Are You at Risk?
Over time, small discrepancies in nutrient intakes can prove problematic for a person, particularly for women in their childbearing years, strict vegetarians, and the elderly.
For instance, shortfalls of iron in the childbearing years may lead to anemia. Too little folic acid very early in pregnancy increases the risk of neural tube defects in developing babies. And vitamin B12 deficits, responsible for irreversible nerve damage and faulty cognition, are more likely in people who avoid animal foods, and in people over age 50, whose bodies are often less efficient at absorbing vitamin B12.
Stampfer and Blumberg advocate multivitamins as a way to shore up diets low in nutrients. But, they warn that multivitamins are dietary supplements, not substitutes for healthy eating.
Here are some common deficiencies most people suffer from:
Have you felt exhausted lately? Can you barely make it up the stairs without getting winded even though you're physically fit? If so, you might be lacking in iron -- especially if you're a woman Although many people don't think of iron as being a nutrient, you might be surprised to learn that low iron is the most common nutritional deficiency in the U.S. Almost 10% of women are iron deficient, according to figures from the Centers for Disease Control and Prevention.
Why Do You Need Iron?
Iron is an essential mineral. "The major reason we need it is that it helps to transport oxygen throughout the body," says Paul Thomas, EdD, RD, a scientific consultant to the National Institutes of Health, Office of Dietary Supplements.
Iron is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron. If you don't have enough iron, your body can't make enough healthy oxygen-carrying red blood cells. A lack of red blood cells is called iron deficiency anemia.
Without healthy red blood cells, your body can't get enough oxygen. "If you're not getting sufficient oxygen in the body, you're going to become fatigued," Thomas says. That exhaustion can affect everything from your brain function to your immune system's ability to fight off infections. If you're pregnant, severe iron deficiency may increase your baby's risk of being born too early, or smaller than normal.
Iron has other important functions, too. "Iron is also necessary to maintain healthy cells, skin, hair, and nails," says Elaine Chottiner, MD, clinical assistant professor and director of General Hematology Clinics at the University of Michigan Medical Center said in an email interview.
How Much Iron Do You Need?
How much iron you need each day depends on your age, gender, and overall health.
Infants and toddlers need more iron than adults, in general, because their bodies are growing so quickly. In childhood, boys and girls need the same amount of iron -- 10 milligrams daily from ages 4 to 8, and 8 mg daily from ages 9 to 13.
Starting at adolescence, a woman's daily iron needs increase. Women need more iron because they lose blood each month during their period. That's why women from ages 19 to 50 need to get 18 mg of iron each day, while men the same age can get away with just 8 mg.
After menopause, a woman's iron needs drop as her menstrual cycle ends. After a woman begins menopause, both men and women need the same amount of iron -- 8 mg each day.
Illness
Chronic illness or infection can cause the body to make fewer red blood cells. This can result in a mild drop in hemoglobin. If you have significant blood loss, then you may develop iron-deficiency anemia. And some drugs and medical treatments can also put you at risk for anemia. Consult your doctor to see if you need iron or other supplements
Anemia
Anemia develops when you don’t have enough robust, healthy red blood cells to carry oxygen throughout your body. The blood cells may lack enough hemoglobin, the protein that gives blood its red color. Anemia affects one in 10 teen girls and women. It also develops in men and children and is linked to some illnesses.
Aplastic Anemia
Aplastic anemia is a rare disorder in which the bone marrow doesn’t make enough blood cells to supply the body. It affects only about three in one million people. It can be caused by high doses of radiation, certain chemical exposures, viruses, or an autoimmune disorder in which your body attacks the bone marrow. About one in five cases is inherited. In severe cases, people need blood transfusions or even a bone marrow transplant.
Cause: Blood Loss
Losing too many red blood cells is a common cause of anemia. Heavy menstruation, ulcers, injury, or surgery can cause enough blood loss to lead to iron-deficiency anemia. Women who have heavy menstrual periods should be tested for anemia every year.
Cause: Faulty Blood Cell Mechanics
Inherited disorders can affect your body’s production of red blood cells. Thalassemias cause the body to make fewer healthy red blood cells and less hemoglobin -- and may be treated with blood transfusions. Among people with hemolytic anemia, red blood cells are destroyed and cleaned out of the bloodstream too quickly.
Sickle Cell Anemia
Sickle cell anemia is an inherited disorder in which the body produces an abnormal form of hemoglobin. This causes red blood cells to change from round to a sickle shape and become stuck together. That can make it difficult for them to pass through blood vessels, leading to pain and damage to body tissues. The red blood cells also die more quickly than normal red blood cells. In the U.S., sickle cell anemia is more common among African-Americans and Hispanics.
Diagnosis: Complete Blood Count
A complete blood count test will check your levels of red blood cells, white blood cells, platelets, and hemoglobin. It will also check other factors such as average size, variability in size, volume, and hemoglobin concentration of red blood cells. If you have iron-deficiency anemia, your red blood cells may be smaller than normal. Your health care provider also may ask about your symptoms, medicines you take, and your family history.
Diagnosis: Other Blood Tests
If the complete blood count shows that you have anemia, you may have additional blood tests. Your blood cells may be checked for an abnormal appearance. Hemoglobin electrophoresis detects the type of hemoglobin in your blood. A reticulocyte count tests how well your bone marrow makes new red blood cells. Iron studies may be ordered to measure iron stores in your body, as well as iron levels in your blood.
Diagnosis: Bone Marrow Test
If your body is producing too few or too many blood cells or their structure appears abnormal, you may need a bone marrow test. Bone marrow, the spongy tissue inside bones, contains stem cells that turn into blood cells. Your doctor will remove a small sample of bone marrow through a needle. The procedure takes about 30 minutes and will cause some soreness.
Treatment: Supplements
Iron pills are often needed for anemia that's caused by a deficiency in that mineral. Ferrous iron is more easily absorbed than ferric iron. It's best taken with food, especially orange juice and other foods rich in vitamin C. But don't mix your iron pill with calcium, coffee, or tea, which can block absorption. And never take iron without a doctor's order or let children near the pills. An iron overdose can be dangerous. Some people may need folic acid or vitamin B12 supplements, too.
Iron and Pregnancy
About half of pregnant women have iron-deficiency anemia. Pregnant women should get about 27 milligrams of iron each day in their diet. Your prenatal vitamin also may contain iron. You may be tested for anemia at your first prenatal visit and after delivery.
Treatment: Medicines
Drugs for anemia often treat the root illness. So in some cases, where the anemia is due to chronic kidney disease, an injection of the hormone erythropoietin (EPO) may be needed. If an autoimmune disorder causes your body to attack its own red blood cells, then a corticosteroid, such as prednisone, can slow the attack and help correct anemia. In sickle cell anemia, a cancer drug called hydroxyruea can lower the number of painful episodes.
Treatment: Procedures
If you have severe anemia, you may need a transfusion of blood that matches your type. When the body's production of red blood cells doesn't work right, anemia may be treated or cured with a transplant. In these cases, bone marrow or cord blood from a donor replaces the person's faulty bone marrow, so the body can start producing healthy blood cells. When blood cells are destroyed too quickly, blood plasma treatments or even removing the spleen may be needed.
Preventing Anemia
You can prevent some types of anemia with a healthy diet. Foods containing iron include lean red meat, liver, fish, tofu, lentils and beans, dark green leafy vegetables, and dried fruits. Also eat foods with vitamin B12 and folic acid, such as eggs and dairy products, spinach, and bananas. Many breads, cereals, and other foods are fortified with all three key nutrients: iron, B12, and folic acid. Vitamin C, found in citrus, other fruits, and vegetables, will help your body absorb iron.
Iron Overload
Too much iron can cause serious problems. Iron overload can be a result of repeated blood transfusions or an inherited condition, but taking too much iron also is a risk. The many symptoms of iron overload are related to excess iron depositing into organs and causing problems in the liver, heart, and pancreas. Iron levels can be reduced through phlebotomy (blood removal) or medications.
Living With Anemia
Treating your anemia and eating a well-rounded diet can give you more energy and enhance your life. Most people can manage their anemia through a healthy diet and iron or vitamin supplements, if a doctor says they are deficient in one of the key nutrients. If you have a chronic disease, then good management of your condition also will help you prevent or manage anemia.
Vitamin D
Vitamin D plays several key roles in your body. Most importantly, vitamin D helps your body absorb the minerals calcium and phosphorus from the food you eat, which is important for bone health.
Many Americans have been found to have low levels of vitamin D. The reasons for this include low availability of vitamin D in food sources, increased time working indoors, and possibly increased use of sunscreens (since sunlight helps the body produce vitamin D).
- Are over 50
- Get very little sun exposure
- Have kidney disease or diseases that affect the absorption of minerals
- Have darker skin
- Are lactose intolerant
- Are vegan
- Are infants who are fed only breast milk
How much vitamin D should you take?
The Institute of Medicine (IOM) has set a recommended dietary allowance for vitamin D. Getting this amount of vitamin D from diet, with or without supplements, should be enough to keep you healthy.
- 600 IU (international units) a day for anyone aged 1-70
- 800 IU/day for anyone over 70
Some experts think that these recommendations are too low, especially for people at risk of osteoporosis. Ask your health care provider how much vitamin D you need.
Recently the IOM reviewed more than 1,000 research papers on vitamin D and concluded that high levels of the supplement are unnecessary and could be harmful.
Vitamin D: Wonder Pill or Overkill?
Wouldn’t it be great if one vitamin could build stronger bones and protect against diabetes, multiple sclerosis, cancer, heart disease, and depression? Or even help you lose weight? Researchers have high hopes for vitamin D -- which comes from our skin's reaction to sunlight, a few foods, and supplements. Learn the facts in the slides ahead … and see who's at risk for a "D" deficiency.
Vitamin D Boosts Bone Health
Vitamin D is critical for strong bones, from infancy into old age. It helps the body absorb calcium from food. In older adults, a daily dose of "D" and calcium helps to prevent fractures and brittle bones. Children need "D” to build strong bones and prevent rickets, a cause of bowed legs, knock knees, and weak bones. Adding the vitamin to milk in the 1930s helped to nearly eliminate the disorder.
Vitamin D and Multiple Sclerosis
Multiple sclerosis (MS) is more common far away from the sunny equator. For years, experts suspected a link between sunlight, vitamin D levels, and this autoimmune disorder that damages the nerves. One newer clue comes from a study of a rare gene defect that leads to low levels of vitamin D – and a higher risk of MS. Despite these links, there's not enough evidence to recommend vitamin D for the prevention or treatment of MS.
Vitamin D and Diabetes
Some studies have shown a link between a low vitamin D level and type 2 diabetes -- the more common version of this blood sugar disorder. So, can boosting your vitamin D levels help ward off the disease? There's not enough proof for doctors to recommend taking this supplement to prevent type 2 diabetes. Excess body fat may play a role in diabetes and low levels of vitamin D.
Vitamin D and Weight Loss
Studies have shown that people who are obese often have low blood levels of vitamin D. Body fat traps vitamin D, making it less available to the body. It's not clear whether obesity itself causes a low vitamin D level or if it's the other way around. But one small study of dieters suggests that adding vitamin D to a calorie-restricted diet may help overweight people with low vitamin D levels lose weight more easily.
Low "D" and Depression
Vitamin D plays a role in brain development and function. One promising study showed that large doses of vitamin D could lessen the symptoms of mild depression. But other studies show mixed results. The best bet is to talk with your doctor about whether vitamin D could ward off the symptoms of depression.
How Does Sun Give You Vitamin D?
Most people get some vitamin D from sunlight. When the sun shines on your bare skin, your body makes its own vitamin D. But you probably need more than that. Fair-skinned people might get enough in 5-10 minutes on a sunny day, a few times a week. But cloudy days, the low light of winter, and the use of sun block (important to avoid skin cancer and skin aging) all interfere. Older people and those with darker skin tones don’t make as much from sun exposure. Experts say it's better to rely on food and supplements.
Dining With Vitamin D
Many of the foods we eat have no naturally occurring vitamin D. Fish such as salmon, swordfish, or mackerel is one big exception -- and can provide a healthy amount of vitamin D in one serving. Other fatty fish such as tuna and sardines have some "D," but in much lower amounts. Small amounts are found in egg yolk, beef liver, and fortified foods like cereal and milk. Cheese and ice cream do not usually have added vitamin D.
Start Your Day With Vitamin D
Choose your breakfast foods wisely, and you can get a substantial amount of vitamin D. Most types of milk are fortified, including some soy milks. Orange juice, cereal, bread, and some yogurt brands also commonly have added vitamin D. Check the labels to see how much “D” you’re getting.
Vitamin D Supplements
Eating D-rich foods is the best way to get vitamin D. If you still need help getting enough, there are two kinds of supplements: D2 (ergocalciferol), which is the type found in food, and D3 (cholecalciferol), which is the type made from sunlight. They're produced differently, but both can raise vitamin D levels in your blood. Most multivitamins have 400 IU of vitamin D. Check with your health care provider for the best supplements for your needs.
Are You Vitamin D Deficient?
Problems converting vitamin D from food or sunshine can set you up for a deficiency. Factors that increase your risk include:
- Age 50 or older
- Dark skin
- A northern home
- Overweight, obese, gastric bypass surgery
- Milk allergy or lactose intolerance
- Liver or digestive diseases, such as Crohn's disease or celiac
Symptoms of "D" Deficiency
Most people with low blood levels of vitamin D don't notice any symptoms. A severe deficiency in adults can cause soft bones, called osteomalacia (shown here). The symptoms include bone pain and muscle weakness. In children, a severe deficiency can lead to rickets and symptoms of soft bones and skeletal problems. Rickets is rare in the United States.
Testing Your Vitamin D Level
There's a simple blood test used to check your vitamin D level, called the 25-hydroxyvitamin D test. Current guidelines by the Institute of Medicine set a blood level of 20 nanograms per milliliter (ng/mL) as a goal for good bone health and overall health. However, some doctors say people should go higher, to about 30 ng/mL to get the full health benefits of vitamin D.
How Much Vitamin D Do You Need?
The recommended dietary allowance for vitamin D is 600 IU (international units) per day for adults up to age 70. People aged 71 and older should aim for 800 IU from their diet. Some researchers recommend much higher doses of vitamin D, but too much vitamin D can hurt you. Above 4,000 IU per day, the risk for harm rises, according to the Institute of Medicine.
Daily "D" for Breast-feeding Babies
Breast milk is best, but it doesn’t have much vitamin D. Breastfed babies need 400 IU of vitamin D until they're weaned to fortified formula and can drink at least one liter (about 4 ¼ cups) every day. Starting at age 1, babies drinking fortified milk no longer need a vitamin D supplement. Be careful not to give too much vitamin D to babies. High doses can cause nausea, vomiting, loss of appetite, excessive thirst, muscle aches, or more serious symptoms.
Vitamin D for Older Children
Most children and adolescents don’t get enough vitamin D from drinking milk. They should have a supplement with 400 IU to 600 IU. That amount is often included in chewable multivitamins. Children with some chronic diseases such as cystic fibrosis may be at increased risk for vitamin D deficiency. Talk to your child’s doctor about the need for extra vitamin D.
How Much Is Too Much Vitamin D?
Some researchers suggest taking far more vitamin D than the 600 IU daily guideline for healthy adults. But too much be dangerous. Very high doses of vitamin D can raise your blood calcium level, causing damage to blood vessels, heart, and kidneys. The Institute of Medicine sets the upper tolerable limit at 4,000 IU of vitamin D per day. You can’t get too much vitamin D from the sun. Your body simply stops making more. But sun exposure without sunscreen can raise your risk of skin cancer.
Drugs That Interact With Vitamin D
Some drugs cause your body to absorb less vitamin D. These include laxatives, steroids, anti-seizure and anti-cholesterol medicines. If you take digoxin, a heart medicine, too much vitamin D can raise the level of calcium in your blood and lead to an abnormal heart rhythm. It's important to discuss your use of vitamin D supplements with your doctor or pharmacist.
Vitamin D and Colon Cancer
It’s too soon to make a strong case for vitamin D as an overall cancer-fighter. But newer studies suggest that people with higher levels of vitamin D in their blood may have a lower risk for colon cancer.
Vitamin D and Other Cancers
Headlines tout vitamin D as a way to prevent breast and prostate cancer. But researchers don’t yet have enough evidence to say that the benefits are real. And, vitamin D may boost the risk of pancreatic cancer. The VITAL Study -- a Harvard university study -- of vitamin D and omega-3 is following 20,000 volunteers to find answers. In the meantime, a healthy body weight, regular exercise, and the diet guidelines of the American Cancer Society may help prevent cancer.
Vitamin D and Heart Disease
Low levels of vitamin D have been linked to a greater risk of heart attack, stroke, and heart disease. Still, it’s not clear whether boosting vitamin D will reduce heart risks and how much vitamin D is needed. Very high levels of vitamin D in the blood can actually harm blood vessels and the heart by increasing the amount of calcium in the bloodstream.
A Factor in Dementia?
Older people are more likely to have vitamin D levels that are too low. Researchers found that older people with vitamin D deficiency performed poorly on tests of memory, attention, and reasoning compared to people with enough vitamin D in their blood. Still, better studies are needed to learn if vitamin D supplements could prevent dementia or slow mental decline.
Vitamin D Boosts Bone Health
Vitamin D is critical for strong bones, from infancy into old age. It helps the body absorb calcium from food. In older adults, a daily dose of "D" and calcium helps to prevent fractures and brittle bones. Children need "D” to build strong bones and prevent rickets, a cause of bowed legs, knock knees, and weak bones. Adding the vitamin to milk in the 1930s helped to nearly eliminate the disorder
Vitamin D and Diabetes
Some studies have shown a link between a low vitamin D level and type 2 diabetes -- the more common version of this blood sugar disorder. So, can boosting your vitamin D levels help ward off the disease? There's not enough proof for doctors to recommend taking this supplement to prevent type 2 diabetes. Excess body fat may play a role in diabetes and low levels of vitamin
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