of these you might see these on ingredient labels. Choline we hear about as being part of eggs, but they have characteristics like vitamins; they're not necessarily vitamins.

And then with the minerals, for the macro minerals, these are things that our bodies need, and you may have heard of most of these: magnesium, sodium, potassium, chloride, sulfur, calcium, and phosphorus. These are the ones that we need larger amounts of, although still, in the big scheme of things, pretty small amounts. And then the micro minerals, which we need just small amounts of, but still certainly very important. So some of these you may have heard of: things like iron and zinc and copper. Many of these we get through the food that we eat.

Vitamins and minerals—we use a term called bioavailability. This is how well they're absorbed and how well they're used in our body. So basically, in other words, how well does your body use a given nutrient? So when you consume something with vitamin C in it, how well is it absorbed and used is called bioavailability. So that all varies depending on what the food is in; if it's a vitamin form versus a food form, there's a lot of differences in how something is absorbed or available, and depending on what it's in or how we're—how we're consuming it.

So there are general recommendations for vitamins and minerals, but there's certainly individual needs that we may have. So with many vitamins and minerals, you'll see kind of an asterisk for pregnancy or lactation where the needs may be higher. There's also, of course, with activity level, needs may change, and then, of course, height and weight. So there are differences specifically for men and women, and also with chronic diseases, there are some cases where you may need more or less of certain vitamins or minerals. So we'll dive into that a little bit today, but just know that any of the recommendations or numbers that you see today, that's not necessarily exactly for everyone; that's the general recommendations, but sometimes there are specific needs. So of course, always, always defer to your provider, or if you think you need to take a vitamin or mineral, please make sure that you ask your provider, as they know your whole medical history and can see if it would be appropriate or not.

So how dietary amounts and recommendations are figured out is kind of complicated, but there are different acronyms that you'll see out there as to how much we should have. So we're going to talk about those a little bit. So the RDA is the recommended daily allowance, and that's the average daily level to meet the nutrient requirement for healthy individuals. So like I said, there are some certain medical—medical conditions that would require different amounts. So this is the average amount for healthy individuals when there's not enough evidence to provide an RDA, or recommended daily allowance, then they use a term called the AI, or adequate intake—the number that we know is probably about what most people need. There's also something called the EAR, which is the estimated average requirement. This is the average intake required to meet the needs of 50% of healthy individuals. So this is not specifically used for like to say this is how much you need; it's for population health to look at whether the—the population as a whole is getting enough of certain nutrients. If we're low on certain nutrients, so this is more—more of a number that someone studying this would use rather than an individual would necessarily use. You would, as an individual, would use the RDA or the AI. And then the UL is a tolerable upper intake level. So this is a maximum daily intake that is unlikely to cause adverse effects. So when I was talking about that toxicity with some of those vitamins, there is an upper level that we know, for the most part, is—you know, go over that, you run that risk of adverse effects potentially.

We're going to talk about a few today. We're gonna focus on some of the vitamins and minerals that are potentially nutrients of concern, are potentially things that some people or some certain populations may not get enough of, and we're going to talk about these a little bit more in depth today. So of course, if we looked at all the vitamins and minerals, we could spend hours and hours. So we're gonna focus on some of the common ones, some of the ones you probably hear about a little bit more often. So we're gonna talk about vitamin D, potassium, calcium, and iron.

Vitamin D—we hear about lots and lots of vitamin D. As I mentioned before, it's fat-soluble, so it actually doesn't occur in a lot of food. So if you are deficient in vitamin D, sometimes it's pretty tough to get it through food. It is certainly available as a dietary supplement, and then also we get some vitamin D through the sun, and of course we hear about that quite often. That's—some people, if they don't get a lot of sun, they may be deficient in vitamin D. However, it's a little bit hard to quantify sometimes.

So the main functions of vitamin D—as you can see, there's a lot of different way—ways that vitamin D works in our body. It does help promote calcium absorption in the gut. You'll see a lot of calcium supplements that are—will have vitamin D in them. It is involved in the calcium phosphorus balance, as well as bone growth and remodeling—so very important in bone health. Vitamin D has also been involved in immune function and in reduction of inflammation, or potential reduction of inflammation. So the—the RDA, or the recommended amounts for healthy individuals—as you can see, for both males and females, age 19 to 70, the recommended amount is 600 IU, and for males and females over the age of 71, it's 800 IU per day. Now, if you—if you have been told to take vitamin D, you've probably been told to take higher amounts than that sometimes. If you are deficient, there will be a larger amount prescribed initially to get you up to baseline, and then more of a maintenance amount. So you may have seen numbers higher than this, but these are the recommended amounts for healthy individuals.

So like I said, there's not a lot of foods that have vitamin D, but there certainly are some foods that naturally have vitamin D in them: things like fatty fish, although disclaimer, you do have to eat the bones, or at least grind up those bones and eat it that way, because that's where most of that vitamin D is. Fish liver oils—so cod liver oil is a source of vitamin D. There are small amounts of vitamin D in some foods such as egg yolks, cheese, and beef liver. Of course, again, it's hard to get a whole lot of vitamin D from some of those foods. And then there are many foods out there that are fortified with vitamin D. Milk is fortified with vitamin D in the US. Infant formula in the U.S. is fortified with vitamin D. There are some ready-to-eat breakfast cereals, orange juice, some yogurts, and some margarines out there. Again, you know, with this fortified food list, especially with like orange juice, I would say go ahead and get all your vitamin D from orange juice, or you know, ready-to-eat breakfast cereals, or even margarine, but it is something to keep in mind that there are ways to get vitamin D through other foods. There are some other foods out there that—that are fortified with vitamin D too, but it's important to read those labels. Also important if you are lactose intolerant and don't—don't drink milk, you know, to look—some of those milk alternatives, some of the plant-based ones, you know, to see is it—does it have vitamin D in it or not, because then that would be potentially another food that could—or another beverage that could have vitamin D.

So there are quite a few people that are at risk for vitamin D deficiency. Doesn't mean that automatically if you're in these categories that you would be vitamin D deficient, but it is good to kind of keep in mind if you have a condition that causes like fat malabsorption—so you don't absorb fat as well—you know, things like celiac disease, Crohn's disease (which I see I know spelled wrong, I apologize for that). There are some diseases because, again, vitamin D is fat-soluble. Since it's soluble in fat, if you're not absorbing that fat, you may not be absorbing that vitamin D. So you know, if you do have gastrointestinal type issues, it's—it's not a bad idea to just keep that in the back of your mind. For individuals that have had gastric bypass surgery, usually vitamin D is something that is monitored and potentially prescribed if necessary. I mentioned lactose intolerance, of course, and you're taking out, you know, a category of food that does have vitamin D, and of course that list is small. Sun exposure can impact vitamin D. If you follow a diet that's more plant-based, again, as you saw, a lot of the foods with vitamin D, it was animal-based—to things like beef liver and eggs and milk, things like that. So there's certainly quite a few people that could be vitamin D deficient, so not a bad idea to keep that in the back of your mind if you're on this list, and also not a bad idea to ask your provider if they haven't checked it, if it's something that you should—you know, be concerned about.

The next nutrient that we're going to look at is potassium. And potassium—when they came out with the 2015 Dietary Guidelines for Americans, one of the nutrients they found that many people were not getting enough of was potassium, actually. And potassium is an essential nutrient; we do need it. It is, however, available in many foods, so we can certainly get potassium in our foods. Now, the key is potassium is in a lot of our fruits and veggies. So of course, if we're not eating a lot of fruits and veggies, that's a way to get more potassium is to increase those fruits and veggies and get a variety of them as well. So potassium has quite a few different functions, but it's required for normal cell function; it's part of nerve transmission, muscle contraction, and kidney function. So the—there's not an RDA for potassium, but the adequate intake is for males and females 19 and over is 4700 milligrams, which sounds like a lot, but there are some foods out there that have easily 300 to 400 milligrams in one serving. And so when you're talking about that big of numbers, you can get to that 4700 pretty easily if you're getting enough of your fruits and veggies. There's also potassium in dairy products; there's potassium in some of our grains. So there's potassium in a lot of—a lot of foods, and a lot of our common fruits and veggies have potassium. So of course, things like bananas, strawberries, tomatoes, potatoes—so a lot of our common foods do have it. So it's very easy to get to the potassium amount, but like I said, if you're not eating fruits and veggies, it's possible that you're not quite getting enough. And then as you can see, we have an asterisk on this one that potassium amounts are increased during lactation.

Food sources of potassium—I mentioned some of them, but here's a few more: fruits—there are many fruits that have potassium; apricots are one of them. Dried fruits have quite a bit of potassium. Vegetables—as you can see, many of the starchy veggies like lentils, winter squash, potatoes, and then of course things like broccoli and tomatoes as well. Dairy products do have potassium in them, and some meats also have potassium. So many ways to get or increase your potassium.

So there are a few populations that are at risk for potassium inadequacy: those with inflammatory bowel disease—so again, if you're not absorbing things as well, potentially. Certain medications can cause potassium—cause you to excrete potassium, so diuretics or laxatives. Then sometimes potassium will need to be supplemented, but it's not really something that we—unless your provider prescribed it—it's not something that you should go seek out if you think you're not getting enough fruits and veggies. Of course, that's a great reason to increase it, and then of course just that variety with fruits and veggies, but definitely not something to just go out and take. It would certainly need to be subscribed—prescribed. There are some individuals that do need to actually limit their potassium. One of those categories is with patients on dialysis, potentially chronic kidney disease in advanced stages. So sometimes there are actually potassium restrictions, and again that's a provider driven, so we wouldn't recommend naturally putting yourself on a potassium restriction or taking it more—so just getting a variety of fruits and veggies.

The next nutrient that we're gonna look at is calcium. Calcium is the most abundant mineral in the body, which we probably could guess because it's located in our bones—at least most of it is in our bones. We can get calcium from foods and supplements, and calcium is also present—present in some medications. So if you think of something like Tums, Tums actually is mostly calcium based. So calcium is part of bones and teeth, maintaining the structure and function, as most of us know, but calcium is also involved in muscle function and nerve transmission. With calcium, of course, there's a very specific amount that our body needs in the blood, and in order to maintain homeostasis, calcium is tightly regulated, and then bone growth and structure and formation; it is adjusted beyond that. So bone formation exceeds resorption in both in children and adolescents. In early to middle adulthood, it's equal, and then in aging adults and postmenopausal women, bone breakdown actually exceeds formation. So that calcium early on, and you know, even in middle adulthood, it's very important that we're building those bones up and—and getting enough calcium early on, and then of course it is important later on, but—but that's why in the early years it's important—important that kids are getting enough calcium.

So the RDA for calcium for men and women 19 to 50 for women and 19 to 70 for men, it's 1000 milligrams. For women, it goes up in that 51 to 70 category, so it goes up a little bit earlier than for men; that is related to changes with menopause. And then over the age of 71 for both men and women, it's 1200 milligrams. This is another area where during pregnancy, calcium needs are a little bit higher. So calcium—generally we can get to our calcium needs with just a few servings of a calcium-rich food, but of course if you're not getting it—the calcium through calcium-rich foods and it's—it's the smaller servings, then it takes a little bit more. So we'll take a look at that next.

The food sources of calcium are dairy products: milk, yogurt, and cheese are the main ones. There are non-dairy sources: so dark leafy greens like kale and broccoli and spinach. However, it takes a lot more of those to equal the amount that we'd find in milk, yogurt, and cheese, but it certainly can be done. And then fortified foods—some grains are fortified with calcium; there are fruit juices—you'll see orange juice sometimes fortified with calcium. Tofu is typically fortified with calcium, and then some cereals as well. So the recommendation is that anyone nine years or older should consume 3 cups of milk or milk equivalence. A milk equivalent is 1 cup of milk, 1 cup of yogurt, or 1 and a half ounces of cheese. Of course, for some people that cannot tolerate milk or choose not to drink milk or eat yogurt, there are alternative milks out there, but again check because the calcium content may vary quite a bit with some of the alternatives—you know, almond milk, rice milk—some of them are fortified with calcium, but it's important to look and—and know. So for example, 1 cup of milk has about 300 milligrams of calcium, and so really we need, with other foods, about three servings of milk a day, usually. For most adolescents and adults, it's about two to three servings of milk or yogurt a day, and then if you add in, you know, dark leafy greens and cheese and things like that, it—you can get to that—that amount. Not all individuals can get to this amount, and then sometimes calcium does need to be supplemented.

So there are two types of calcium supplements: there's calcium carbonate. This is more commonly available. So if you look for calcium supplements, most of them are calcium carbonates. They are less expensive, but they do—usually they're tolerated better and absorb better when they're taken with food. So just, you know, kind of a key thing with—with the calcium carbonate, but many of the ones out there are calcium carbonate. There's also calcium citrate. This can be taken with or without food, which is convenient, and typically they're tolerated a little bit better. So what we do know with calcium supplements—a lot of times you'll see calcium supplements come in greater than 500 milligram doses, but we know that there's actually better absorption with like less than 500 milligrams at a time, or the smaller doses. So mega doses of calcium—really they're not absorbed better. So sometimes, you know, it's better to do a smaller amount and go from there. So important again to make sure you're talking to your provider or a dietician to make sure that you're getting appropriate amounts and the right kind of supplement for you. Usually with most supplements, do recommend the food first, but sometimes calcium is a tricky one to—to get enough of if you're—if you're not able to do dairy products.

So calcium deficiency—for those that are at risk for calcium deficiency, certainly those that are lactose intolerant, have a milk allergy, or can't tolerate milk or milk products. Postmenopausal women are a little more at risk for calcium deficiency. If individuals are vegetarian or vegan, because again there's less of those calcium-rich options, and then some athletes may be at risk for calcium deficiency if they are not getting enough total calories, potentially. We're not going to focus too much on the female athlete triad today, but that—to do with athletes and energy needs—not quite meeting those energy needs. So that's a population that can be at risk. Like I mentioned before, the circulating blood levels of calcium are tightly regulated, and so if calcium—blood serum calcium is low, oftentimes there's other medical conditions; it doesn't necessarily mean that it's because you're not drinking enough calcium—that would be—or eating enough calcium—that would be more so related to what that bone health. So long-term calcium deficiency—if you haven't consumed enough calcium over the course of your life—that's where we see it in more osteopenia, osteoporosis, and that—that bone health.

And then we—the last one that we're going to talk about is iron. And iron is something that we do hear about quite often as, you know, being a potential nutrient of concern for some individuals. It's present in foods and supplements, and there are two forms of iron. So the first form of iron is heme iron, and that's from animal foods, and non-heme iron is from plant foods. So what we do know is that they are absorbed a little bit differently, and there are two different forms, so it is important to know if you are someone that needs to—you know, is trying to eat more iron. We're going to talk about the two because it is an important piece to know. Iron is part of our blood; it makes up an essential component of our blood that transports oxygen to our lungs. It helps support metabolism; it's involved in growth—metabolite is a key of that—and then part of the building of hormones and connective tissue—so involved in a lot of different processes.

So the RDA for iron is 8 milligrams for males age 19 to 51 plus, and then for females it's quite a—quite a bit higher between the ages of 19 and 50; it's 18 milligrams. And for females ages 51 and over, it goes back down to 8 milligrams. Again, that's related to menopause. And then there are increased needs for iron in both pregnancy, lactation, and then if someone is following a vegetarian or vegan diet, they actually do need more iron, and I will explain why in just a second. So the non-heme iron, which is the plant-based iron, is not absorbed nearly as well. So if you remember that bioavailability—bioavailability of non-heme iron is not as good. So in order to make sure that people that are following a plant-based diet get enough iron, the recommendation for their needs is actually significantly higher; it's about one and a half times the regular amount so that they are getting enough. So the non-heme iron is things like nuts and beans and veggies, and though that non-heme iron is absorbed better with vitamin C. So we usually suggest consuming a food that has vitamin C. There's many fruits out there that have vitamin C. When you're consuming a non-heme iron, you'll also see sometimes if you're taking a supplement that has iron, it will automatically have vitamin C along with it. And then the best sources of heme iron are lean meats and seafood. So most of our animal-based protein is going to have heme iron in it. Again, iron isn't something that I would suggest just taking a supplement of; it should be provider driven. It is in some multivitamins, so that's one of the main differences in specific multivitamins for women is the amount of iron, and usually 100% of the daily value is in there. As far as multivitamins for men and seniors, they don't contain iron because those needs are significantly less. So that's a big difference, you know, when you're looking at vitamins and potentially a multivitamin, which ones to take. It is important that you get the right—the right age for gender because that—that iron content will be significantly different potentially. And then the iron-only supplements can contain really large amounts of iron, and they can have pretty significant GI side effects. So it's important that if you—that you only take an iron supplement if it's been prescribed by your provider, or you've had a discussion with your provider, just because those can be pretty—pretty hard on the stomach as far as GI concerns. Not everyone tolerates them as well, so not something to just go and take unless you know that you need it and you've talked to your provider.

Those that are at risk for iron deficiency—as you can see on the bottom here, there's a pretty significant list of individuals that may be at risk for iron deficiency. Again, just because you're on this list doesn't mean you necessarily would be iron deficient, but may be at a higher risk for it. Again, disorders of the GI system where things are not being absorbed as well could be a concern. Pregnant women, infants, and young children may have an increased need for iron or maybe are increased risk for iron deficiency. Usually it's related to other nutrient disorders, and it can be associated with a poor diet or disorders where you're not absorbing things or blood loss. So there's a lot of different reasons why there may be an iron deficiency.

So I just touched on multivitamins a little bit before, but let's talk a little bit more specifically about that. So there are so many different multivitamins out there, and there's constantly new ones. It's really hard sometimes to wade through that and know what to take. What we do know is that about a third of Americans take a multivitamin, but it's really hard to do studies on them because there's so many other factors that can play a role in whether that multivitamin is effective or not. And so there really aren't good studies if—if they're necessary or how necessary they are, how well they work. What we do know is that although you may be able to get some nutrients from a multivitamin, they don't replace the fiber that you get from those fruits and veggies. So there is that component; it's not necessarily a one-to-one. If you take a vitamin, it's not necessarily the same as eating an apple. So just, you know, keep that in mind that it can be a supplement, but just that a supplement, not a replacement. Sometimes with multivitamins, they can increase the risk of having too much of a certain nutrient. So again, remember with those, especially the fat-soluble ones, it's possible to get too much. And then the recommended amount of a nutrient might vary. So again, really make sure you're watching the age and gender on those multivitamins so that you are getting the correct amount for you. Like I said, the studies are tough because they use—the studies use different products; manufacturers can change composition. And sometimes what they've found is that individuals that take a multivitamin actually already have a healthier lifestyle and a healthier diet to begin with. So again, really hard to tell if that's actually doing anything.

There are some categories of individuals that we know really do need to supplement with certain vitamins: for those that are planning to become pregnant or are pregnant, we know that folic acid is really important, and then also we know that vitamin D is—is important as well, but that folic acid is important for baby's development. And then people over the age of 50, we know we're at an increased risk of not having enough vitamin B12, so that sometimes as a nutrient that those individuals need to take. And then we know individuals that follow a vegan diet do need to supplement with vitamin B12 as it's nearly impossible for them to get it through food because it's in animal products. There is, however, vitamin B12 in like nutritional yeast, so that is one way that those that follow a vegan diet can potentially get vitamin B12, but many people that follow a vegan diet are—we typically recommend to take a vitamin—to take vitamin B12.

So if you think you may be—or deficient, or you would need to take a vitamin, or you're not sure, always good to—you know, have a discussion and talk to your provider about if you should take something. They can do the appropriate tests to determine if you're deficient or recommend the appropriate tests, and they also can take a look at your medical history to know if there's any medication interactions or contraindications to taking something. So that would be, you know, step one. The second step would be to—you know, do your research and also make sure that you're eating a varied diet. So before I recommend a supplement, I always suggest, can we do it through food? Can we get enough calcium or vitamin D through food first and then possibly a supplement? Because again, we know that that food is absorbed better, and you also get all the benefits from that food as well. Fruits and veggies are key—again, I sound like a broken record dietician—fruits and veggies, but a lot of the nutrients that we need we can get through fruits and veggies, and one of the keys is also the variety with those fruits and veggies. Also, if you're not sure, you can always ask a dietitian. We can take a look at diets and—and have an estimate of, are you getting enough of this nutrient? What are other ways we can add that nutrient? There's—sometimes we can take an objective eye and see where—where you could fit it in or how you could get it in through food there.

If you are looking into taking a supplement, one of the places that I would very highly suggest is the National Institutes of Health, the Office of Dietary Supplements. Take that—put it in Google; that's the easiest way to get there. And there is—what will come up is a page where you can go to fact sheets for any vitamins and minerals. So if you say, I think I might need to take calcium, go to the fact sheet for calcium, and you can find all sorts of information. There's a consumer fact sheet, and then there's also a professional fact sheet. So for some of you, depending on your medical background, the professional fact sheet may be interesting or more helpful for you. There is an app that goes along with this, but I use this site all the time. It's up to date; it's research-based, and there's also a lot of—some of the supplements that are out there that maybe are newer or are—you know, we're not really sure—you can find the latest information on them. So really helpful, great resource. You can also go to the FDA and look up different dietary supplements. ChooseMyPlate and the Academy of Nutrition and Dietetics has more general nutrition information, but there are some good articles on supplements there as well.

What I would suggest with supplements is definitely do your research. You want it to be third-party tested because with supplements, we just can't be sure of the purity, of how effective it is, and then you can't always be sure of the safety because sometimes there can be nutrients or ingredients in those vitamins that are not on the label or are not in the amounts that they say they're going to be. And so really use a critical eye, do your research, ask questions, and try to get the nutrients through food as best as possible, and then look into those supplements. And of course, if you have any questions, please let me know. Please talk to your provider, and please—you know—check out some of these resources here.