Poor diet and widespread depletion of nutrients place people in modern societies at risk of developing nutrient deficiencies. This problem is compounded by the increasing exposure to reactive chemicals, alcohol and drugs that impair nutrient absorption and use with subsequent depletion of cellular reserves. It has become common practice for individuals to take supplementation with multiple nutrients, such as vitamins and minerals.

COMMONLY SUPPLEMENTED VITAMINS AND MINERALS

Vitamin A (retinol)

Vitamin C (ascorbic acid)

Vitamin D (cholecalciferol)

Vitamin E (d-alpha-tocopherol)

clinical applications

Maintenance nutrition

Pregnancy and lactation

Children

Increased requirements

athletes

allergies

stress

missed meals

medication use

ageing

pre and postsurgery

chronic illness

inflammatory disorders

Poor absorption

hypochlorhydria

diarrhoea

pancreatic insufficiency

Convalescence

Detoxification

Vegetarians/vegans

contraindication

In lead absorption. There is some evidence to suggest that vitamin D supplements can enhance the toxic effects of lead, so people with lead poisoning or at risk of developing lead poisoning should take vitamin D supplements very cautiously.

Technical information

Vitamins

Vitamin A

The term vitamin A covers several fat-soluble compounds including retinol, which is the most important component, and two lesser components, retinal and retinoic acid. Vitamin A is only found in animal produce but various vitamin A-type compounds, the most important of which is beta-carotene, are found in vegetables.

The most important and well-known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye (xerophthalmia) and corneal changes. The normal function of the retina, the part of the eye involved with vision, and particularly the function of the light-sensitive areas of the eye, are also dependent upon sufficient vitamin A. In Third World countries, half a million people lose their sight every year because of vitamin A deficiency and some two thirds of these will die within a few weeks of developing deficiency. Further, beta-carotene is the most effective receptor of free radical oxygen which is relevant in situations involving cancer, inflammatory diseases and atherosclerosis in which free radical mechanisms are thought to play a part.

A connection between vitamin A and zinc metabolism has been described by several researchers. It appears that in severe zinc deficiency the formation of the protein which carries vitamin A, retinol-binding protein, is decreased. Zinc is an important constituent of many enzymes, including one found in the retina that is involved in vitamin A metabolism. Night blindness which does not improve with vitamin A supplements has been described in zinc deficient individuals, particularly in alcoholics with liver disease who are often vitamin A and zinc deficient. In diseases such as alcoholic cirrhosis, pancreatic disease and cystic fibrosis, zinc and vitamin A and other deficiencies also often occur together.

Deficiency symptoms and signs

Vitamin A deficiency is one of the most common and most serious world-wide nutritional deficiencies. Severe vitamin A deficiency is rarely seen in developed countries, but isolated examples occur in people who have malabsorption states. In particular, anyone with fatty stools caused by pancreatic disease, biliary obstruction, or small bowel disease, is at risk. The earliest symptoms of vitamin A deficiency include night blindness (difficulty in seeing well in dim light) and dryness of the eyes. Skin signs of vitamin A deficiency induced follicular hyperkeratosis, a condition in which the whole hair follicle and its adjacent skin is raised by a plug of horny keratin. Dryness of the skin can be a feature of vitamin A deficiency, but this may be due to an associate essential fatty acid deficiency or a deficiency of other micronutrients such as vitamin B complex, vitamin C and zinc involved in fatty acid metabolism. Deficiency can occur without skin signs. In general, in developing countries, vitamin A deficiency is associated with poor growth and development, and impaired resistance to infection.

Vitamin B

The B group of vitamins is a collection of essential nutrients that have certain characteristics in common. Firstly, they are all water-soluble, and secondly, they are usually found in similar food sources such as brewers’ yeast, animal meats, wholegrain cereals and vegetable proteins. Whilst chemically distinct from one another, the ways they work in the body are closely interrelated. For example, someone with vitamin B2 deficiency may have red, greasy facial skin which might also be caused by a coexistent vitamin B6 deficiency.

It is usual therefore, that when a deficiency of one of the vitamins is suspected, a B complex supplement is given. There are certain people who are particularly susceptible to vitamin B deficiency.

These include:

Alcoholics, partly because of their poor diet and partly because of the effects of alcohol upon vitamin B metabolism.

Those with poor dietary intakes. For example, those who eat much ‘junk’ food, or the elderly.

Those with increased requirements (e.g., pregnant and breast- feeding women, growing children and adolescents).

Those on long-term drugs such as anticonvulsants, certain antibiotics, and oral contraceptives.

Those with a psychiatric history. Deficiencies of vitamin B1, B6, folic acid and vitamin B12 are particularly likely.

Symptoms such as a painful, sore, red tongue, cracking at the corners of the mouth and red, greasy facial skin, may all suggest deficiencies of any one of several B vitamins. Someone can have symptoms of vitamin B deficiency for a considerable length of time before any outward signs become apparent. A chronic deficiency, particularly, may result in mental changes without any physical signs.

Vitamin C

Vitamin C is an extremely important nutrient involved in a wide variety of metabolic functions. It is essential for the synthesis of collagen and connective tissue, and must be available in adequate amounts for normal healing to occur. Ligament, tendon, cartilage, muscle, bone and teeth all require vitamin C for proper healing and maintenance. The effect of vitamin C on the synthesis of collagen is also important for capillary integrity. The importance of vitamin C in viral infections is well-known. The most widely taken nutritional supplement is, in fact, vitamin C.

Collagen is a component of the mucopolysaccharides which make up the intracellular glue that holds the cells of the capillary wall together and gives them strength. Therefore, adequate collagen synthesis may reduce the permeability of the capillary wall. This can provide a number of beneficial effects. In injury, healthy capillaries protect against haemorrhaging, bruising, oedema and inflammation and enhance the healing process. In allergy, they can reduce the release of histamine and other inflammatory substances into tissue, thereby reducing the symptoms of allergy. Vitamin C is also valuable because it exerts a detoxifying, deactivating effect on histamine and other substances which produce symptoms in allergy.

Vitamin C is very important for cardiovascular health, immune and adrenal function. By participating in the metabolism of tryptophan, phenylalanine and tyrosine, it exerts a beneficial effect on mental function. Ascorbic acid enhances the absorption of iron and folic acid and potentiates the effects of a number of other vitamins.

There are a number of factors which increase the need for vitamin C. These include physical or mental stress, infection, injury, pregnancy, lactation, allergies, old age or a high protein diet. Smoking or the use of aspirin, oral contraceptive agents, alcohol and numerous other drugs also increase the requirement for ascorbic acid.

Vitamin D

Vitamin D has its main effects on calcium metabolism and bone but also has an important part to play in the health of other tissues. The actions of vitamin D are:

• In the gastrointestinal tract. Vitamin D increases the absorption of calcium and phosphate from the food we eat.

• In bone. Vitamin D is essential for calcification of newly formed bone which is present at the growing end of the bones.

• In kidney metabolism. Vitamin D enhances the reabsorption of calcium and phosphate from the urine so that it is not lost in the urine.

• In lead absorption. There is some evidence to suggest that vitamin D supplements can enhance the toxic effects of lead, so people with lead poisoning or at risk of developing lead poisoning should take vitamin D supplements very cautiously.

Deficiency symptoms and signs

The clinical picture of vitamin D deficiency depends upon the age of the individual involved. The most striking features relate to changes in the skeleton as a result of a loss of calcium.

The major symptoms and signs of both rickets and osteomalacia are:

Infants

rickets (mainly seen in children)

excessive sweating

irritability

delayed development of movements

softening of the skull bones

thickening of the top of the skull

teeth appear late

enlargement of the joints where the ribs meet

the breastbone

chest and spinal deformities

bowed legs.

Adolescents

aching legs

swelling of the ends of long bones

knee aches and pains

impaired immunity with repeated infections

poor musculature

poor growth

osteomalacia (mainly seen in adults)

bone pain

bone tenderness

weakness of certain muscles, particularly of the hip girdle (difficulty in getting out of a chair or climbing stairs)

deafness

disorderly gait

Vitamin D deficiency is virtually clinically unknown in Australia due to the extensive exposure to sunlight. Vitamin D supplementation is common is colder areas of the Northern Hemisphere, particularly where there is a large dark-skinned population.

Vitamin E

The tocopherols are all fat-soluble and their absorption from the intestine depends upon effective fat digestion and fat absorption. So, diseases of the stomach, pancreas and liver can produce a vitamin E deficiency just as they predispose to deficiencies of the other fat-soluble vitamins (A, D and K). Vitamin E is thought to be particularly valuable in that it is an antioxidant. Living tissues are particularly sensitive to the damaging effects of oxygen and other oxidising substances called free radicals which can seriously damage the structure of cell membranes, as well as the contents of living cells; accelerated damage may lead to cell death. Vitamin E helps to protect cells from this kind of damage.

There are a number of well-defined indications, some rare and some common, for taking vitamin E. Clearly, vitamin E is most likely to be beneficial wheree there is a deficiency. A healthy individual who eats a well-balanced diet, and who has no special need to increase vitamin E, is most unlikely to benefit from the vitamin. Patients with coronary artery disease have been given vitamin E in doses in the region of 300-1,200 IU per day.

Vitamin E has been most studied as a treatment for the poor circulation in the legs usually found in smokers. Stopping smoking, regular exercise, and taking of vitamin E (300-600 IU a day) is of proven value when followed for at least six months. This treatment offers a real alternative to major surgery for some people.

Vitamin E can also lower raised cholesterol levels, particularly in young people. Its cholesterol-lowering effect in older people has not been properly investigated. Those who have suffered a single or a recurrent stroke may, by taking vitamin E (as well as other nutrients), and by making appropriate dietary changes, reduce their risk of having further strokes. Premature infants have especially high needs for vitamin E. They have very low levels in their blood, and a lack of the vitamin means that they are particularly susceptible to potentially damaging effects from oxygen. Often they have to have oxygen administered to them in an incubator, and this disorderitional oxygen may produce lung and eye damage. It appears that these potentially damaging effects from disorderitional oxygen can be reduced by giving vitamin E.

Other conditions for which vitamin E has been successfully given include premenstrual tension, premenstrual breast tenderness, period pains, menopausal hot flushes, certain blood diseases (e.g., sickle cell anaemia and thalassaemia), Dupuytren’s contracture (disfiguring and shortening of the tendons in the hand, sometimes associated with diabetes), chronic leg ulcers and osteoarthritis. In some conditions, such as cystic fibrosis and other diseases of the pancreas or liver, specialised forms of vitamin E may be required as absorption of dietary vitamin E is impaired.

Minerals

The minerals are a major group of vital substances. The essential elements for man can be categorised in different ways. Perhaps the most practical way is to divide them into macrominerals and trace minerals.

The macrominerals

Calcium, phosphorus, magnesium, sodium, potassium and chlorine - these are the bulk elements that are required in quantities of several hundred milligrams per day. They are involved in structural functions (bones and cells) as well as metabolic ones.

Calcium

Calcium is one of the bulk minerals required by the body. Of the body’s total calcium, ninety-nine per cent is required for the bones and teeth. The remaining one per cent is in solution and helps biochemical functions of various kinds. The importance of the right calcium balance for the maintenance of health cannot be overestimated In this section we will cover the main points of calcium metabolism that can be overlooked by some doctors.

Uses

It is important to detect calcium insufficiency in the adult, as prolonged low blood levels of calcium may produce cataracts. In individuals with allergies, calcium insufficiency is often a problem. This may be obvious if the symptoms are clearly related to the gastrointestinal tract, but is less obvious if the problems are asthma, eczema or hay fever. Postmenopausal women who develop multiple sensitivities, intolerances and allergies are often helped by correcting their calcium status. Many people on elimination diets for the management of their allergies are on a vitamin D and/or a calcium-deficient diet. This occurs with disturbing frequency in both those whose diets are self-imposed and in patients who have been under medical supervision.

Cancer

A little known role of calcium is to communicate with cells and tell them not to divide. Calcium deficience can lead to cellular proliferation and consequent cancncer of epithelial tissue, i.e. skin, intestines and breast.

Toxic metal exposure

Calcium and/or vitamin D deficiency predispose to an increased gastrointestinal absorption of lead and aluminium, two elements which are ‘let in’ through the gastrointestinal lining by those mechanisms which also permit the increased intestinal absorption of calcium. Aluminium is also known to influence parathyroid gland activity and disrupt calcium status. Both lead and aluminium are known to have widespread detrimental effects on the body, especially on the central nervous system. If someone is exposed to these two elements, calcium supplementation is almost essential.

Mental function

Too much parathyroid hormone can lead to high blood calcium which is associated with bone pains, psychiatric symptoms and constipation. This should always be sought as the cause for these symptoms in any psychiatric patient, because an excess of parathyroid hormone is easily corrected surgically, with magical results. Conversely, calcium insufficiency is also associated with a wide range of mental disturbances. Defective calcium metabolism is often found in a wide range of psychiatric conditions, many of which respond to calcium supplementation. The most common are depression, anxiety, panic attacks, nervous tics and twitches, insomnia and hyperactivity.

Joint pains and arthritis

Many people with joint pains and arthritis appear to have symptoms attributable to overactivity of the parathyroid gland. This is not a true disease of the parathyroid gland, but is caused by nutritional overactivity as a result of inadequate dietary calcium and/or vitamin D intake, or as a result of a low dietary calcium:phosphorus ratio, or any of the many causes of calcium malabsorption. The condition of many of these people is improved by calcium supplementation, by increasing the calcium in the diet, or a reduction of dietary phosphorus or phytates.

Phosphorus

Phosphorus is involved, along with calcium, in the formation of bones and teeth. Like calcium, it also has a number of other functions. It is necessary for the working of every cell in the body and is involved in energy production, storage and release. Calcium is the only mineral that we require in greater quantities than phosphorus. Phosphorus is widely available in foods and in the West a deficiency is rare. In fact, many problems are centred around excessive phosphorus in the diet in relation to amounts of calcium and magnesium.

Potassium

In the UK, the daily intake of potassium is estimated to be 2,g daily. The daily intake of sodium is estimated to be 3-6 g. There is some evidence to show that ‘primitive’ diets and unprocessed-food diets consumed in non-industrialised nations supply the body with more potassium than sodium. There is increasing evidence that the reversal of the dietary sodium:potassium ratio from a ‘natural’ pattern can contribute to a number of different medical conditions seen in modern Westernised society. Most of the potassium in our bodies is inside the cells, at a concentration thirty times greater than that in the fluid surrounding the cells. The sodium:potassium ratio is 1:10 inside the cells, and 28:1 outside. The difference in concentration across the cell membrane is actively maintained by what is called the ‘sodium pump’. This is a biochemical mechanism that pumps the sodium out of the cell. The kidney regulates sodium and potassium balance and helps maintain the blood potassium level within a fairly narrow range, despite a wide variation of dietary intake and total body content of potassium. So it is that blood levels of potassium can be normal, despite considerable potassium depletion of the body as a whole. A normal blood potassium level is therefore no guarantee of overall potassium adequacy.

Potassium is important in a wide range of bodily functions and is present in every cell in the body. It is especially essential for the correct working of the heart, the muscles and nervous system and for the maintenance of normal blood glucose levels.

Deficiency symptoms and signs

Potassium deficiency produces muscle fatigue, poor appetite, mental apathy and fatigue, depression, constipation caused by poor muscle tone in the intestines, an irregular heartbeat, and muscle cramps. Weakness, irritability, tissue swelling, headaches, bone and joint pain, and a rapid heartbeat are also sometimes seen. Urinary frequency may also be observed especially concommitant with adrenal insufficiency

Magnesium

Magnesium has long been known as a treatment for high blood pressure in pregnancy, and as an anticonvulsant. Its effects on the heart were first described as long ago as 1935. However, magnesium could be considered a forgotten mineral until recently, when more reports of its importance have appeared in the medical literature.

Magnesium is the second most abundant mineral within cells (after potassium), and its distribution across cell membranes is closely linked with calcium and phosphorus metabolism. The average human adult has 20-30 g of magnesium, seventy per cent of which is contained in teeth and bones; the remainder - the physiologically important component - is found mainly in the cells. The average daily intake of a healthy adult should be 400-800 mg, but requirements can increase in certain circumstances, such as with high-protein, high-calcium, high-phosphorus, or high-vitamin D intake.

A diet high in refined and processed foods is often deficient in magnesium, and this is made more significant if bran is disordered to such a diet because it binds what little magnesium is present, so rendering it less easily absorbed. Magnesium is essential for many metabolic processes, especially the cellular ‘pumps’ which maintain the correct distribution of sodium, potassium and calcium across cell membranes. Magnesium deficiency is associated with muscle cramps, or, in extreme cases, tetany - continuous cramps, especially of the hands and feet. Because magnesium is involved in so many enzyme systems a deficiency has widespread metabolic consequences.

Deficiency symptoms and signs

The symptoms of magnesium deficiency centre around the neuropsychiatric end of the spectrum of disorders and include:

loss of appetite

nausea

apathy

weakness and tiredness

numbness and tingling

confusion and disorientation

learning disability and memory impairment

vertigo

convulsions, epilepsy

muscle cramps, grimaces, jerks, tremors

tremor and jerks of the tongue

eyes flick uncontrollably

muscular incoordination

insomnia

hyperactivity

constipation

heart rhythm problems

susceptibility to the toxic effects of digoxin

hypoglycaemia

difficulty in swallowing

abnormal ECG

premenstrual symptoms

Uses

Magnesium status should be assessed in anyone with these complaints. Because magnesium is needed for vitamin B1 metabolism, many of the symptoms can be associated with a vitamin B1 or B6 deficiency and these should be investigated in anyone complaining of these symptoms.

Until recently, doctors measured serum magnesium, which is an extremely poor indicator of magnesium status. As a result, doctors’ awareness of magnesium deficiency has been low.

Osteoporosis

Osteoporosis is a condition in which calcium is lost from the bones, resulting in brittle bones that fracture easily. It is common in the elderly and especially in post-menopausal women. Two hormones, calcitonin (CT) and parathyroid hormone (PTH), regulate the skeletal turnover of calcium. Magnesium suppresses PTH and stimulates CT secretion, thus favouring the deposition of calcium in the bones and the removal of calcium from soft tissues. Further, magnesium enhances calcium absorption from food and its retention in the body, whereas increasing calcium intake suppresses magnesium absorption. So there are sound theoretical grounds for using magnesium supplements in preventing or treating osteoporosis.

Joint problems

When deposition of calcium in soft tissue is increased by a deficiency of magnesium, muscle and joint aches and pains could result.

Psychiatric symptoms

These include nervousness, anxiety, insomnia, childhood hyperactivity, depression, anorexia, apathy, weakness and tiredness. Many of these are associated with vitamin B1 deficiency, and magnesium is essential for the efficient utilisation of vitamin B1 as well as B6. Magnesium deficiency is also associated with increased lactate levels, which have in turn been linked to a wide range of psychiatric symptoms. (Vitamin B1 deficiency can result in increased lactate levels.) Clearly, magnesium deficiency must be considered as a possible cause of, or contributing factor to, a whole range of psychiatric symptoms.

PMT/PMS

Magnesium supplementation, along with vitamin B6, can be of real value in the management of the premenstrual syndrome (PMS). Vitamin B6 alone increases red-cell magnesium levels, which are often low in women suffering from PMS, and magnesium supplementation along with several other nutrients has been shown to increase premenstrual progesterone levels. Also, women in the premenstrual phase are more subject to hypoglycaemia and it has been found that hypoglycaemia is more marked in magnesium deficiency. Magnesium reduces the extent of reactive hypoglycaemia and its symptoms.

Heart disease

Spasm of the coronary arteries and increased excitability of the heart muscle due to magnesium deficiency, can produce abnormal cardiac rhythms and even cause sudden death from a heart attack. People who die from heart attacks have been found to have lower magnesium in their heart muscle than those dying from car-accident injuries.

Magnesium deficiency caused by diuretics

Short-term, vigorous diuretic treatment, or moderate-dosage long-term treatment can give rise to significant magnesium shortages. This depletion is also often compounded by hospital diets (which are surprisingly low in magnesium), a soft water supply or a high alcohol intake.

Hypertension

Magnesium deficiency has been recognised as a possible causative factor in hypertension.

Kidney stones

Research has shown an abundance of evidence linking too much oxalic acid in the urine and urinary oxalate stones to a variety of nutritional problems, including magnesium deficiency. Supplements of magnesium and vitamin B6 have been found to prevent urinary oxalate stone formation.

Alcohol problems

Magnesium is one of the elements that is depleted in chronic alcoholism, probably as a result of decreased intake, the poor absorption of foods, and poor reabsorption of magnesium by the kidneys. Alcohol acts as a diuretic and promotes the loss of both potassium and magnesium in the increased urine output. It has been found that levels of magnesium in sweat and blood can be low in alcoholics and that this can be partially corrected after three weeks of abstinence.

Diabetes

Diabetes mellitus causes substantial magnesium loss partly because of the large volumes of urine passed. This loss can further be contributed to by the kidney disease so commonly seen as a complication of diabetes.

Epilepsy and convulsions

There is a definite correlation between magnesium deficiency and the incidence of convulsions.

The trace elements

These include iron, zinc, copper, manganese, iodine, chromium and molybdenum. These are required in very small quantities (a few milligrams or less per day). They have subtle but vitally important effects on metabolism. As the ability to measure them more accurately has been developed, these are now recognised as essential.

Iron

Iron is a constituent of the proteins haemoglobin and myoglobin, which act as oxygen transporters in red blood cells and muscles. It is also a vital component of many of the body’s enzyme systems. In a healthy adult male, about two thirds of the total of 4-6 g of iron in the body consists of haemoglobin, which is found in the red blood cells. The second largest amount consists of storage iron, found mainly in the liver, spleen and bone marrow. A third and much smaller quantity includes compounds such as myoglobin and iron-containing enzymes. Finally, there is a very small amount of iron that is carried around in the blood by the iron-binding protein, transferrin.

Iron deficiency can cause many symptoms, most of which are linked to the anaemia it produces. The symptoms of anaemia resulting from iron deficiency include listlessness, fatigue, a very obvious heartbeat on exertion, sometimes a sore tongue, cracks at the corners of the mouth, difficulty with swallowing, and concave nails. In children, poor appetite, poor growth and a decreased resistance to infection are common. Abnormalities of the gastrointestinal tract, including the production of too little stomach acid, have long been observed in iron deficiency anaemia. So iron deficiency can cause too little stomach acid and iron malabsorption, as well as being caused by these two situations. Iron deficiency can exist without any blood changes and without the person being anaemic, and this is far more common than is realised. One study in Canada indicated that nineteen per cent of the population had evidence of deficiency but only two per cent were anaemic.

Iron deficiency is very common both in Australia and the USA. Those most at risk are children, pregnant women and those with heavy periods, strict vegetarians and people from low socioeconomic groups who have a poor diet. Others who may be at risk are those with malabsorption problems, those who are on limited exclusion diets for food allergy, and those with very little gastric acid following the removal of part of the stomach in an operation for ulcers. A study of fifteen- to twenty-five-year-old women in England revealed an iron intake of only seventy to seventy-five per cent of the officially recommended levels. It has been claimed that worldwide iron deficiency is the most common nutritional disease - much of it totally unrecognised.

Zinc

Zinc is fast becoming recognised as a vital nutrient, involved in a wide range of metabolic processes which become disturbed in many diseases. Despite the fact that there are thousands of published papers (two and a half thousand in the last two years alone) indicating the clinical importance of zinc, only a handful of clinicians are applying the knowledge that is available. Much is known about deficiency effects, the role of zinc in enzyme function, dietary requirements and the effects of zinc. However, there is a great deal to learn about interactions between zinc and other nutrients, factors that affect individual requirements, zinc metabolism and people’s tolerance of excesses, and the precise mechanisms by which a deficiency of zinc exerts its observable effects.

Deficiency symptoms and signs

Zinc deficiency results in a wide variety deficiency symptoms including:

slow growth

infertility/delayed sexual maturation

low sperm count

hair loss

skin conditions of various kinds

immune deficiencies

behavioural and sleep disturbances

night blindness

impaired taste or smell

impaired wound healing

white spots on finger nails and nail ridging

frequent and/or severe infections

impotence, infertility and low sperm count, reduced sex drive

impaired glucose tolerance

connective tissue disease

reduced appetite

gastrointestinal problems (diarrhoea)

Prostatic hypertophy and prostate cancer

A common test for zinc deficiency is a taste test for zinc solution. A zinc deficient person will experience a reduced taste sensation.

A variety of individuals will have increased zinc requirements:

people suffering from starvation, burns, diabetes mellitus

those taking diuretics

those taking the drug penicillamine

those with chronic blood loss, or on dialysis (chronic renal disease)

those with exfoliative dermatitis, excessive sweating

sufferers from inflammatory bowel disease, intestinal parasites and hookworm

alcoholics

people with liver disease (including viral hepatitis)

those with diarrhoeal fluid loss and ileostomy fluid loss

people who have just undergone surgery or physical trauma

Copper

Copper has been known for over 150 years to exist in plants an animal tissues. More than fifty years ago it was shown to be essential for animals. Human copper deficiencies were reported forty years ago and, more recently, copper deficiency states have been discovered. Copper deficiency produces anaemia, skeletal defects, degeneration of the nervous system, reproductive failure, elevated blood cholesterol, cardiovascular problems, impaired immunity, and defects in the pigmentation and structure of hair.

Copper is one of those elements which can easily be taken in excess, although it is essential for normal metabolism. The liver controls copper storage and any excess is excreted via the bile: however, if your copper intake increases, so does the amount retained. There are a number of copper-containing enzymes that have been isolated, several of which are involved in brain metabolism. Copper is also involved in the oxidation of vitamin C. About thirty per cent of the copper we eat is absorbed, and typical daily dietary intake is 2-5 mg of copper. This means that the daily absorption is somewhere between 0.6-1.6 mg.
Copper is an antagonist to zinc and water supplied by copper plumbing has led to widespread zinc deficency 75%> in our society.

Vanadium

Vanadium is probably a trace element for humans and may be of value protecting against heart disease and cancer. Much has yet to be learnt about the complex biochemistry of vanadium. The total amount of vanadium in the average adult body may be close to 173 mg. It is involved in growth and fat metabolism. It has been found that vanadium deficiency results in increased blood cholesterol and triglyceride levels. Animal studies have revealed that vanadium deficiency results in an impaired reproductive performance that does not show up until the fourth generation of animals mated. It is also possible that an adequate vanadium intake will protect against the development of heart disease. Vanadium has also been recommended for treating atherosclerosis.

Iodine

Iodine has been known to be an essential trace element for over 150 years. Nevertheless it is estimated that more than 200 million people throughout the world suffer from iodine deficiency diseases, mainly because they live in iodine-deficient soil areas.

The main iodine deficiency sign is an enlargement of the thyroid gland in the neck (goitre). Giving iodine to such people cures the goitre and disordering iodised salt to their diet can prevent it from occurring at all.

Iodine is essential for the production of thyroid hormones which play a fundamental part in controlling metabolism. Since thyroid hormones are so important in the maintenance of normal metabolic processes in the body, a defect in their production can play havoc with the body’s normal functioning. Eating too much iodine suppresses the thyroid gland. This fact is put to good use in people who have an overactive thyroid gland (thyrotoxicosis) and can bring about a resolution of the overactivity when used in conjunction with low-dose lithium under medical supervision. Iodine excess can aggravate acne, and skin contact with iodine can lead to dermatitis.

Silicon

Although silicon appears to be an essential element, more information is needed to prove this. Silicon is very similar to carbon, which is also ubiquitous in nature. Silicon can form long, complex molecules in the same way that carbon. However, the bond between silicon atoms is stronger, which makes silicon-containing molecules relatively stable and structurally strong. So, structurally ‘strong’ tissues such as arteries, tendons, skin, connective tissue, cornea and sclera (white of the eye) contain large amounts of silicon, whereas other tissues such as liver, kidney and blood contain very little. Collagen, the tough substance that holds other tissues together, contains much silicon. Silicon is a structural part of collagen and silicon-containing substances are found in all cartilage.

In atherosclerotic arteries there is fourteen times less silicon than in disease-free arteries. There does, therefore, seem to be a link between silicon status and the incidence of arteriosclerosis. Researchers in the USA and in Finland have found that in areas with a high silicon level in the drinking-water, there is a reduced incidence of arteriosclerosis.

Molybdenum

The average adult has 10 mg of molybdenum, concentrated mostly in the liver, kidney, adrenal glands, bones and skin. It is possible that molybdenum deficiencies will become recognised as an important aspect of health and disease, since the refining of food reduces molybdenum content substantially. It is possible that molybdenum deficiency is linked to an increased risk of cancer of the oesophagus, but this is yet to be proven. There is some evidence that sensitivity to bisulphites which are used as preservatives of salad greens may be in part due to molybdenum deficiency.

Chromium

Chromium is an essential trace element, recently discovered to be necessary for blood sugar control. Because chromium is present in blood in very minute quantities, in the past there have been problems with its accurate measurement. This means that early scientific literature cannot be relied upon to present a true picture. However, with more recent advances in analytical techniques, chromium can now be measured accurately in body tissues.

Chromium may be an important factor in the development of a number of chronic degenerative diseases in the Western world. It is evident that not only are some diets deficient in chromium, but that these very same diets increase the excretion of chromium in the urine, so resulting in a depletion of whatever chromium reserves an individual may have. Refined carbohydrates have had the chromium removed during processing and also tend to increase the rate at which chromium is excreted in the urine, so diets high in refined carbohydrates can produce a chromium deficiency. This may have some bearing on the fact that there is a range of different diseases (including diabetes, heart disease and hardening of the arteries) that are more prevalent in the Western world where there is a higher intake of refined carbohydrates. Refined carbohydrates also cause a rapid increase in the blood sugar level, which in turn results in an increased secretion of insulin. With increased circulating insulin levels, the demand for chromium increases.

Symptoms of chromium deficiency include impaired handling of glucose, reduced effectiveness of insulin, corneal opacity, atherosclerosis, depressed sperm count, elevated blood sugar and hypoglycaemia, loss of sugar in the urine.

Manganese

This is an enigmatic, but nevertheless essential, element found in bone, soft tissues, pituitary gland, liver, and kidney, in decreasing order of concentration. It is necessary for normal intrauterine growth, growth generally, normal cartilage, the functioning of nervous tissue and for many of the body’s ‘activator’ systems. Manganese is also known to be essential for the metabolism of amino acids and carbohydrates. Manifestations of manganese deficiency include disc and cartilage problems, glucose intolerance, reduced brain function, middle-ear imbalances, birth defects, reduced fertility, and growth retardation. A healthy body contains 12-20 mg of manganese. The body loses about 4 mg a day of this element, so to be safe it makes sense to at least replace this amount, whether in food or as supplements.

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