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Gender: Female
Name: June
Age: 23
Patient presents with extreme abdominal pain and was referred to a nutritionist by the primary care provider. The new client is experiencing symptoms characteristic of IBS. The patient presents with extreme abdominal pain, frequent constipation, and trouble passing stools.

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Here is a narrated overview of what I discuss in the padlet!

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Gender: Male
Name: August
Age: 33
Patient is seeking nutrition advice after feeling dizzy and lethargic. He wonders if he's drinking enough fluids and keeping his electrolytes balanced.

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IBS, or Irritable Bowel Syndrome is a disorder that affects the stomach and bowels. IBS is chronic, but there are ways that you can learn to manage it!

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How does IBS differ from a normal intestine?

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How does IBS differ from a normal intestine?

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A typical digestive tract is lined with muscle which contracts to move food through the digestive system. With IBS, your digestive tract is lined with muscle like a normal tract, but the contractions the muscles make may be stronger and last longer than normal. This is what causes the symptoms you may be experiencing such as gas, bloating, and changes in stool.

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The cause of IBS is unknown, however many factors can trigger symtpoms in patients. The severity of symtpoms also varies person-to-person and symtpoms may come annd go over an extended period of time.

IBS symtpoms may arise due to;
-Inflammation
-Bacterial overgrowth
-Intestinal bacteria
-Stress, anxiety, or depression

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IBS can have a variety of symptoms including but not limited to;
-Abdominal Pain and cramping
-Changes in bowel movement frequency
-Bloating
-Gas
-Diarrhea and Constipation
-Mucus in the stool
-Triggers to specific foods
-Nausea

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IBS-D   IBS With Diarrhea
Irritable Bowel syndrome with diarrhea may look like;
-Frequent bowel movements
-Loose stools
-Feelings of urgency
-Abdominal pain and cramping
-Gas and bloating
-Symptoms occurring at least once a week

IBS-C   IBS With Constipation
Irritable bowel syndrome with constipation may include;
-Having less than 3 bowel movements per week
-Having lumpy or hard stools
-Straining during bowel movements
-Abdominal pain, gas, and bloating

IBS-U   IBS with Alternating Bowel Patterns

IBS-M  IBS without Specific Bowel Patterns

For more information:
https://www.mindsethealth.com/matter/types-of-ibs-understanding-your-symptoms

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Electrolytes are essential minerals that have many key functions in the body. Some electrolytes include sodium, calcium, chloride, potassium, and magnesium.

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Dietary sources of necessary electrolytes
Overall, fruit, poultry & dairy are excellent sources. However, here are some specific examples;
-Spinach (Calcium & Magnesium)
-Pickled vegetables (Sodium & Chloride)
-Lentils (Magnesium, Potassium, & Phosphorous)
-Apricots (Potassium)
-Sunflower seeds (Phosphorous & Magnesium)
-Avocado (Potassium)
-Sports drinks (all of the electrolytes)

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Electrolytes help your body with a variety of important chemical reactions, along with keeping your body in homeostasis. Your body is 55-60% water. Electrolytes are minerals that take on a positive or negative electric charge when dissolved in bodily fluids, allowing them to help move electrical signals through your body. This aids in:
-Muscle contraction
-Nervous system function
-Brain function
-Osmosis
-Cell communication

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Your electrolyte levels keep your body in homeostasis. Some things that can cause you to lose electrolytes are:
Sweating
Fever
Diarrhea
Exposure to hot temperatures
Alcohol consumption
Caffeine consumption

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So we know that electrolytes help keep our bodies in homeostasis, so what happens when your levels are off?

Symptoms of electrolyte imbalance include:
-Confusion & irritability
-Diarrhea & constipation
-Fatigue
-Headaches
-Irregular heartbeat
-Muscle cramps, spasms, or weakness
-Nausea & vomiting
and more!

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Adult women should drink around 2.7 liters and adult men should drink around 3.7 liters. This will vary based on age, height & weight, and activity level.

Some ways to ensure adequate fluid and electrolyte intake:
-Stay well-hydrated
-Consider electrolyte beverages after exercise
-Drink when you're thirsty
-Try to maintain clear urine

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A trustworthy resource to reference.

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Overview

What are electrolytes?

Electrolytes are substances that have a natural positive or negative electrical charge when dissolved in water. An adult's body is about 60% water, which means nearly every fluid and cell in your body contains electrolytes. They help your body regulate chemical reactions, maintain the balance between fluids inside and outside your cells, and more.

Your body gets electrolytes or their components from what you eat and drink. Your kidneys filter excess electrolytes out of your body and into your urine. You also lose electrolytes when you sweat.

Key terms to know:

Hyper-: A condition that starts with "hyper" means it involves too much of something.

Hypo-: A condition that starts with "hypo" means it involves too little of something.

Ion: An atom that has an electrical charge.

Cations: Ions with a positive charge.

Anions: Ions with a negative charge.

pH: A scale that measures whether a liquid is an acid or base. Your body's natural blood pH is between 7.36 and 7.44.

Acidic: Has a pH of less than 7.

Neutral: Has a pH of 7.

Basic: Has a pH of more than 7 (basic is also known as "alkaline").

What do electrolytes do?

Your cells use electrolytes to conduct electrical charges, which is how your muscles contract. Those same electrical charges also help with chemical reactions, especially when it comes to hydration and the balance of fluids inside and outside of cells.

The key principle that electrolytes rely on is that certain chemical elements can naturally hold a positive or a negative electrical charge. When those elements are dissolved in a liquid, that liquid can then conduct electricity.

An example of this is salt water, which conducts electricity easily. Salt consists of sodium (positively charged) and chlorine (negatively charged), and when combined, their charges balance each other out. Atoms with an electrical charge are called ions (positive ions are called cations, while negative ions are called anions).

Dissolving salt in water splits the sodium and chlorine atoms apart, which means they go back to being positively and negatively charged. Electricity jumps between the sodium and chlorine ions - not the water molecules - because they have opposite electrical charges.

At the most basic chemical level, electrolytes help your body maintain balance. Just like electricity uses ions to travel from place to place in salt water, your body uses ions to transport chemical compounds in and out of cells.

What are the key electrolyte components?

There are several key elements that your body needs to maintain normal electrolyte levels. The following section includes the major elements, marked as positive (+) or negative (-), and what happens when there's too much or too little of that element.

Sodium (+)

Sodium plays a critical role in helping your cells maintain the right balance of fluid. It's also used to help cells absorb nutrients. It's the most abundant electrolyte ion found in the body.

Hypernatremia (too much sodium): Can cause confusion or behavior changes, unusually strong reflexes and loss of muscle control, seizures and coma.

Hyponatremia (not enough sodium): Confusion, irritability, weakened reflexes, nausea and vomiting, seizures and coma.

Magnesium (+)

Magnesium helps your cells as they turn nutrients into energy. Your brain and muscles rely heavily on magnesium to do their job.

Hypermagnesemia (too much magnesium): Heart rhythm changes and arrhythmias, weakened reflexes, decreased ability to breathe and cardiac arrest (your heart stops).

Hypomagnesemia (not enough magnesium): Muscle weakness, twitching and loss of control, heart arrhythmias. This commonly happens in connection with calcium and potassium deficiencies.

Potassium (+)

Your cells use potassium alongside sodium. When a sodium ion enters a cell, a potassium ion leaves, and vice versa. Potassium is also especially critical to your heart function. Too much or too little can cause serious heart problems.

Hyperkalemia (too much potassium): Weakness, inability to move muscles, confusion, irregular heart rhythms (arrhythmias).

Hypokalemia (not enough potassium): Muscle weakness and cramps, feeling unusually thirsty and needing to pee frequently, dizziness or passing out when standing up too quickly. At higher levels, muscle tissue begins to break down (a condition called rhabdomyolysis, which can severely damage your kidneys) and heart arrhythmias become a serious threat.

Calcium (+)

Calcium is a key element in your body, but it does more than just build strong bones and teeth. It's also used to control your muscles, transmit signals in your nerves, manage your heart rhythm and more. Having too much or too little calcium in your blood can cause a wide range of symptoms across different systems in your body.

Hypercalcemia (too much calcium)

Brain: Headache, fatigue, apathy and confusion.

Digestive tract: Constipation, abdominal pain and vomiting.

Kidneys: Frequent need to pee, kidney stones and kidney failure.

Heart: Arrhythmias, some of which can be severe.

Skeletal: Pain in the bones and joints.

Hypocalcemia (not enough calcium)

Brain: Confusion and behavior changes.

Muscles: Unusually strong reflexes and loss of muscle control, muscle twitching, spasms in the throat muscles making it hard to speak or breathe.

Chloride (-)

Chloride (the name for a chlorine ion) is the second-most abundant ion in the body. It's also a key part of how your cells maintain their internal and external balance of fluid. It also plays a role in maintaining the body's natural pH balance.

Hyperchloremia (too much chloride)

This can cause acidosis, which is when your blood's acidity is too high. It results in nausea, vomiting and fatigue, as well as rapid, deeper breathing and confusion. This usually happens in connection with too much or too little potassium.

When related to hyperkalemia: When associated with too much potassium, it can cause severe kidney problems or kidney failure.

When related to hypokalemia: When connected with too little potassium, it can cause diarrhea, fluid leakage from the pancreas, and other serious urinary tract problems.

Hypochloremia (not enough chloride)

This causes your blood to become more alkaline, a condition called alkalosis. It usually happens with hyponatremia or vomiting. Symptoms of alkalosis are apathy, confusion, arrhythmias and muscle twitching or loss of control.

Phosphate (-)

Phosphate is a phosphorous-based molecule that's a key part of transporting chemical compounds and molecules outside your cells. It helps your cells metabolize nutrients, and it's also a key part of molecules called nucleotides, which are the building blocks that make up your DNA.

Hyperphosphatemia (too much phosphate): This typically causes you to experience hypocalcemia because your body tries to use calcium as a substitute for phosphorus. It usually doesn't cause symptoms until it becomes severe, and symptoms of hypocalcemia also often happen with this. It can also be associated with excessive itching.

Hypophosphatemia (not enough phosphate): The early symptom of this condition is usually muscle weakness. As it gets worse, more severe symptoms occur. They include rhabdomyolysis (breakdown of muscle tissue, which can cause severe kidney damage), seizures, reduced heart function and trouble breathing (caused by muscle weakness).

Bicarbonate (-)

Not all the carbon dioxide that your body makes gets sent to your lungs for you to breathe it out. Instead, some gets recycled into bicarbonate, which your body uses to keep your blood pH levels normal.

Acidosis. Too little bicarbonate causes acidosis, where your blood is too acidic. This causes fatigue, nausea and vomiting, and you will breathe faster and deeper. It can also cause confusion.

Alkalosis. Too much bicarbonate causes alkalosis, where your blood becomes too alkaline. Symptoms include confusion, apathy, arrhythmias and muscle twitching.

Test Details

What tests help identify electrolyte problems?

Electrolyte problems are detectable using several different varieties of lab tests. Testing usually involves a broader type of test called a metabolic panel. If those results are abnormal, your healthcare provider may order follow-up tests, which can narrow down what's causing the electrolyte imbalances. These follow-up tests are critical, as the specific cause of an electrolyte imbalance may need a specific type of treatment that won't work for other causes.

Broader tests that can detect electrolyte problems include the following blood tests:

This test looks at several different processes in your body and shows data related to:

BUN (blood urea nitrogen). This is a test that shows how well your kidneys are functioning and may suggest dehydration.

The balance of fluids and several electrolytes, including sodium, potassium, carbon dioxide and chloride levels.

Blood sugar. This test may indicate diabetes or prediabetes if you are fasting.

This test is similar to the basic metabolic panel but with additional data gathered. The additional items gathered include:

Calcium levels.

Albumin (a protein produced by your liver) levels.

Total blood protein levels.

Bilirubin (a chemical compound made in your liver).

Levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), enzymes that are connected to your liver function.

Electrolyte panel

This is a broader test like the above metabolic panels, but it only looks for electrolytes. The electrolytes analyzed include sodium, chloride, potassium and bicarbonate.

Tests that are more specific for electrolyte problems include:

Aldosterone blood test. This test looks for a specific hormone produced by your kidneys. The results can indicate certain types of electrolyte problems.

Aldosterone 24-hour urine test. This test also looks for aldosterone but does so using several urine samples collected during a 24-hour timeframe.

Anion gap blood test. The test compares the levels of specific electrolytes to see if there's a difference between the measured levels of positive-charge and negative-charge electrolytes, which may be is a sign of certain conditions.

Antidiuretic hormone test (blood). This test looks for levels of antidiuretic hormone. It can help rule out certain medical conditions that share symptoms - especially excessive thirst or fluid imbalance - with electrolyte-based conditions.

Carbon dioxide blood test. This test measures the amount of carbon dioxide in your blood. That level can indicate if your blood is too acidic or too alkaline (basic).

Chloride blood test. This test analyzes a blood sample for the level of chloride found in your blood.

Chloride urine test. This test measures the amount of chloride in a urine sample. In some cases, it can involve several samples taken over a 24-hour period.

Magnesium blood test. This test analyzes levels of magnesium in your blood.

Blood osmolality test. This test measures the amount of certain substances in your body. It's frequently used in cases where you're dehydrated, overhydrated, or when poisoning is possible or suspected.

Urine osmolality test. This test checks fluid balance, especially with changes in how often you need to pee. Urine osmolality tests use a "clean-catch" method, which requires getting the sample in a way so that there's no contamination from microbes that may be on your genitals.

Phosphorus blood test. This test measures the amount of phosphorus in your blood.

Phosphorus urine test. This test measures the amount of phosphorus that's found in your urine. It may involve more than one sample taken over a 24-hour period.

Sodium blood test. This test measures the level of sodium in your blood.

Sodium urine test. This test measures the amount of sodium in your pee. It can involve multiple samples collected over a period of 24 hours.

Urine concentration test. This test shows healthcare providers how well your kidneys are functioning, especially their ability to manage the amount of fluid in your body. It looks specifically for the concentration of particles in your urine, electrolyte levels and particle concentration (osmolality).

Results and Follow-Up

What type of results will I get?

Most lab results include your result number and a reference range. A reference range has an upper and a lower limit, and any result that falls between the two is considered a "normal" result. Most of these results are communicated as "how much of a substance can be found in a specific sample size."

Mass is a unit of "how much." It's not the same as weight. The units of mass that are used are millimoles, milliequivalents or milligrams.

Millimoles are the most constant and can be used for all electrolyte atoms and molecules.

Milliequivalents per liter are often used instead of millimoles. This is because milliequivalents take into account the strength of an ion's charge, which is why ions with stronger charges have different amounts than the same test results in millimoles.

Milligrams per deciliter may sometimes be used for larger atoms and molecules.

The prefix "milli-" means "1/1,000th." The units of volume are usually displayed as a liter or fractions of a liter, like a deciliter (dL, which is 1/10th of a liter) or milliliter (mL, which is 1/1,000th of a liter).

What are the normal ranges for electrolyte levels?

In blood, the normal amounts for electrolytes are as follows:

In urine, stool or other measurable forms, the normal amounts for electrolytes are as follows:

Does a normal result mean everything is fine, or does an abnormal result always mean I have a problem?

Because everyone is different, sometimes you may have a result that falls outside the reference range. In other cases, you may have a normal result, but symptoms you're having and other test results will show you have a health problem.

One way to understand it is to think of the carnival trick where an entertainer spins a plate on the end of a wooden stick. If the plate leans too far in any direction, it will fall off, so balance is crucial. Your electrolyte levels and lab results rely on a similar balancing act, and your body is always trying to keep things as balanced as possible. Your body may be masking a problem by compensating with another body system or process. If your medical provider runs more than one test, they are likely making sure that your body isn't hiding one problem by creating another.

When should I know the results of the test?

Your healthcare provider or their staff can tell you when to expect your test results back.

When should I call my doctor?

If you don't understand your test results or have a result that isn't within the reference range and you have questions or concerns, you should call your healthcare provider. You should also call your healthcare provider if you notice a sudden change in any symptoms related to any test done on your electrolyte levels.

A note from Cleveland Clinic
Electrolytes are an essential part of how your body functions, affecting everything from hydration to how your heart beats. They can also help doctors diagnose a wide range of medical conditions and problems. Understanding electrolytes and the potential concerns that surround them can help you care for yourself, and help you avoid future health concerns. That way, you can take charge of your electrolytes and keep them from negatively affecting your life and routine.

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Electrolytes: Types, Purpose & Normal Levels

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Electrolytes are substances that have a natural positive or negative electrical charge when dissolved in water. An adult's body is about 60% water, which means nearly every fluid and cell in your body contains electrolytes. They help your body regulate chemical reactions, maintain the balance between fluids inside and outside your cells, and more.

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Short video for visual learners.

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Fluid and Electrolytes Easy Memorization Tricks for Nursing NCLEX RN & LPN

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Food is essential for everyone. It plays a role in our culture, heritage and everyday lives, from ordinary days to special occasions and holidays. Learn about the importance of each food group and how to properly plan and prepare nutritious meals and snacks in a safe way.

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Gender: Female
Name: April
Age: 45
Patient reports that she is always tired and seems to get sick every time one of her coworkers has any kind of symptom.  She has also noticed that her illnesses last much longer than those of her coworkers.
Serum Vitamin C: 12.1 mg/dL
Serum Vitamin E: 20.4 mg/L
Serum Vitamin A: 30 mcg/dL

We deducted that the patient is deficient in Vitamin C, likely causing the fatigue, and reduced immunity. Patient will be incorporating more fruits and vegetables, as well as citrus fruits which she noted she likes, into her diet. Levels will be reevaluated in two weeks.

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Vitamin C is an essential nutrient your body needs to properly form and heal tissue, muscle, and bone. Vitamin C is also an antioxidant that helps protect your cells from free radicals. Free radicals are molecules that come from radiation, x-ray waves, tobacco smoke etc that can cause harm to the body. Free radicals are also shown to help prevent anything from common colds to heart disease and cancer.

Ideal levels of Vitamin C are between 75-90mg/dL

Vitamin C deficiency is rare, but can cause;
-Rough skin
-Slow-healing wounds
-Joint pain
-Bleeding gums
-Poor immunity
-Fatigue

Your body doesn't produce vitamin C, so you have to get it from your diet. Some foods high in vitamin c include;
-Strawberries
-Bell peppers, or peppers in general
-Broccoli and cauliflower
-Papaya
-Brussels Sprouts
-Citrus fruits
-Kiwi
-Melon
-Pineapple

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Vitamin E is an essential nutrient that acts as an antioxidant in the body, protecting it from free-radicals and playing a role in immunity. This can help prevent a variety of diseases including cancer, vision-loss, and other conditions.

Ideal levels of Vitamin E are around 15mg/L

A deficiency in Vitamin E, while rare, can look like;
-Slow reflexes
-Anemia
-Loss of coordination

Vitamin E comes from our diet, some great dietary sources include;
-Sunflower seeds
-Avocado
-Spinach
-Olive oil
-Hazelnuts, Peanuts, Almonds
-Broccoli
-Sweet potato
-Squash
-Salmon and trout

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Vitamin A is an essential, anti-inflammatory nutrient responsible for maintaining a healthy immune system, healthy vision, healthy skin, and more. Adequate vitamin A is also crucial for children because it's necessary for proper human body development. In terms of immunity, vitamin A plays a large role in adaptive immune cell response, and regulates immune cell response.

Ideal levels of Vitamin A range from 700 - 900 mcg/dL

Some symptoms of vitamin A deficiency;
-Night blindness
-Dry eyes
-Spotty vision
-Irritated skin
-Stunted growth
-Infertility

Some dietary sources of Vitamin A include;
-Bell pepper
-Carrots
-Melon
-Spinach
-Sweet potato
-Broccoli
-Tuna
-Lettuce
-Grapefruit

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Selenium is an essential component in DNA creation. It also acts as a powerful anti-inflammatory antioxidant which helps protect cells against free radicals, support immune health and prevent infections. Selenium is shown to help support heart health and thyroid health as well.

Ideal levels of selenium range from 120 - 160 ug/L or 55 micrograms

Selenium deficiency often presents as;
-Nausea and vomiting
-Headaches
-Lethargy
-Dizziness
-Muscle soreness
-Hair loss

Some dietary sources of Selenium include;
-Beans
-Shellfish
-Spinach
-Brazil nuts
-Eggs
-Pork, beef, and poultry

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Zinc is an essential anti-inflammatory mineral responsible for helping fight off infection, heal from injury, and synthesize protein in the body. Zinc also aids in the creation of new cells, tissues, and DNA.

Normal zinc levels range from 66 - 106 mcg/dL

Zinc deficiency can cause;
-Diarrhea
-Decreased immunity
-Hair thinning
-Impaired taste or smell
-Dry skin
-Infertility
-Impaired wound healing

Some dietary sources of zinc include;
-Legumes (lentils, chickpeas, lima beans)
-Broccoli
-Green beans
-Mushrooms
-Kale
-Pork, beef, lamb, poultry
-Shellfish (oysters, crab, etc)

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A snapshot of the essential vitamins and minerals

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A snapshot of the essential vitamins and minerals

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This includes a table with the recommended daily allowances.

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Vitamins and minerals are micronutrients required by the body to carry out a range of normal functions. However, these micronutrients are not produced in our bodies and must be derived from the food we eat.
Vitamins are organic substances that are generally classified as either fat soluble or water soluble. Fat-soluble vitamins ( vitamin A, vitamin D, vitamin E, and vitamin K) dissolve in fat and tend to accumulate in the body. Water-soluble vitamins ( vitamin C and the B-complex vitamins, such as vitamin B6, vitamin B12, and folate) must dissolve in water before they can be absorbed by the body, and therefore cannot be stored. Any water-soluble vitamins unused by the body is primarily lost through urine.

Minerals are inorganic elements present in soil and water, which are absorbed by plants or consumed by animals. While you're likely familiar with calcium, sodium, and potassium, there is a range of other minerals, including trace minerals (e.g. copper, iodine, and zinc) needed in very small amounts.

In the U.S., the National Academy of Medicine (formerly the Institute of Medicine) develops nutrient reference values called the Dietary Reference Intakes (DRIs) for vitamins and minerals. [1] These are intended as a guide for good nutrition and as a scientific basis for the development of food guidelines in both the U.S. and Canada. The DRIs are specific to age, gender, and life stages, and cover more than 40 nutrient substances. The guidelines are based on available reports of deficiency and toxicity of each nutrient. Learn more about vitamins and minerals and their recommended intakes in the table below.

Recommended Daily Intake of Vitamins and Minerals for Adults

Ages 19-50: 15 micrograms (600 IU)

Ages 51-70: 15 micrograms (600 IU)

Ages 71+: 20 micrograms (800 IU)

Ages 19-50: 15 micrograms (600 IU)

Ages 51-70: 15 micrograms (600 IU)

Ages 71+: 20 micrograms (800 IU)

100 micrograms (4,000 IU)

Phosphorus
700 milligrams

700 milligrams

Ages 31-70: 4,000 milligrams

Ages 71+: 3,000 milligrams

1,500 milligrams*

1,500 milligrams*

Not determined; however a chronic disease risk reduction intake has been established

* Denotes Adequate Intake (AI). An AI is a recommended intake when an RDA can't be determined. RDA is the average daily dietary intake sufficient to meet the nutrient requirement of 97-98% of healthy individuals in a particular group according to stage of life and gender.
** May play a role in the human body, but adequate research regarding its nutritional importance is not available so RDA or AI has not been set.

What about multivitamins?

A diet that includes plenty of fruits, vegetables, whole grains, good protein packages, and healthful fats should provide most of the nutrients needed for good health. But not everyone manages to eat a healthful diet. Multivitamins can play an important role when nutritional requirements are not met through diet alone. Learn more about vitamin supplementation.

Did you know?

Vitamins and their precise requirements have been controversial since their discovery in the late 1800s and early 1900s. It was the combined efforts of epidemiologists, physicians, chemists, and physiologists that led to our modern day understanding of vitamins and minerals. After years of observation, experiments, and trial and error, they were able to distinguish that some diseases were not caused by infections or toxins-a common belief at the time-but by vitamin deficiencies. [2] Chemists worked to identify a vitamin's chemical structure so it could be replicated. Soon after, researchers determined specific amounts of vitamins needed to avoid diseases of deficiency.

In 1912, biochemist Casimir Funk was the first to coin the term "vitamin" in a research publication that was accepted by the medical community, derived from "vita" meaning life, and "amine" referring to a nitrogenous substance essential for life. [3] Funk is considered the father of vitamin therapy, as he identified nutritional components that were missing in diseases of deficiency like scurvy (too little vitamin C), beri-beri (too little vitamin B1), pellagra (too little vitamin B3), and rickets (too little vitamin D). The discovery of all vitamins occurred by 1948.

Vitamins were obtained only from food until the 1930s when commercially made supplements of certain vitamins became available. The U.S government also began fortifying foods with specific nutrients to prevent deficiencies common at the time, such as adding iodine to salt to prevent goiter, and adding folic acid to grain products to reduce birth defects during pregnancy. In the 1950s, most vitamins and multivitamins were available for sale to the general public to prevent deficiencies, some receiving a good amount of marketing in popular magazines such as promoting cod liver oil containing vitamin D as bottled sunshine.

References

1. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); and Dietary Reference Intakes for Calcium and Vitamin D (2011). These reports may be accessed via www.nap.edu.

2. Semba RD. The discovery of the vitamins. Int J Vitam Nutr Res. 2012 Oct 1;82(5):310-5.

3. Piro A, Tagarelli G, Lagonia P, Tagarelli A, Quattrone A. Casimir Funk: his discovery of the vitamins and their deficiency disorders. Ann Nutr Metab. 2010;57(2):85-8.

Last reviewed March 2023
Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

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Vitamins and minerals are micronutrients required by the body to carry out a range of normal functions. However, these micronutrients are not produced in our bodies and must be derived from the foo...

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Gender: Female
Name: May
Age: 29
Assessment:
Patient has experienced repeated bone fractures while performing everyday tasks. We have been working together for some time when she came to your practice having experienced unexplained vomiting, diarrhea, and abdominal cramps for extended periods without any sense for the cause. Patient presents with a magnesium deficiency.

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Human bone, while it seems rock-solid, is made up of a dense honeycomb structure inside and a compact bone exterior. This inner matrix structure helps give bones rigidity, and strength.

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Human bone is constantly being renewed; broken down, and built back up. Osteoclasts break bone down, and osteoblasts form new bone. As we age, the amount of bone being broken down starts to out-weight the amount of bone being built, naturally causing loss of bone density. if you click on the video, it will show you a simple, one-minute clip explaining how bone is formed on a cellular level.

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60 seconds · Clipped by Cara Eaton · Original video “The Skeletal System: Crash Course Anatomy & Physiology #19” by CrashCourse

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Osteoporosis occurs when the bones become very fragile, and the honeycomb structure of the bone becomes less dense. This causes bone to be more likely to fracture.
Osteoporosis often presents as common low-impact fractures, and oftentimes back pain.
Read more on the National Institute of Health:
https://www.nia.nih.gov/health/osteoporosis

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Nutrition and Bone Health: The important micronutrients

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Nutrition and Bone Health: The important micronutrients

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Nutrition plays a big role in bone health!
Specific micronutrients are essential to promote strong bones. These include:
Calcium
Vitamin D
Phosphorous
Magnesium
Fluoride

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Essential nutrients your body needs for building bone - Harvard Health

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Calcium is the mineral often associated with bone health for good reason. While it also plays a role in blood clotting, muscle contraction, and heart rhythm, about 99% of calcium is stored in the bones. Ensuring the body gets enough calcium is essential for the function of osteoblasts and osteoclasts which control the creation and breakdown of bone tissue.
The daily recommended intake is: 1000 mg
Some dietary sources of calcium:
-Green Leafy vegetables (kale, broccoli)
-Fortified foods
-Dairy products (milk, yogurt, cheese)
-Almonds
-Soy milk and soybeans
-Chia seeds
-Fish (salmon)

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Vitamin D is a nutrient that is essential in helping your body absorb calcium (which is critical for bone formation).
The daily recommended intake is: 15 micrograms or 600IU
Some dietary sources of Vitamin D:
-Fish (tuna, salmon, sardines)
-Fortified juice
-Fortified cereals
-Egg yolk
-Fortified dairy and alternative milks
Vitamin D3 can also be formed when UV light is absorbed through the skin.

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Vitamin D and Calcium Absorption - Biochemistry Lesson

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About 85% of the body’s phosphorus is stored in bones and teeth, making it the most abundant mineral in the body aside from calcium. A correct balance of phosphorus and calcium is necessary for bone health because if more phosphorus is more abundant in the body than calcium, the body will use the calcium stored in bones which can cause osteoporosis.
The daily recommended intake is: 700 milligrams
Some dietary sources of phosphorus:
-Dairy (milk, yogurt, cheese)
-Salmon
-Beef
-Poultry
-Pork
-Legumes
-Nuts and seeds
-Whole wheat bread and cereal
-Some vegetables (asparagus, tomatoes)

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Phosphorus is a mineral that naturally occurs in many foods and is also available as a supplement. It plays multiple roles in the body. It is a key element of bones, teeth, and cell membranes. It helps to activate enzymes, and keeps blood pH within a normal range. Phosphorus regulates the normal function of nerves and muscles, including the heart, and is also a building block of our genes, as it makes up DNA, RNA, and ATP, the body's major source of energy. [1]

The kidneys, bones, and intestines tightly regulate phosphorus levels in the body. If the diet lacks phosphorus or too little phosphorus is absorbed, several things happen to preserve its stores and try to maintain normal levels: the kidneys excrete less phosphorus in urine, the digestive tract becomes more efficient at absorbing phosphorus, and the bones release its stores of phosphorus into the blood. [1] The opposite actions occur in these organs if the body has adequate phosphorus stores.

Recommended Amounts

RDA: The Recommended Dietary Allowance (RDA) for adult men and women 19+ years is 700 mg a day. Pregnancy and lactation require the same amount of phosphorus at 700 mg daily. [2]

UL:The Tolerable Upper Intake Level (UL) is the maximum daily intake unlikely to cause harmful effects on health. The UL for phosphorus for adult men and women ages 19-70 years old is 4,000 mg daily, and for older adults 71+ years, 3,000 mg daily. The UL for pregnant and lactating women ages 14-50 years is 3,500 and 4,000 mg, respectively.

Phosphorus and Health

Chronic kidney disease

Kidneys help to regulate normal levels of phosphorus in the body. If the body has adequate stores of the mineral, the kidneys will push out extra phosphorus in the urine. With chronic kidney disease (CKD), the kidneys cannot perform this action and the amount of phosphorus can rise to harmful levels in the blood. Studies show that adults with CKD have higher phosphate levels than those with normal kidney function. [3] This may quicken the progression of CKD, and increase the risk of cardiovascular disease, bone disorders, and death. [4,5] It appears that patients with higher phosphate levels and more advanced levels of CKD (such as those on dialysis) have a greater risk of disease progression and death than those with milder forms of CKD. [6-9]

Even so, it is unclear if lowering phosphate levels in those with CKD improves health outcomes later on. Dietary recommendations for phosphorus depend on how much the disease has progressed, and a person's blood level of phosphorus. Some recommendations suggest limiting animal protein while increasing plant proteins, and reading food labels to limit foods with phosphate additives. [4] Plant-based proteins like legumes, nuts, and seeds contain phytates, which interfere with the absorption of phosphorus in the gut. [10] Medications like phosphate binders are also sometimes prescribed to be taken with food to reduce the amount of phosphorus absorbed in the gut.

Cardiovascular disease

Some studies have found that excess phosphorus can promote the calcification, or hardening, of heart arteries and increase inflammation. [11] Higher phosphate levels may be associated with an increased risk of cardiovascular disease (CVD). A meta-analysis of six cohort studies of more than 120,000 healthy adults followed for up to 29 years showed a 36% increased risk of deaths from CVD and all causes in those with the highest levels of serum phosphorus, compared with the lowest levels. [12] Deaths from all causes were seen mainly in men, not women.

The foods highest in phosphorus are animal proteins, which also tend to be high in other components related to CVD, like saturated fat. So it is not clear if phosphorus alone is associated with an increased risk of CVD, or if high levels are an indicator of another risk factor. The research is also unclear if restricting dietary phosphorus can prevent CVD in otherwise healthy adults. [2]

Bone health

Elevated phosphorus levels may disrupt the normal hormonal balance of phosphorus, calcium, and vitamin D that regulates bone health. Animal studies have shown that high dietary phosphorus intakes are detrimental to bone health. Yet the evidence is less clear in humans, partly because it is difficult to estimate accurate phosphorus intakes. Most studies measure phosphorus in the blood, which may not reflect true dietary intakes of phosphorus, since the majority of the mineral is stored in bones and the body maintains blood levels within a specific range. However, research has shown that a higher intake of phosphate additives, from various foods like cola beverages and salad dressings that are very well-absorbed in the gut, are associated with negative effects on bone metabolism. [13] These include fractures and a lower bone mineral density. [14] More research is needed in this area.

Food Sources

A variety of foods naturally contain phosphorus, and the richest sources are dairy, red meat, poultry, seafood, legumes, and nuts. Phosphorus from these foods is called organic phosphorus. It is absorbed more efficiently from animal foods than plant foods. Plant foods like seeds, legumes, and whole grains contain a storage form of phosphorus called phytates or phytic acid that can reduce the mineral's absorption. The body lacks an enzyme needed to break down phytic acid, so as it passes through the digestive tract it can bind not only to phosphorus but other minerals like iron and zinc. Cooking, sprouting, and soaking are some food preparation techniques that help to break down phytic acid so that phosphorus is more easily absorbed.

Inorganic phosphorus is a processed form added to foods to preserve color, moisture, and texture. It is found in fast foods, deli meats, canned and bottled beverages, and many other processed foods. Phosphate additives and preservatives are a significant contributor to phosphorus intakes, comprising up to 30% in the U.S. diet. [4] Inorganic phosphorus is very easily absorbed in the gut: about 90%, compared with 40-60% from natural animal and plant foods. [15] Phosphorus is also available in supplement form.

Dairy: milk, yogurt, cheese

Beef

Poultry

Pork

Nuts, seeds

Whole wheat breads and cereals

Some vegetables: asparagus, tomatoes, cauliflower

Processed foods (as inorganic phosphorus), especially deli meats, bacon, sausage, sodas, sports drinks, and other bottled beverages

Signs of Deficiency and Toxicity

Deficiency

A phosphorus deficiency is called hypophosphatemia, defined by blood levels that fall below the normal range. However, blood levels of phosphate do not necessarily show the total amount of phosphorus in the body, as most of it is stored in bones and teeth. The most common causes of deficiency are kidney problems or a condition called hyperparathyroidism, in which too much parathyroid hormone is released that causes phosphorus to exit the body through urine. Also, the overuse of aluminum-containing antacids can bind to phosphorus and increase the risk of a deficiency.

A notable but less common occurrence of hypophosphatemia occurs with refeeding syndrome, seen in people with severe malnutrition. Patients who are malnourished from conditions like cancer, advanced liver disease, alcohol abuse, or anorexia nervosa may be started on supplemental nutrition feedings through a tube or vein. However because their starved state has reduced their ability to efficiently process food, reintroducing nutrition can cause problems. A sudden infusion of nutrients and calories causes an insulin surge, which results in rapid shifts in electrolytes and fluids in the blood. Blood levels of electrolyte nutrients like potassium, phosphorus, and magnesium may quickly drop. If untreated, refeeding syndrome can lead to respiratory failure, coma, cardiac arrest, and even death. The situation can be avoided by giving these electrolytes intravenously to the patient prior to the nutritional feedings.

Symptoms appearing with a phosphorus deficiency:

Poor appetite

Anemia

Muscle weakness

Bone pain

Bone disease (osteomalacia, rickets)

Confusion

Increased susceptibility to infections

A toxicity from phosphorus, called hyperphosphatemia, is rare because the body will regulate any excess levels in healthy individuals. It might occur with supplement use, but generally the use of phosphorus supplements is not common and the amount of phosphorus in them is typically not high. (2) People with hyperphosphatemia may show no symptoms; others may develop calcium deposits and hardening of soft tissues in the body, such as in the kidney, resulting from a disruption in the normal metabolism of calcium.

Did You Know?

Phosphorus is the second most abundant mineral in the body, second to calcium. About 85% of the body's phosphorus is stored in bones and teeth.

Inorganic phosphorus as phosphorus additives are commonly found in foods like processed meats and baked goods as well as beverages like soda, iced teas, bottled coffee drinks, and flavored waters. Examples to look for in the ingredients list are phosphoric acid, dicalcium phosphate, sodium phosphate, and trisodium phosphate. If one is following a low phosphorus diet, it is important to be aware of these "hidden" well-absorbed dietary sources of phosphorus by reading food labels carefully.

Related
Vitamins and Minerals

References

1. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1997.

2. National Institutes of Health Office of Dietary Supplements: Phosphorus Fact Sheet for Health Professionals https://ods.od.nih.gov/factsheets/Phosphorus-HealthProfessional/. Accessed 6/8/2020.

3. Moore LW, Nolte JV, Gaber AO, Suki WN. Association of dietary phosphate and serum phosphorus concentration by levels of kidney function. The American journal of clinical nutrition. 2015 Aug 1;102(2):444-53.

4. Chang AR, Anderson C. Dietary phosphorus intake and the kidney. Annual review of nutrition. 2017 Aug 21;37:321-46.

5. Da J, Xie X, Wolf M, Disthabanchong S, Wang J, Zha Y, Lv J, Zhang L, Wang H. Serum phosphorus and progression of CKD and mortality: a meta-analysis of cohort studies. American Journal of Kidney Diseases. 2015 Aug 1;66(2):258-65.

6. Hou Y, Li X, Sun L, Qu Z, Jiang L, Du Y. Phosphorus and mortality risk in end-stage renal disease: A meta-analysis. Clinica chimica acta. 2017 Nov 1;474:108-13.

7. Selamet U, Tighiouart H, Sarnak MJ, Beck G, Levey AS, Block G, Ix JH. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: The Modification of Diet in Renal Disease Study. Kidney international. 2016 Jan 1;89(1):176-84.

8. Murtaugh MA, Filipowicz R, Baird BC, Wei G, Greene T, Beddhu S. Dietary phosphorus intake and mortality in moderate chronic kidney disease: NHANES III. Nephrology Dialysis Transplantation. 2012 Mar 1;27(3):990-6.

9. Mehrotra R, Peralta CA, Chen SC, Li S, Sachs M, Shah A, Norris K, Saab G, Whaley-Connell A, Kestenbaum B, McCullough PA. No independent association of serum phosphorus with risk for death or progression to end-stage renal disease in a large screen for chronic kidney disease. Kidney international. 2013 Nov 1;84(5):989-97.

10. Chauveau P, Koppe L, Combe C, Lasseur C, Trolonge S, Aparicio M. Vegetarian diets and chronic kidney disease. Nephrology Dialysis Transplantation. 2019 Feb 1;34(2):199-207.

11. Gutiérrez OM. The connection between dietary phosphorus, cardiovascular disease, and mortality: where we stand and what we need to know. Advances in nutrition. 2013 Nov;4(6):723-9.

12. Bai W, Li J, Liu J. Serum phosphorus, cardiovascular and all-cause mortality in the general population: a meta-analysis. Clinica Chimica Acta. 2016 Oct 1;461:76-82.

13. Calvo MS, Tucker KL. Is phosphorus intake that exceeds dietary requirements a risk factor in bone health?. Annals of the New York Academy of Sciences. 2013 Oct;1301(1):29-35.

14. Vorland CJ, Stremke ER, Moorthi RN, Hill Gallant KM. Effects of excessive dietary phosphorus intake on bone health. Current osteoporosis reports. 2017 Oct;15(5):473-82.

15. Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinaberger CS, Noori N, Hirschberg R, Benner D, Nissenson AR, Kopple JD. Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2010 Mar 1;5(3):519-30.

Last reviewed March 2023
Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

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Phosphorus is a mineral that naturally occurs in many foods and is also available as a supplement. It plays multiple roles in the body. It is a key element of bones, teeth, and cell membranes. It h...

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Magnesium plays a significant role in many enzymatic reactions, including building proteins and strong bones. 60% of the body’s magnesium is stored in the bone, and it is directly involved in the function of osteoclasts which help build bone tissue.
The daily recommended intake is: 310 - 400 milligrams
Some dietary sources of magnesium:
-Almonds, cashews, peanuts
-Pumpkin seeds
-Peanut butter
-Beans
-Soybeans and soy milk
-Green leafy vegetables (spinach, swiss chard)
-Brown rice
-Salmon

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Magnesium is naturally present in a variety of foods, available as a supplement, and an ingredient in antacids and laxatives. The mineral plays an important role in assisting more than 300 enzymes to carry out various chemical reactions in the body such as building proteins and strong bones, and regulating blood sugar, blood pressure, and muscle and nerve functions. Magnesium also acts an electrical conductor that contracts muscles and makes the heart beat steadily.

More than half of the magnesium in our body is stored in bones, and the remaining in various tissues throughout the body.

Recommended Amounts

RDA: The Recommended Dietary Allowance (RDA) for adults 19-51+ years is 400-420 mg daily for men and 310-320 mg for women. Pregnancy requires about 350-360 mg daily and lactation, 310-320 mg.

UL:The Tolerable Upper Intake Level is the maximum daily intake unlikely to cause harmful effects on health. The UL for magnesium is 350 milligrams from supplements only. High-dose supplements can lead to diarrhea, nausea, and cramping in some people. Extra magnesium from food is safe because the kidneys will eliminate excess amounts in urine.

Magnesium and Health

Magnesium is a key factor in making several parts of the body run smoothly: the heart, bones, muscles, nerves, and others. Without enough magnesium, these areas malfunction. This is summarized in research, which finds that a magnesium deficiency or low magnesium diet leads to health problems. Although epidemiological studies show that higher magnesium diets are associated with lower rates of disease, results are mixed from clinical trials showing that magnesium supplementation can correct these conditions. It may be because a magnesium-rich diet is often higher in other nutrients, which collectively work together in disease prevention as opposed to a supplement containing a single nutrient.

For disease prevention, a good rule of thumb is to eat a daily diet that includes some magnesium-rich foods and take a supplement if directed by a physician to correct a deficiency if blood levels are low.

Bone health

Magnesium is a component of bone; in fact 60% of the body's magnesium is stored in bone. It is also involved with the activity of bone-building cells and the parathyroid hormone, which regulates calcium levels. Population studies have found an association of greater bone mineral density in men and women with higher magnesium diets. [1] A cohort study of 73,684 postmenopausal women from the Women's Health Initiative found that a lower magnesium intake was associated with lower bone mineral density of the hip and total body, although the authors cautioned that their finding did not translate into an increased risk of fractures. [2] A meta-analysis of 24 observational studies examining fracture risk did not find that higher magnesium intakes were associated with a reduced risk of hip and total fractures. [3] Clinical trials have shown mixed results with the use of magnesium supplements to increase bone mineral density. More research is needed to see if and how much of a supplement can reduce fracture risk.

Migraines

Magnesium is sometimes prescribed as a complementary treatment for migraine headaches, as clinical studies have found low magnesium levels in people suffering from this condition. [4] Randomized double-blind controlled trials have found that magnesium citrate and magnesium oxide supplements (about 500 mg/day) taken for up to 3 months were protective against migraines. [5] In a randomized double-blind clinical trial, 70 patients who were admitted to the emergency room with acute migraine headache were given either the usual IV treatment for migraine (dexamethasone/metoclopramide) or IV magnesium sulfate. The study found the magnesium to be more effective and faster-acting than the typical treatment. This was a one-time administration in an acute setting, so studies with longer follow-up are needed to confirm this benefit.

The National Headache Foundation suggests a daily dose of 400-600 mg of magnesium to reduce the frequency of migraine attacks; however because this is greater than the RDA, it may lead to side effects (e.g., muscle weakness, diarrhea) in some people and may not be safe with certain medical conditions. They recommend discussing the use of high-dosage magnesium supplements with a physician.

Depression

Magnesium assists with neurological pathways that, when not functioning correctly, are believed to lead to mood disorders like depression and anxiety. Several observational studies have linked lower magnesium levels with increased depression. [6,7] However, a small number of randomized clinical trials have not shown consistent results that magnesium supplementation is an effective treatment for depression. [7] The control groups in these trials, either given a placebo or an antidepressant medication, showed similar effects as the treatment group receiving magnesium supplements. The trials also tended to have a small number of participants with a short duration, ranging from 1-8 weeks. Longer trials with standardized depression rating scales are needed to better assess this connection.

Cardiovascular disease (CVD)

High blood pressure is a risk factor for cardiovascular disease (CVD), and magnesium helps to regulate blood pressure. Studies have shown an association with magnesium deficiency and high blood pressure. However, the results of clinical studies are mixed on using magnesium supplements to lower blood pressure. Epidemiological studies have found an association of the DASH diet (including magnesium-rich fruits, vegetables, and low-fat dairy products) with decreased blood pressure, but DASH is also rich in potassium and calcium that may lower blood pressure, so it is not clear if magnesium or a combination of nutrients is protective. Other population studies have shown that higher magnesium intakes and/or higher blood levels of magnesium are associated with a lower risk of stroke and deaths from heart disease, although again it is difficult to separate out other nutrients in these same foods that are protective against CVD. [1]

Type 2 diabetes

Magnesium assists enzymes that regulate blood sugar and insulin activity. Prospective cohort studies show an association of diets low in magnesium with an increased risk of type 2 diabetes. [4] However, the results are mixed in clinical trials of magnesium supplements for people with diabetes, some finding an improvement in insulin sensitivity when correcting a magnesium deficiency, and others showing no change. Results are also mixed on the effectiveness of supplements in improving overall blood sugar control. Part of the reason may be differences in the study design of these clinical trials. The American Diabetes Association reports a lack of evidence at this time to recommend magnesium supplements to improve blood sugar control in people with diabetes. [8]

Food Sources

Magnesium is found in plant foods like legumes, dark green leafy vegetables, nuts, seeds, whole grains, and fortified cereals. It is also in fish, poultry, and beef.

Supplements

A magnesium supplement may be prescribed if the body is having problems absorbing the nutrient. Over-the-counter magnesium supplements come in different forms; liquid types like magnesium citrate or chloride may be better absorbed than solid tablets like magnesium oxide and sulfate.

Magnesium can have a laxative effect at high doses; in fact, it is sold as a laxative in the form of magnesium hydroxide. Magnesium hydroxide is also an ingredient in some popular antacids to treat heartburn and upset stomach; it is important to be aware of the laxative effect when using magnesium hydroxide tablets for an upset stomach.

Signs of Deficiency and Toxicity

Although magnesium is naturally found in a variety of foods and some fortified foods, national dietary surveys show that most Americans of all ages eat less than recommended amounts. [9] However, these deficiency levels are marginal and not likely to produce symptoms. The body also helps to preserve magnesium levels when stores are low by limiting the amount excreted in urine and absorbing more magnesium in the gut. [4]

A true deficiency occurs with a long-term low magnesium diet, malabsorption, and large losses from alcohol abuse or use of medications that deplete magnesium (some diuretics, proton pump inhibitors, and antibiotics).

Signs of deficiency include:

Fatigue, weakness

Poor appetite

Nausea, vomiting

Numbness or tingling in skin

Muscle cramps

Seizures

Abnormal heart rate

Risk factors for deficiency include:

Alcohol abuse. A long-term excessive intake of alcohol is associated with a poor diet low in magnesium, digestive upset that leads to malabsorption, and problems with various organs that can flush out too much magnesium through urine.

Older ages. The elderly have lower magnesium intakes according to national dietary surveys. Aging also causes decreased absorption of magnesium in the gut and increased excretion in urine. Furthermore, older adults are more likely to be on medications for chronic diseases that can lower magnesium stores.

Conditions with malabsorption. Diseases that interfere with digestion can lower the amount of magnesium absorbed. Most magnesium is absorbed in the largest segment of the small intestine, the ileum, which may be compromised in conditions like celiac and Crohn's disease. Surgery that removes the ileum, which is sometimes needed with colon cancer, ulcerative colitis, or Crohn's disease, further adds to a deficiency risk.

Type 2 diabetes mellitus. Insulin resistance or uncontrolled diabetes can cause the kidneys to make extra urine to rid the body of high levels of blood sugar. This increased amount of urine may also flush out magnesium.

Toxicity

Toxicity is rare from food sources because the kidneys will remove excess magnesium in the urine. However toxic levels may occur with long-term use of high-dosage supplements. People with kidney disease have a higher risk of toxicity because their kidneys are not working properly and cannot flush out extra magnesium.

Signs of toxicity include:

Nausea, vomiting

Diarrhea

Low mood, depression

Muscle weakness

Low blood pressure, abnormal heartbeat

Heart attack

Did You Know?

Magnesium supplements are a popular remedy for leg and foot cramps, a bothersome condition that may jolt you awake in the middle of the night or during exercise. A deficiency of magnesium can certainly cause muscle cramping, but these supplements are often used whether or not people know they are truly deficient.

Evidence so far does not support this treatment for muscle cramps. A Cochrane review of seven randomized controlled trials looking at the effects of magnesium supplements on muscle cramps did not find a significant difference in intensity or duration of cramps in people using the supplements versus a placebo for one month. [10] Information was not available on the participants' blood levels of magnesium at the start of the trials, so it is not known if the muscle cramps were related to a deficiency versus other factors.

References

1. National Institutes of Health Office of Dietary Supplements: Magnesium Fact Sheet for Health Professionals https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/. Accessed 9/2/2019.

2. Orchard TS, Larson JC, Alghothani N, Bout-Tabaku S, Cauley JA, Chen Z, LaCroix AZ, Wactawski-Wende J, Jackson RD. Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study. Am J Clin Nutr. 2014 Apr;99(4):926-33.

3. Farsinejad-Marj M, Saneei P, Esmaillzadeh A. Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis. Osteoporos Int. 2016 Apr;27(4):1389-1399.

4. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. . 2015 Sep 23;7(9):8199-226

5. Volpe SL. Magnesium in disease prevention and overall health. . 2013 May 1;4(3):378S-83S.

6. Tarleton EK, Littenberg B. Magnesium intake and depression in adults. J Am Board Fam Med. 2015 Mar-Apr;28(2):249-56.

7. Kirkland AE, Sarlo GL, Holton KF. The Role of Magnesium in Neurological Disorders. . 2018 Jun 6;10(6).

8. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS Jr. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013;36:3821-42.

9. Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R. What We Eat in America, NHANES 2005-2006: Usual Nutrient Intakes from Food and Water Compared to 1997 Dietary Reference Intakes for Vitamin D, Calcium, Phosphorus, and Magnesium. U.S. Department of Agriculture, Agricultural Research Service. 2009. https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/0506/usual_nutrient_intake_vitD_ca_phos_mg_2005-06.pdf. Accessed 9/2/2019.

10. Garrison SR, Allan GM, Sekhon RK, Musini VM, Khan KM. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD009402.

Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

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Magnesium is naturally present in a variety of foods, available as a supplement, and an ingredient in antacids and laxatives. The mineral plays an important role in assisting more than 300 enzymes to carry out various chemical reactions in the body such as building proteins and strong bones, and regulating blood sugar, blood pressure, and muscle and nerve functions.

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Fluoride in the body is an anion of the element fluoride. Teeth have enamel which is made of minerals, so consuming minerals like fluoride, calcium, and phosphorus help remineralize the enamel and promote strong teeth. Getting adequate fluoride can also help stimulate bone formation which helps promote strong bones.

Daily recommended intake is: 3 - 4 milligrams
Dietary Sources of fluoride:
-Black tea
-Coffee
-Canned shellfish
-Oatmeal
-Raisins
-Potatoes

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Fitness & Lifestyle Habits to Support Bone Health

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Fitness & Lifestyle Habits to Support Bone Health

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Some healthy habits that can help support bone health include:
Regular & Safe exercise: Walking, Hiking, Climbing stairs, Strength-training, Weight-bearing aerobic activity, Balance exercises, etc.
Regular exercise can help strengthen muscles, improve balance (reducing risk of falls), improve posture, decrease pain, and decrease overall risk for bone fracture. Read more about the role of exercise on bone health;
https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis/art-20044989

Consider not smoking: Smoking can increase risk for weakened bones.

Limit Alcohol: Drink in moderation. Alcohol can increase the symptoms of aging including bone loss.

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https://www.hsph.harvard.edu/nutritionsource/vitamins/
https://www.bonehealthandosteoporosis.org/
https://orthoinfo.aaos.org/en/staying-healthy/bone-health-basics/
https://www.hsph.harvard.edu/nutritionsource/fluoride/
https://www.hsph.harvard.edu/nutritionsource/vitamin-d/

Sheng, Bin MDa; Li, Xin MSca; Nussler, Andreas K. PhDb; Zhu, Sheng MDb,∗. The relationship between healthy lifestyles and bone health: A narrative review. Medicine 100(8):p e24684, February 26, 2021. | DOI: 10.1097/MD.0000000000024684

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Vitamins and minerals are micronutrients required by the body to carry out a range of normal functions. However, these micronutrients are not produced in our bodies and must be derived from the food we eat.
Vitamins are organic substances that are generally classified as either fat soluble or water soluble. Fat-soluble vitamins ( vitamin A, vitamin D, vitamin E, and vitamin K) dissolve in fat and tend to accumulate in the body. Water-soluble vitamins ( vitamin C and the B-complex vitamins, such as vitamin B6, vitamin B12, and folate) must dissolve in water before they can be absorbed by the body, and therefore cannot be stored. Any water-soluble vitamins unused by the body is primarily lost through urine.

Minerals are inorganic elements present in soil and water, which are absorbed by plants or consumed by animals. While you're likely familiar with calcium, sodium, and potassium, there is a range of other minerals, including trace minerals (e.g. copper, iodine, and zinc) needed in very small amounts.

In the U.S., the National Academy of Medicine (formerly the Institute of Medicine) develops nutrient reference values called the Dietary Reference Intakes (DRIs) for vitamins and minerals. [1] These are intended as a guide for good nutrition and as a scientific basis for the development of food guidelines in both the U.S. and Canada. The DRIs are specific to age, gender, and life stages, and cover more than 40 nutrient substances. The guidelines are based on available reports of deficiency and toxicity of each nutrient. Learn more about vitamins and minerals and their recommended intakes in the table below.

Recommended Daily Intake of Vitamins and Minerals for Adults

Ages 19-50: 15 micrograms (600 IU)

Ages 51-70: 15 micrograms (600 IU)

Ages 71+: 20 micrograms (800 IU)

Ages 19-50: 15 micrograms (600 IU)

Ages 51-70: 15 micrograms (600 IU)

Ages 71+: 20 micrograms (800 IU)

100 micrograms (4,000 IU)

Phosphorus
700 milligrams

700 milligrams

Ages 31-70: 4,000 milligrams

Ages 71+: 3,000 milligrams

1,500 milligrams*

1,500 milligrams*

Not determined; however a chronic disease risk reduction intake has been established

* Denotes Adequate Intake (AI). An AI is a recommended intake when an RDA can't be determined. RDA is the average daily dietary intake sufficient to meet the nutrient requirement of 97-98% of healthy individuals in a particular group according to stage of life and gender.
** May play a role in the human body, but adequate research regarding its nutritional importance is not available so RDA or AI has not been set.

What about multivitamins?

A diet that includes plenty of fruits, vegetables, whole grains, good protein packages, and healthful fats should provide most of the nutrients needed for good health. But not everyone manages to eat a healthful diet. Multivitamins can play an important role when nutritional requirements are not met through diet alone. Learn more about vitamin supplementation.

Did you know?

Vitamins and their precise requirements have been controversial since their discovery in the late 1800s and early 1900s. It was the combined efforts of epidemiologists, physicians, chemists, and physiologists that led to our modern day understanding of vitamins and minerals. After years of observation, experiments, and trial and error, they were able to distinguish that some diseases were not caused by infections or toxins-a common belief at the time-but by vitamin deficiencies. [2] Chemists worked to identify a vitamin's chemical structure so it could be replicated. Soon after, researchers determined specific amounts of vitamins needed to avoid diseases of deficiency.

In 1912, biochemist Casimir Funk was the first to coin the term "vitamin" in a research publication that was accepted by the medical community, derived from "vita" meaning life, and "amine" referring to a nitrogenous substance essential for life. [3] Funk is considered the father of vitamin therapy, as he identified nutritional components that were missing in diseases of deficiency like scurvy (too little vitamin C), beri-beri (too little vitamin B1), pellagra (too little vitamin B3), and rickets (too little vitamin D). The discovery of all vitamins occurred by 1948.

Vitamins were obtained only from food until the 1930s when commercially made supplements of certain vitamins became available. The U.S government also began fortifying foods with specific nutrients to prevent deficiencies common at the time, such as adding iodine to salt to prevent goiter, and adding folic acid to grain products to reduce birth defects during pregnancy. In the 1950s, most vitamins and multivitamins were available for sale to the general public to prevent deficiencies, some receiving a good amount of marketing in popular magazines such as promoting cod liver oil containing vitamin D as bottled sunshine.

References

1. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); and Dietary Reference Intakes for Calcium and Vitamin D (2011). These reports may be accessed via www.nap.edu.

2. Semba RD. The discovery of the vitamins. Int J Vitam Nutr Res. 2012 Oct 1;82(5):310-5.

3. Piro A, Tagarelli G, Lagonia P, Tagarelli A, Quattrone A. Casimir Funk: his discovery of the vitamins and their deficiency disorders. Ann Nutr Metab. 2010;57(2):85-8.

Last reviewed March 2023
Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

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Vitamins and minerals are micronutrients required by the body to carry out a range of normal functions. However, these micronutrients are not produced in our bodies and must be derived from the foo...

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Gender: Male
Name: October
Assessment:
The client reports extreme fatigue while performing everyday tasks involving light housework and routine household chores.  It has been difficult to attend to daily living tasks of cooking meals, attending to laundry, and tidying up the house. I have been working with this client for some time and the symptoms of exhaustion have been increasing as self-reported over the last four quarterly visits. In additional to constantly feeling tired, regardless of the amount of nightly sleep, your client reports difficulty remembering routine details throughout the day, occasional sleeplessness, occasional blurred vision, unexplained skin lesions without any sense for the cause.  Laboratory test results indicate deficient levels of
Vitamins B1, B2, B3, and B5.
It's probable that the patient is also deficient in Choline, Vitamin B6, and Vitamin B7 (biotin).

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Vitamins and Minerals are organic substances that are required by the body to aid in normal function. These micronutrients are not produced in our bodies so we have to get them from the foods we eat.
The National Academy of Medicine creates recommended daily intake amounts for each of these micronutrients, which are specific to age and gender. These give guidance on how much of each micronutrient is needed for proper bodily function.

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Vitamin B3 (Niacin)
RDI: 14 - 16 mg
Vitamin B3 helps the body's cell change carbohydrates into energy for the body. It also plays a role in muscle contraction and the conduction of nerve signals.

Vitamin B2 (Riboflavin)
RDI: 1.1 - 1.3 mg
Vitamin B2 helps the body turn carbohydrates into ATP for energy in the body. It also helps break down fats and steroids to help produce energy for the body.

Vitamin B1 (Thiamine)
RDI: 1.1 - 1.2 mg
Vitamin B1 is involved in basic cell functions, and is used by over 20 proteins in enzymatic reactions.

Vitamin B6
RDI: 1.3 - 1.5 mg
Vitamin B6 is involved in over 100 catalytic reactions. It helps the body break down proteins, carbohydrates, and fats. It also supports immunity and brain health.

Pantothenic Acid (Vitamin B5)
RDI: 5 mg
Pantothenic acid is necessary for the body to synthesize fatty acids and cholesterol. Vitamin B5 also may help lower cholesterol.

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Other Essential Micronutrients for Optimal Energy

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Other Essential Micronutrients for Optimal Energy

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Choline
RDI: 425 - 550 mg
Choline is essential for bile synthesis, major metabolic reactions, and neurotransmission in the central and peripheral nervous systems.

Manganese
RDI: 1.8 - 2.3 mg
Manganese helps regulate biological processes, regulates mitochondrial reactions, and helps enzymes work.

Iodine
RDI: 150 micrograms
Iodine is required for thyroid hormone synthesis, and the regulation of metabolism. It also regulates cardiac and endocrine function.

Chromium
RDI: 25 - 35 micrograms
Chromium modulates insulin sensitization, and is involved in the regulation of blood glucose levels.

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What do deficiencies in these micronutrients mean?

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What do deficiencies in these micronutrients mean?

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Vitamin B1 Deficiency can cause:
-Weight Loss
-Confusion & Memory loss
-Muscle Weakness
-Lowered immunity
-Fatigue
-Abdominal discomfort
-Loss of appetite

Vitamin B2 Deficiency can cause:
-Dry skin and cracked lips
-Sore throat
-Swelling of the mouth and throat
-Hair loss
-Anemia
-Itchy eyes or cataracts
-Fatigue
-Depression
-Blurred vision

Vitamin B3 Deficiency can cause:
-Headache
-Fatigue
-Memory loss
-Depression
-Vomiting and diarrhea
-Swollen mouth and tongue

Vitamin B5 Deficiency can cause:
-Headache
-Fatigue
-Irritability
-Disturbed sleep
-Nausea, vomiting, and stomach cramps
-Muscle cramps
-Numbness in hands or feet

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Thanks for visiting. Don't miss your FREE gift.

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The truth about nutrient deficiencies - Harvard Health

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Nutrient deficiencies are unusual in people who eat a broad and varied diet. But aging, hormonal factors, or diet can leave women short of four key vitamins and minerals: vitamin D, iron, vitamin B12, and calcium. Various tests can reveal nutrient deficiencies.

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A few commonalities between deficiencies of Vitamin B1, B2, B3, and B5 is memory loss and fatigue, along with blurred vision and sleepiness. This is likely the cause of the extreme fatigue and exhaustion outlined by the patient. Luckily, there are a plethora of ways to raise these levels through diet or supplementation.
It's possible that the patient is also deficient in choline, vitamin B6, and biotin which all cause; fatigue, low-energy, and memory loss. Vitamin B6 and biotin deficiency also present as unexplained skin rashes which may explain the patient's skin lesions.

Some Guidance for picking supplements is provided below:
Always pick a supplement that is as close to the recommended daily intake as possible, and make sure to check the drug interactions.

https://www.webmd.com/vitamins/index
https://www.hsph.harvard.edu/nutritionsource/vitamins/

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You're probably familiar with Vitamin B6 and B12, but did you know there are actually eight B vitamins?

These vitamins help a variety of enzymes do their jobs, ranging from releasing energy from carbohydrates and fat to breaking down amino acids and transporting oxygen and energy-containing nutrients around the body.

Spotlight on Three of the Bs: Folate, Vitamin B6, and Vitamin B12

One of the advances that changed the way we look at vitamins was the discovery that too little folate is linked to birth defects such as spina bifida and anencephaly.

Folate (Folic Acid) - Vitamin B9

Folate is the natural form of vitamin B9, water-soluble and naturally found in many foods. It is also added to foods and sold as a supplement in the form of folic acid; this form is actually better absorbed than that from food sources-85% vs. 50%, respectively.
Learn more about folate and health
Another line of research about folate and two other B vitamins, vitamin B6 and vitamin B12, explores their roles in reducing some types of cancer and heart disease.

Vitamin B12

Vitamin B12, or cobalamin, is naturally found in animal foods. It can also be added to foods or supplements. Vitamin B12 is needed to form red blood cells and DNA. It is also a key player in the function and development of brain and nerve cells.
Learn more about vitamin B12 and health
Related
Vitamins and Minerals Last reviewed March 2023
Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

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You're probably familiar with Vitamin B6 and B12, but did you know there are actually eight B vitamins? B1 (thiamin) B2 (riboflavin) B3 (niacin) B5 (pantothenic acid) B6 (pyridoxine) B7 (biot...

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Some dietary ways to boost Vitamins B1, B2, B3, B5, B7, B12, chromium, choline, iodine, and manganese:
B Vitamins:
-Whole Grains
-Fish (salmon & shellfish)
-Beans & legumes
-Enriched/fortified products (grains, soy)
-Beef & pork
-Poultry
-Fruits (banana, oranges)
-Sweet potato
-Eggs
-Nuts & seeds
-Yogurt, milk, & other dairy products
-Cauliflower
-Leafy vegetables
-Mushrooms
-Avocado
-Tomato
Chromium:
-Meats (beef & pork)
-Nuts & seeds
-Fruits
-Vegetables
-Beer & wine
Choline:
-Meat (beef & pork)
-Legumes
-Nuts & seeds
-Tomatoes
-Asparagus
-Corn
-Garlic
-Spinach
-Dairy
-Grains
Iodine:
-Seafood
-Dairy
-Eggs
-Iodized salts
-Grains
-Fruits
-Legumes
-Vegetables
Manganese:
-Whole grains
-Shellfish
-Seeds & nuts
-Coffee & tea
-Spices
-Legumes
-Leafy vegetables

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Gender: Female
Name: July
Age: 45
Your client was referred to you for dietary design and micronutrient management after gastric bypass surgery.  It is extremely important that a plan is developed to make every dietary choice count due to the restricted amounts of food that can be managed with each nutritional intake opportunity. Your task is to storyboard a design using Padlet to develop an educational resource for your CCIP resource that you might use to educate this client and others in understanding the micronutrients of Vitamin B12, Vitamin K, Iron, and Copper, all necessary to maintain optimal blood and brain health as introduced in the weekly readings.  This communication should outline the key functions each micronutrient serves in regards to healthy circulatory and neurologic health.  Highlighting the roles each micronutrient plays in mediating vital physiological processes in these crucial body systems, will be imperative to assisting your client and his or her family to understand the need to incorporate a strategic combination of nutritional sources of these micronutrients into new dietary plans for implementation after gastric bypass surgery.  The goal is to assist your client in maintaining optimal health through recommended nutritional plans and healthy lifestyle habits.

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As you may know, gastric bypass surgery makes your stomach much smaller, which changes the way your body handles the food you eat. This comes with some postoperative nutrition care to ensure that your body is getting all the nutrients you need! After this surgery, your body may have trouble absorbing all the vitamins and minerals you need, so following a specific diet and implementing supplements as needed is very important! I will walk you through some of the essential vitamins and minerals, what they do for your body and why you need them. Remember to talk to your healthcare provider about any trouble you may have with recovery, and I am here to help you with your diet!

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The Role of Nutrition on Blood & Brain Health

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The Role of Nutrition on Blood & Brain Health

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The foods we eat directly impact our neurological and circulatory systems. Especially after gastric bypass surgery diet will play an essential role in staying happy and healthy for the rest of your life! The 5-minute video attached gives an overview of how food affects the brain and overall health.

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How the food you eat affects your brain - Mia Nacamulli

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Vitamin B12
Recommended Daily Intake: 2.4 micrograms

Vitamin B12 is responsible for forming red blood cells and DNA. It's also integral in the development of brain and nerve cells. B12 is also plays a role in serotonin production!

Signs of Deficiency:
-Fatigue
-Headaches
-Loss of appetite
-Vision problems
-Shortness of breath
-Heart palpatations
-Diarrhea

Dietary Sources of Vitamin B12;
-Shellfish
-Tuna
-Beef and Pork
-Fortified Cereals
-Fortified non-dairy milk
-Low-fat milk
-Cheese
-Eggs

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Vitamin K
Recommended Daily Intake: 90 - 120 micrograms

Vitamin K is necessary for blood clotting and bone formation. It also helps regulate blood calcium levels, and may help prevent mineralization build-up in the arteries, allowing the heart to pump blood freely throughout the body.

Deficiency of vitamin K may cause;
-Bruising easily
-Blood clots beneath nail beds
-Excess bleeding and trouble clotting
-Blood in the stool
-Internal bleeding

Dietary sources of vitamin K;
-Green leafy vegetables (Kale, collard greens, broccoli, spinach, cabbage, lettuce, etc.)
-Parsley, chives, basil, cilantro
-Avocado
-Pomegranate
-Kiwi
-Watercress
-Green onions

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Iron
Recommended Daily Intake: 8 - 18 mg
Iron is essential to maintain a healthy circulatory system. It helps hemoglobin carry oxygen from the lungs to the rest of the body. Iron comes in two main forms; heme and non-heme.

Non-heme iron is found in:
-Whole grains
-Nuts and seeds
-Legumes
-Leafy greens

Heme iron is found in:
-Beef & pork
-Poultry
-Seafood
-Other animal meat

Iron deficiency symptoms;
-Extreme fatigue and weakness
-Pale skin
-Chest pain or shortness of breath
-Cold extremeties
-Brittle nails
-Dizziness, faintness, or lightheadedness
-Inflammation of the tongue

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Copper
Recommended Daily Intake: 900 micrograms, or 0.9 mg

Copper is an essential mineral responsible for red blood cell formation, as well as nervous and immune system function. Copper helps the body form collagen and absorb iron, which plays a role in energy production.

Symptoms of copper deficiency;
-Anemia
-Low body temperature
-Bone fractures or osteoporosis
-Low white blood cell count
-Thyroid dysfunction
-Irregular heartbeat
-Loss of color in the skin or paleness

Dietary sources of copper;
-Shellfish
-Nuts and seeds
-Organ meat from animals
-Whole-grain products
-Chocolate
-Sweet Potato
-Mushroom
-Avocado
-Chickpeas

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Some tips for post-surgery:
-Take 30 minutes to eat each meal
-Eat small meals throughout the day
-Try not to snack between meals
-Don't eat when you're not hungry
-Try using small plates to help with portion sizes!
-Avoid alcohol and other calorie-dense foods with little to no nutritional value

Macronutrient Recommendations:
-Protein is very important; try eating plenty of skinless chicken, lean beef, fish, eggs, legumes, and dairy products.

Key Micronutrient Recommendations:
-Iron (18 mg/day)
-Vitamin B12 (2.4 mcg/day)
-Calcium (1000 mg/day)
-Vitamin K (90 mcg/day)
-Copper (900 mcg/day)

Tips for choosing a supplement:
Make sure to choose a supplement that is as close to the recommended daily value as possible. Consider a daily multivitamin containing calcium, vitamin D, iron, vitamin C, vitamin D, and vitamin B12. Make sure to keep an eye out for common signs of deficiency, and talk to your doctor and dietitian if you are feeling any negative side effects.

For more information: https://www.upmc.com/services/bariatrics/surgery-process/post-surgery/diet/vitamin-supplements#:~:text=Gastric%20Bypass%3A%20Doctors%20recommend%20that,Others%20may%20be%20recommended.

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Remember, supplements are not very well regulated, however here are some accessible and affordable options I trust;
-NatureMade Multivitamin with Iron
-Everlywell Multivitamin
-Olly Women's Multivitamin
-Nature's Bounty Women's Multivitamin

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Formulated with 23 key nutrients for daily nutritional support. It's one convenient tablet with one impressive collection of nutrients. Item Number: 2518 Serving size: 1 tablet

Benefits & Description Ingredients Nutrient Shortfalls Dosage & Interactions

Your body needs various vitamins and minerals every day to function properly. And Nature Made® Multi with Iron is specially formulated with 23 of them. † Vitamin D supports bone, teeth, muscle and immune health. † Vitamins C and E have antioxidant properties that help neutralize free radicals in the body and help support the immune system. † And vitamin A supports healthy eye function along with a healthy immune system. † Nature Made ® Multi with Iron is designed to provide your body with daily nutritional support, every day.

Nature Made® Multi with Iron is specially formulated with 23 key nutrients

Vitamin A is essential for healthy eye function and supports a healthy immune system†

Vitamin D supports bone, teeth, muscle and immune health†

Vitamins C and E are antioxidants that help neutralize free radicals in the body and support the immune system†

Nature Made® Multi with Iron is guaranteed to meet our high quality standards. It's made from carefully selected ingredients under strict manufacturing processes.

United States Pharmacopeia (USP) Verified

Supports

GENERAL WELLNESS

Product Facts

SOURCED FROM HIGH QUALITY INGREDIENTS

CAN BE FOUND IN A WELL BALANCED MEAL

What's in our Multivitamin Tablets with Iron

Ingredients

Amount Per Serving: 750 mcg Vitamin A|180 mg Vitamin C|25 mcg Vitamin D3|22.5 mg Vitamin E|80 mcg Vitamin K|1.5 mg Thiamin|1.7 mg Riboflavin|20 mg Niacin|6 mg Vitamin B6|655 mcg DFE Folate (400 mcg Folic Acid)|25 mcg Vitamin B12|30 mcg Biotin|10 mg Pantothenic Acid|160 mg Calcium|18 mg Iron|150 mcg Iodine|100 mg Magnesium|15 mcg Zinc|70 mcg Selenium|2 mg Copper|4 mg Manganese|120 mcg Chromium|75 mcg Molybdenum

No Colors Added

No Artificial Flavors

Gluten Free

Suggested Use: Adults, take 1 tablet daily with water and a meal.

Interactions

This product contains multiple nutrients. For questions about interactions on individual nutrients, please refer to the product pages for each nutrient. Given that no two people are alike, if you are taking any medications you should be aware that potential drug-nutrient interactions may occur and are encouraged to consult a healthcare professional before using this product. Combining certain prescription drugs and dietary supplements can lead to undesirable effects such as:

Diminished drug effectiveness

Reduced supplement effectiveness

Impaired drug and/or supplement absorption

Use Caution:

If you are taking medication or have blood clotting issues, consult your physician before use. WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep this product out of reach of children. In case of accidental overdose, call a doctor or poison control center immediately.

Disclaimer:
† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

References:

1.Reider CA, Chung RY, Devarshi PP, Grant RW, Hazels Mitmesser S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients. 2020;12(6):1735. Published 2020 Jun 10. doi:10.3390/nu120617354.

Benefits & Description

Your body needs various vitamins and minerals every day to function properly. And Nature Made® Multi with Iron is specially formulated with 23 of them. † Vitamin D supports bone, teeth, muscle and immune health. † Vitamins C and E have antioxidant properties that help neutralize free radicals in the body and help support the immune system. † And vitamin A supports healthy eye function along with a healthy immune system. † Nature Made ® Multi with Iron is designed to provide your body with daily nutritional support, every day.

Nature Made® Multi with Iron is specially formulated with 23 key nutrients

Vitamin A is essential for healthy eye function and supports a healthy immune system†

Vitamin D supports bone, teeth, muscle and immune health†

Vitamins C and E are antioxidants that help neutralize free radicals in the body and support the immune system†

Nature Made® Multi with Iron is guaranteed to meet our high quality standards. It's made from carefully selected ingredients under strict manufacturing processes.

United States Pharmacopeia (USP) Verified

Supports

GENERAL WELLNESS

Product Facts

SOURCED FROM HIGH QUALITY INGREDIENTS

CAN BE FOUND IN A WELL BALANCED MEAL

Ingredients

What's in our Multivitamin Tablets with Iron

Ingredients

Amount Per Serving: 750 mcg Vitamin A|180 mg Vitamin C|25 mcg Vitamin D3|22.5 mg Vitamin E|80 mcg Vitamin K|1.5 mg Thiamin|1.7 mg Riboflavin|20 mg Niacin|6 mg Vitamin B6|655 mcg DFE Folate (400 mcg Folic Acid)|25 mcg Vitamin B12|30 mcg Biotin|10 mg Pantothenic Acid|160 mg Calcium|18 mg Iron|150 mcg Iodine|100 mg Magnesium|15 mcg Zinc|70 mcg Selenium|2 mg Copper|4 mg Manganese|120 mcg Chromium|75 mcg Molybdenum

No Colors Added

No Artificial Flavors

Gluten Free

Nutrient Shortfalls

Dosage & Interactions

Suggested Use: Adults, take 1 tablet daily with water and a meal.

Interactions

This product contains multiple nutrients. For questions about interactions on individual nutrients, please refer to the product pages for each nutrient. Given that no two people are alike, if you are taking any medications you should be aware that potential drug-nutrient interactions may occur and are encouraged to consult a healthcare professional before using this product. Combining certain prescription drugs and dietary supplements can lead to undesirable effects such as:

Diminished drug effectiveness

Reduced supplement effectiveness

Impaired drug and/or supplement absorption

Use Caution:

If you are taking medication or have blood clotting issues, consult your physician before use. WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep this product out of reach of children. In case of accidental overdose, call a doctor or poison control center immediately.

Disclaimer:
† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

References:

1.Reider CA, Chung RY, Devarshi PP, Grant RW, Hazels Mitmesser S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients. 2020;12(6):1735. Published 2020 Jun 10. doi:10.3390/nu120617354.

Compare with similar products

See our frequently asked questions below:

What do multivitamins help with?

Multivitamins help fill potential nutrient gaps from your diet by providing daily nutritional support.

How many multivitamins can you take a day?

We would only recommend you take one serving per day unless the Suggested Use says otherwise. Please check the label of your multivitamin for specific instructions. However, as with all supplement regimens and especially during pregnancy, you should consult with your healthcare professional before starting any supplement routine.

Are your multivitamins gluten free?

Most Nature Made products are gluten free. Please refer to the label of the bottle or packaging that it is contained in. If you have any additional questions, please call us and we'll be happy to assist you.

What ages are these multivitamins intended for?

Our multivitamins are made for people ages 18 and over.

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Please refer to the expiration date on the bottle.

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Multivitamin Tablets with Iron | Nature Made®

# data[].attributes.attachment_link.description
Formulated with 23 key nutrients for daily nutritional support. It's one convenient tablet with one impressive collection of nutrients. Item Number: 2518 Serving size: 1 tablet Benefits & Description Ingredients Nutrient Shortfalls Dosage & Interactions Your body needs various vitamins and minerals every day to function properly.

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After surgery, it's important to start slow and let your body recover appropriately. Start with low-intensity exercise such as walking or swimming to start.

It is recommended to start with at least 20 minutes of cardiovascular exercise 3-4 days/week -walking, jogging, swimming, cycling. You'll want to work up to doing cardiovascular exercise for at least 30 minutes, 5+ days/week in the first 6 months-1 year, and start incorporating strength and flexibility training into your routine.

Read more about post-surgery exercise here:
https://www.uchealth.com/en/media-room/articles/a-guide-to-the-best-exercises-before-and-after-weight-loss-surgery

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https://med.libretexts.org/Courses/American_Public_University/APUS%3A_Basic_Foundation_of_Nutrition_for_Sports_Performance_(Byerley)/03%3A_Digestion_and_Absorption/3.04%3A_Nutrients_Are_Essential_for_Organ_Function#:~:text=The%20circulatory%20system%20transports%20nutrients,for%20central%20nervous%20system%20function.

https://www.hsph.harvard.edu/nutritionsource/vitamins/

https://www.uchealth.com/en/media-room/articles/a-guide-to-the-best-exercises-before-and-after-weight-loss-surgery

Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr. 2017 Mar 15;8(2):382-394. doi: 10.3945/an.116.014258. PMID: 28298280; PMCID: PMC5347111.

Post-Bariatric Surgery Vitamins and Supplements | UPMC. (2023). UPMC | Life Changing Medicine. https://www.upmc.com/services/bariatrics/surgery-process/post-surgery/diet/vitamin-supplements#:~:text=Gastric%20Bypass%3A%20Doctors%20recommend%20that

‌
Coen, P. M., Carnero, E. A., & Goodpaster, B. H. (2018). Exercise and Bariatric Surgery: An Effective Therapeutic Strategy. Exercise and sport sciences reviews, 46(4), 262–270. https://doi.org/10.1249/JES.0000000000000168

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Vitamins and minerals are micronutrients required by the body to carry out a range of normal functions. However, these micronutrients are not produced in our bodies and must be derived from the food we eat.
Vitamins are organic substances that are generally classified as either fat soluble or water soluble. Fat-soluble vitamins ( vitamin A, vitamin D, vitamin E, and vitamin K) dissolve in fat and tend to accumulate in the body. Water-soluble vitamins ( vitamin C and the B-complex vitamins, such as vitamin B6, vitamin B12, and folate) must dissolve in water before they can be absorbed by the body, and therefore cannot be stored. Any water-soluble vitamins unused by the body is primarily lost through urine.

Minerals are inorganic elements present in soil and water, which are absorbed by plants or consumed by animals. While you're likely familiar with calcium, sodium, and potassium, there is a range of other minerals, including trace minerals (e.g. copper, iodine, and zinc) needed in very small amounts.

In the U.S., the National Academy of Medicine (formerly the Institute of Medicine) develops nutrient reference values called the Dietary Reference Intakes (DRIs) for vitamins and minerals. [1] These are intended as a guide for good nutrition and as a scientific basis for the development of food guidelines in both the U.S. and Canada. The DRIs are specific to age, gender, and life stages, and cover more than 40 nutrient substances. The guidelines are based on available reports of deficiency and toxicity of each nutrient. Learn more about vitamins and minerals and their recommended intakes in the table below.

Recommended Daily Intake of Vitamins and Minerals for Adults

Ages 19-50: 15 micrograms (600 IU)

Ages 51-70: 15 micrograms (600 IU)

Ages 71+: 20 micrograms (800 IU)

Ages 19-50: 15 micrograms (600 IU)

Ages 51-70: 15 micrograms (600 IU)

Ages 71+: 20 micrograms (800 IU)

100 micrograms (4,000 IU)

Phosphorus
700 milligrams

700 milligrams

Ages 31-70: 4,000 milligrams

Ages 71+: 3,000 milligrams

1,500 milligrams*

1,500 milligrams*

Not determined; however a chronic disease risk reduction intake has been established

* Denotes Adequate Intake (AI). An AI is a recommended intake when an RDA can't be determined. RDA is the average daily dietary intake sufficient to meet the nutrient requirement of 97-98% of healthy individuals in a particular group according to stage of life and gender.
** May play a role in the human body, but adequate research regarding its nutritional importance is not available so RDA or AI has not been set.

What about multivitamins?

A diet that includes plenty of fruits, vegetables, whole grains, good protein packages, and healthful fats should provide most of the nutrients needed for good health. But not everyone manages to eat a healthful diet. Multivitamins can play an important role when nutritional requirements are not met through diet alone. Learn more about vitamin supplementation.

Did you know?

Vitamins and their precise requirements have been controversial since their discovery in the late 1800s and early 1900s. It was the combined efforts of epidemiologists, physicians, chemists, and physiologists that led to our modern day understanding of vitamins and minerals. After years of observation, experiments, and trial and error, they were able to distinguish that some diseases were not caused by infections or toxins-a common belief at the time-but by vitamin deficiencies. [2] Chemists worked to identify a vitamin's chemical structure so it could be replicated. Soon after, researchers determined specific amounts of vitamins needed to avoid diseases of deficiency.

In 1912, biochemist Casimir Funk was the first to coin the term "vitamin" in a research publication that was accepted by the medical community, derived from "vita" meaning life, and "amine" referring to a nitrogenous substance essential for life. [3] Funk is considered the father of vitamin therapy, as he identified nutritional components that were missing in diseases of deficiency like scurvy (too little vitamin C), beri-beri (too little vitamin B1), pellagra (too little vitamin B3), and rickets (too little vitamin D). The discovery of all vitamins occurred by 1948.

Vitamins were obtained only from food until the 1930s when commercially made supplements of certain vitamins became available. The U.S government also began fortifying foods with specific nutrients to prevent deficiencies common at the time, such as adding iodine to salt to prevent goiter, and adding folic acid to grain products to reduce birth defects during pregnancy. In the 1950s, most vitamins and multivitamins were available for sale to the general public to prevent deficiencies, some receiving a good amount of marketing in popular magazines such as promoting cod liver oil containing vitamin D as bottled sunshine.

References

1. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); and Dietary Reference Intakes for Calcium and Vitamin D (2011). These reports may be accessed via www.nap.edu.

2. Semba RD. The discovery of the vitamins. Int J Vitam Nutr Res. 2012 Oct 1;82(5):310-5.

3. Piro A, Tagarelli G, Lagonia P, Tagarelli A, Quattrone A. Casimir Funk: his discovery of the vitamins and their deficiency disorders. Ann Nutr Metab. 2010;57(2):85-8.

Last reviewed March 2023
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Vitamins and minerals are micronutrients required by the body to carry out a range of normal functions. However, these micronutrients are not produced in our bodies and must be derived from the foo...

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For IBS-C, Some foods to avoid are;
-White bread, pasta, baked goods etc.
-Fatty or fried foods
-Citrus fruits
-White rice
-Red Meat
-Chocolate & Cocoa
-Persimmons
-Potato chips
-Unripe bananas
-Full-fat cream and dairy

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Foods that are higher in soluble fiber, healthy polyunsaturated fat, and monounsaturated fat are better for those struggling with constipation:
-Whole grain breads and cereals
-Oat bran
-Apples, Pears, Figs
-Beans, peas, and lentils
-Skinless chicken and fish
-Green leafy vegetables
-Yogurt and kefir
-Seeds and Nuts
-Non-fat dairy (some)
-Dried fruit

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Depending on the type of IBS you have, there may be different food triggers. Some dietary recommendations for IBS are;
-Eat at regular meal times throughout the day. Chew well and slowly.
-Reduce insoluble fiber, alcohol, caffeine, artificial sweeteners, and spicy or fatty foods.
-Enjoy exercise regularly.
-Drink plenty of fluids to stay hydrated.
-Try cooking vegetables so they're easier to digest.
-Consider a low-FODMAP diet

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FODMAP foods are fermentable, oligosaccharides, disaccharides, monosaccharides and polyols. An individual with IBS can benefit from eating Low-FODMAP foods. A diet high in FODMAP foods can worsen symptoms due to the indigestibility of the short-chain carbohydrates.

These are specific carbohydrates that often trigger gut symtpoms, and some that do not. For a comprehnsive list of FODMAP foods go to;
https://www.ibsdiets.org/fodmap-diet/fodmap-food-list/

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If you decide you're ready to try the low-FODMAP diet, here is some guidance!

Phase 1: Restrict high-FODMAP foods for a short period of time. Between 3 and 6 weeks.

Phase 2: Slowly introduce the FODMAP foods one at a time and assess your reaction and tolerance to each one.

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https://gi.org/topics/irritable-bowel-syndrome/

https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/eating-diet-nutrition

https://www.dietvsdisease.org/diy-low-fodmap-diet/

https://patient.gastro.org/irritable-bowel-syndrome-ibs/

https://aboutibs.org/

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Learn more about IBS and ways to get involved by downloading our IBS Media Toolkit here.