During prenatal care, you will be reminded to take folic acid and calcium, but what about vitamin B2?
Vitamins in the B complex play an important role in supporting a healthy pregnancy and to the health of breastfeeding mothers.
Vitamin B2, part of the vitamin B complex is also known as Riboflavin. it is water soluble, which means that your body doesn't store it. You must replace them through your diet or prenatal vitamins.
Why vitamin B2 during pregnancy?
In general, there are many health benefits of vitamin B2:
• Headaches - Vitamin B2 can prevent headaches and treat migraine headaches. It reduces the pain you feel during a migraine attack and stops them from lasting too long.
• Energy - Vitamin B2 is an important part of the metabolic process. The body uses it to properly digest food to give us the energy we want. So without it, we don't process food properly and end up gaining weight and not having the energy to get through the day. Vitamin B2 breaks proteins down into their amino acid bases, fats and carbs by converting them into glucose; the main fuel of the body.
• Cancer - Vitamin B2 is responsible for the production of glutathione which removes these free radicals from breaking down our bodies and keeps the liver clean. Free radicals do a lot of damage to the body and are the main reason you get sick. (1)
During pregnancy, consumption of vitamin B2 lowers the risk of developing preeclampsia, a pregnancy complication. It also promotes the healthy development and growth of baby's bones, muscles and nerves. For moms, vitamin B2 helps your skin look glowing and refreshed! Don't you want to look radiant even when you are pregnant? This is also because vitamin B2 increases blood circulation for mother and foetus and helps prevent pregnancy-related anaemia.
Not only that! Breastfeeding mothers need even more vitamin B2 than pregnant mothers. Some women need up to 50% more daily intake of riboflavin than they did before pregnancy. To provide for the hungry baby, breast milk absorbs much of the vitamin B2 than the mother ingests.
How do you know if you are riboflavin deficient?
Anemia, magenta (dry and red tongue), skin rash, dermatitis, dryness and cracking around mouth, nose and lips are all signs of riboflavin deficiency (2). If you are on a special diet due to lactose intolerant, vegetarian or anorexia, then you are at higher risk of riboflavin deficiency. (3)
What dietary sources contains vitamin B2?
The best sources of riboflavin are almond, mushrooms, wild rice, milk, yogurt, eggs, broccoli, brussels sprouts, spinach and whole grains. Flours and cereals are often fortified with riboflavin.
However, riboflavin can be destroyed by light. So food should be kept away from light to protect its riboflavin content. Although riboflavin is not destroyed by heat, it can be lost in water when foods are boiled or soak. The best way is to roast or steam the foods to preserve more riboflavin rather than frying or scalding your food.
Should you take a supplement?
YES - Although you can get enough riboflavin from a diet that includes grains, fairy products, meats, green vegetables and eggs, your doctor will advise you to take a prenatal supplements which provide the dietary reference intake (DRI) for riboflavin.
The recommended daily dietary intake for riboflavin (4)
• Women, 19 years and older: 1.1 mg (RDA)
• Pregnant women: 1.4 mg (RDA)
• Breastfeeding women: 1.6 mg (RDA)
What is Vitamin E
Vitamin E is an antioxidant. This means it protects body tissue from damage caused by substances called free radicals, which can harm cells, tissues, and organs. They are believed to play a role in certain conditions related to aging.
Vitamin E is also important in the formation of red blood cells and it helps the body use vitamin K. It also helps widen blood vessels and keep blood from clotting inside them. On top of that the body also needs vitamin E to help keep the immune system strong against viruses and bacteria.
In epidemiological studies, higher intakes of vitamin E have been related to reduction in cardiovascular disease, diabetic, certain cancers and cataracts. (1)
It is estimated that >90% of Americans do not consume sufficient dietary vitamin E, as α-tocopherol, to meet estimated average requirements. (2)
Deficiency of Vitamin E
Symptoms not very clear cut, but may include fatigue, inflamed varicose veins, wounds healing slowly, premature aging and sub-fertility, acne, anemia, muscle disease, dementia, cancers, gallstones, shortened red blood cell life span, spontaneous abortion (miscarriage), and uterine degeneration
Without sufficient E in the body, the essential fatty acids are altered so that blood cells break down and hemoglobin formation is impaired. Several amino acids cannot be utilized, and pituitary and adrenal glands reduce their level of functioning, iron absorption and hemoglobin formation are impaired.
The average diet today contains much less natural vitamin E than it did 50 years ago. This is partially due to lack of nutrients in the soil as well as use of farming pesticides.
Where is Vitamin E found?
Vitamin E is found in nuts, oils, vegetables, sunflower seeds, whole grains, spinach, oils, seeds, wheat oils, asparagus, avocado, beef, seafood, apples, carrots, celery, etc .
Vitamin E is lost in food processing which includes milling, cooking, freezing, long storage periods and when exposed to air. Vitamin E should not be taken together with inorganic iron supplements as it may destroy the vitamin, while organic iron, such as ferrous gluconate and ferrous fumarate does not affect the vitamin.
Vitamin E in Pregnancy:
Vitamin E is important for the development of your baby
1. Vitamin E for Baby's Brain Health
Vitamin E is critical to the early development of an embryo's nervous system. Part of the reason is because one of its function is to protect the Omega-3 fatty acids functioning, in particularly DHA and DHA is crucial for brain health
2. Development of Eyes and Head
When it comes to embryo nervous system development, one of the most important parts are the eyes and head. Correct amount (not too much of Vitamin E) will assist in healthy development
3. Stunting of Growth
Deficiency of Vitamin E during pregnancy can cause stunted growth
4. Improved cognitive function
Higher concentration of Vitamin E at birth has been associated with superior cognitive function at the age of 2 years old. (2)
How about supplements?
Look out for "d-alpha-tocopherol" on the list of ingredients - that means that the Vitamin E is from natural sources, whereas "dl-alpha-tocopherol" will indicate that it is synthetic.
Recommended daily intake
So what are the recommended daily intake of Vitamin E? For adults older than 18 years, pregnant women, and breastfeeding women, the maximum dose is 1,000 milligrams daily (or 1,500 IU).
2. Traber MG. Vitamin E inadequacy in humans: causes and consequences. Adv Nutr.
2014 Sep;5(5):503-14. Review.
Types of Vitamin A
There are 2 types of Vitamin A in the human diet:
- Preformed vitamin A (also called retinol) is used directly by the body and is found in animal products like eggs, milk, and liver.
- Provitamin A carotenoids are found in green leafy vegetables, orange/yellow-coloured fruit and vegetables like cabbage, carrot, lettuce, spinach, mango. By far the most important provitamin A carotenoid is beta-carotene (1)
What does Vitamin A do for you?
Vitamin A help preserve vision, fight infections, maintain healthy skin and bones, and regulate cell growth and division. Without enough vitamin A, you may be at a higher risk for night blindness or experience skin disorders or infections. It is also a key structural component in the development and maintenance of the heart, lungs, kidneys and other organs.
Vitamin A plays a critical role in:
- Maintaining body homeostasis
- Prevention of anemia
- Support pregnancy metabolism
- Pregnancy fetal development, especially bones, teeth, skin, and vision
So do you need to have good source of Vitamin A during pregnancy? The truth is developing babies need some Vitamin A. Vitamin A deficiency can lead to fetal and infant growth retardation. In fact, The World Health Organization (WHO) estimates that between 250,000 and 500,000 children are born blind every year. WHO also estimates that 13.8 million children have some degree of visual loss related to vitamin A deficiency.(2) If the pregnant mother don’t have enough Vitamin A in her body to start with, how would the fetal development be normal?
It is important to remember however that taking too much Vitamin A during pregnancy brings a small risk of birth defects, however too little Vitamin A brings risk of visual loss and growth retardation hence it will be extremely important to take a balance.
The Linus Pauling Institute states that “No increase in the risk of vitamin A-associated birth defects has been observed at doses of preformed vitamin A from supplements below 3,000 mcg/day (10,000 IU/day). Since a number of foods in the U.S. are fortified with preformed vitamin A, pregnant women should avoid multivitamin or prenatal supplements that contain more than 1,500 mcg (5,000 IU) of vitamin A. Vitamin A from beta-carotene is not known to increase the risk of birth defects.”
How much Vitamin A you need:
(RDAs for vitamin A are given as mcg of retinol activity equivalents (RAE) to account for the different bioactivities of retinol and provitamin A carotenoids)
Pregnant women age 18 and younger: 750 mcg RAE per day
Pregnant women age 19 and older: 770 micrograms RAE per day
Breastfeeding women age 18 and younger: 1,200 mcg RAE per day
Breastfeeding women age 19 and older: 1,300 mcg RAE per day
Nonpregnant women: 700 mcg RAE per day
You don't have to get the recommended amount of vitamin A every day. Instead, aim for that amount as an average over the course of a few days or a week.
2. Vision Disorders—Advances in Research and Treatment: 2012 Edition
Vitamin D is a very important vitamin for the baby's mother and baby. Mothers need to ensure their vitamin D levels are normal during pregnancy and while breastfeeding.
But first, what actually is vitamin D? It is a vitamin that is formed mainly in the skin and then altered in the body to a more active component. Most importantly, it is needed in every cell for the body to function properly!
Also known as the sunshine vitamin, 90% of vitamin D is made from sunlight exposure directly onto the skin. Women who do not get enough sun are observed to have low levels of vitamin D. The darker your skin, the more sun exposure one needs! So mothers need to expose themselves to sun to prevent getting low levels of Vitamin D or take a vitamin D supplementation.
Apart from that, a normal level of vitamin D is needed to absorb calcium from food. Calcium, which is vital for building strong bones, strong teeth and is important for the nervous system. Adequate levels are important for the immune system to work properly.
A recent study found that 1,500 to 2000IU of vitamin D daily had the greatest benefits in preventing preterm labour/births and infections. (1)
What happens if you don't?
Vitamin D deficiency is common during pregnancy. A newborn baby's vitamin D level is the same as its mother. If the mother has a low vitamin D level during pregnancy, then her baby too will be born with a low vitamin D level. There will be very little vitamin D contain in breast milk, so if the baby is vitamin D deficient, they will remain deficient while being breastfed. Because Vitamin D deficiency symptoms are generally less obvious, one might think they have sufficient amounts until getting a blood test!
Low levels of Vitamin D in children and adults have also been linked to the development of many illnesses.
Inadequate vitamin D can lead to abnormal bone growth, fractures or rickets in newborns! Because the bones don't form normally, the child can be short and the legs bowed. At times, when the calcium level in the blood is very low, it will lead to the child having seizures(fits). If you think this is 'kind of' rare, check out Dr Rangan Chatterjee's story on how his son had seizure because of being deficient in this simple vitamin. (2)
Vitamin D from food consumption alone is not enough!
Only 10% of food contain vitamin D naturally, so a lot are fortified with this vitamin. All milk are vitamin D fortified. The best way to really ensure adequate vitamin D is through supplementation.
1. Dawodu A, Akinbi H. Vitamin D nutrition in pregnancy: current opinion. International Journal of Women’s Health. 2013;5:333-343. doi:10.2147/IJWH.S34032.
Alzheimer's Disease is the number one cause of dementia (70% of cases). Causes include cardiovascular events whereby there is reduced blood flow to the brain, aging, genetics, etc. Risk factors include older age, family history, having Apolipoprotein E (ApoE), abnormal MRI, history of cardiovascular disease.
Associated with multiple changes including:
- Cognitive Differences ( difficulty finding words, disorientation, forgetfulness etc)
- A reduction in Daily Functioning ( getting lost, neglecting self care)
- Personality Changes ( social withdrawal, disinterest, easy frustration)
- Problem Behaviors ( obsessive/compulsive behavior, nightime restlessness)
- Mental Health Issues ( depression, paranoia, abnormal beliefs, anxiety etc)
To slow the disease:
1. Vitamin E (as dl-alpha-tocopheryl acetate) 1000IU twice a day
Based on a large clinical trial published in Journal of the American Medical Association (JAMA), a 5 year study with more than 600 participants showed that the Vitamin E group, taking 2000IU of Vitamin E per day, experienced significant delay of more than 6 months in progression of the disease (1). On top of that caregiver time also decreased by 2 hours each day which means better quality of life for both the patient and the caregiver.
2. Panax Ginseng or Korean Red Ginseng
The primary active ingredients in ginseng are ginsenosides and there are 7 main ones found in dietary supplements namely Rb1, Rb2, Rc, Rd, Re, Rf and Rg1. Some of them have been shown in laboratories to be able to reduce levels of a compound called amyloid beta peptide which is found in brains of Alzheimer's patients. Moreover it also improves blood flow.
3. Omega-3 Supplements
May improve the appetite and weight gain in Alzheimer's patients. They might even help with reducing depressive symptoms.
4. Lifestyle Changes
This includes finding the right protein, fat, and carb balance. Studies have shown that diet high in lean protein and healthy fats may protect against mild cognitive impairment. On top of that, more exercise not just physically but also mentally are really important. Play more crossword puzzles and reading will reduce the risk of AD. Lastly, make sure to take time to de-stress as chronic stress can increase the amount of stress steroids in your body and this can block brain activities as well as increase risk of AD.
It is important to remember in Alzheimer that heart healthy = brain healthy so prevention is extremely important.
1. Dysken MW, Sano M, Asthana S, et al. Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease: The TEAM-AD VA Cooperative Randomized Trial. JAMA.2014;311(1):33-44. doi:10.1001/jama.2013.282834.
Bloating and distension have been reported in up to 96% of patients with irritable bowel syndrome (IBS) and in 20% to 30% of the general population, In fact, more than 50% of persons with bloating and distension report a significant impact on quality of life. In general, the term bloating refers to the subjective sensation of increased abdominal pressure without an increase in abdominal size, whereas distension describes the same subjective sensation but with a corresponding objective increase in abdominal girth.
Patients who are constipated commonly report bloating and more than 80% describing severe symptoms. The pathogenesis of bloating in patients with constipation is likely multifactorial. First, the direct mechanical effects of fecal impaction and colonic loading can mimic bloating. Second, colonic stasis may cause increased fermentation of the colonic contents by intestinal bacteria and, therefore, increased gas production. Other than that rectal hypersensitivity is also a common scenario found in IBS and patients with constipation. Interestingly, alterations in visceral sensitivity may explain why symptoms of bloating and distension may be worse in women during the perimenstrual phase as visceral sensitivity varies throughout the menstrual cycle and is generally most acute in the perimenstrual phase (1)
The most significant advance in the treatment of bloating has been the identification of a group of poorly absorbed short-chain carbohydrates (FODMAPs) and individually, these carbohydrates have been considered to be potential triggers of IBS symptoms for decades. In well controlled dietary trials, modification in diet to a low-FODMAP diet can decrease symptoms in at least 75% of IBS patients (2).
If there is severe constipation, laxatives can be used as initial treatment to ensure that constipation is aggressively managed. On top of that, consider using probiotics. A systematic review concluded that bloating is significantly reduced by the probiotic Bifidobacterium infantis 35624 (3).
There is emerging evidence that kiwifruit is effective in the treatment of constipation and bloating. Although the mechanisms remain unknown, kiwifruit appears to promote both laxation and gastric motility.
In conclusion, bloating and distension are highly prevalent symptoms with a marked effect on health status and quality of life. Emerging evidence indicates that targeting colonic motility, gut flora, visceral sensitivity, and dietary intake is helpful in controlling such symptoms.
1. Altman G, Cain KC, Motzer S, Jarrett M, Burr R, Heitkemper M. Increased symptoms in female IBS patients with dysmenorrhea and PMS. Gastroenterol Nurs. 2006;29(1):4-11.
2. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e5
3. Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol. 2009;104(4):1033-1049; quiz 1050.
I am a medical doctor and a researcher hence I believe in evidence based medicine. I was very shocked to find this article recently (by accident) titled " A Nutritional-Toxicological Assessment of Antarctic Krill Oil versus Fish Oil Dietary Supplements ". This article was published in 2014 in Nutrients Journal by researchers from Griffith University and CSIRO Food and Nutrition in Tasmania. This research is also funded by ARC Discovery Grant DP666891.
So here comes the shocking part. They actually tested multiple readily available fish oils on the market and found that the DHA content in particularly 2 products fell below (~10%–30%) the manufacturer specifications namely Nature’s Way Kidsmart (133 mg specified vs. 95 mg observed) and Blackmores Pregnancy and Breastfeeding Gold (125 mg specified vs. 85 mg observed).
When I shared this piece of article with my friends they asked me how could the manufacturers be so misleading and why is this even allowed? To be absolutely honest, I am not here to judge or comment on different brands but merely sharing what I found published in the medical research world.
The next table below is where the researchers did an analysis of the contamination level of all the products. Even though they found that none of the products analysed in the current study (at their highest recommended dosage) came close to fulfilling tolerable daily intake (TDI) levels for any single analyte, they have listed the top five products with the greatest contaminant burden for five key compound groups, plus TEQ values, ranking them from 1–5 with the sample containing the highest concentrations receiving a score of 5.
Bioceuticals Omegasure liquid fish oil and Blackmores 1000 mg both carried a cumulative score of 16, Blackmores Pregnancy and Breastfeeding Gold formula and Nature’s Own 1000 mg each received a score of 12.
According to the researchers, Blackmore’s Pregnancy and Breastfeeding Gold formula incorporates tuna oil, sourced from northern hemisphere oceans, thereby likely contributing to the higher contaminant burdens found in this formulation, despite its lower oil content.
This again highlights that translational research is very important. What is translational research? In a medical research context, it aims to "translate" findings in fundamental research into medical practice and meaningful health outcomes. It is very common in medical research where great amount of research work and funding has been put in but there is lack of dissemination of information to the public. This is a gap that needs to be bridged and my blog is all about this. In regards to this article, it was an accidental find for me, to better educate myself (and definitely to warn all my pregnant friends to not take the particular product mentioned) and the public.
The researchers in the article has concluded that ongoing monitoring of the pollutant content of fish and krill oil products will become increasingly important as food authorities seek
regulatory overview of this rapidly expanding industry.
Make sure you know what you are taking and whether you are really paying for the quality.
Bengtson Nash SM, Schlabach M, Nichols PD. A Nutritional-Toxicological Assessment of Antarctic Krill Oil versus Fish Oil Dietary Supplements. Nutrients. 2014;6(9):3382-3402. doi:10.3390/nu6093382.
Menstrual cramps, otherwise known as dysmenorrhea is thought to affect about 50% of the women. Doctors tend to deal with it by either dismissing the pain as a psychological problem or prescribing painkillers. Today researchers have come a long way toward a better understanding of menstrual cramps.
There are 2 types of dysmenorrhea:
- Primary dysmenorrhea: Dysmenorrhea not caused by any physical abnormality of reproductive organs. Characterised by sharp, spasmodic pains in your lower abdomen OR dull ache in your lower back at the beginning of your period, or a day or two earlier, and it lasts two to three days.
- Secondary dysmenorrhea: Dysmenorrhea marked by pelvic and lower-back pain in which the pain is a symptom of another disease or condition that may require treatment such as endometriosis, pelvic inflammatory disease, uterine fibroids, and adenomyosis.
Main cause of dysmenorrhea:
- Dysmenorrhea happens when your uterus contracts to push out the menstrual blood. Imbalances between the hormones progesterone and estrogen worsen menstrual cramping. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions and higher levels of prostaglandins are associated with more-severe menstrual cramps (1).
- Warm bath or lying down with a heating pad or hot-water bottle on your lower abdomen
- Exercise, take a walk around the block or a few sit-ups will stimulate your muscles to release feel-good endorphins
- Birth control or estrogen pills to decrease your body's production of prostaglandin.
- Calcium 1000mg daily has been found to reduce both premenstrual and menstrual symptom scores (2). In fact high intake of calcium and Vitamin D may reduce risk of premenstrual syndrome (PMS) (3).
- According to Christiane Northrup, M.D in her book 'Women's Bodies, Women's Wisdom (Revised Edition): Creating Physical and Emotional Health and Healing', she suggested getting plenty of essential fatty acids (salmon, flaxseed oil etc); take extra magnesium and a multivitamin-and-mineral supplement; take extra vitamin E during your menstrual cycles; eliminate trans-fatty acids from your diet; cut down on stress and consider yoga or massage.
1. Mayo Clinic http://www.mayoclinic.org/diseases-conditions/menstrual-cramps/basics/causes/con-20025447
2. Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med. 1989 May-Jun;4(3):183-9. PubMed PMID: 2656936.
3. Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005 Jun 13;165(11):1246-52. PubMed PMID: 15956003.
Several studies have demonstrated that vegetarians and vegans have much lower plasma concentrations of omega-3 fatty acids (DHA and EPA) when compared to those who eat fish. A recent study published in Clinical Nutrition showed low blood omega-3 levels in vegans and the fatty acid analysis data was presented on more than 160 vegans who were not supplementing with DHA and EPA (1). The result of the study showed the average omega-3 index of the vegans in the study was 3.7% with a total of 64% of the vegans having levels lower than 4%; 27 percent had levels lower than 3%; and a small number (about 1%) had very low levels (lower than 2%). It is also important to note that omega-3 index of lower than 4% has been known as a risk factor for heart disease.
As you may already know, omega-3 fatty acids are crucial components of cell membranes in the human brain (2) and I have highlighted in my previous posts that it could even potentially reverse ageing by affecting the telomere lengths.
It is understood that many vegans probably consume a huge amount of flax seeds, walnuts, chia seeds etc to try and boost their omega-3 fatty acid levels. However, what they are actually consuming is actually ALA (Alpha-lipoic-acid) which is the plant based omega-3 fatty acids which then converts to EPA and DHA. This conversion actually varies with different individuals and factors involved includes genetic factors (3). So eating plenty of ALA-rich foods is simply not enough for many people to achieve sufficient DHA and EPA levels—supplementation is often necessary.
In conclusion, if you are vegan (which means you are more prone to omega-3 fatty acid deficiency), please check your levels with a blood test to assure that you are sufficient, or take the supplement as a preventative measure.
1: Sarter B, Kelsey KS, Schwartz TA, Harris WS. Blood docosahexaenoic acid and eicosapentaenoic acid in vegans: Associations with age and gender and effects of an algal-derived omega-3 fatty acid supplement. Clin Nutr. 2015 Apr;34(2):212-8.
2. Higdon J: Essential Fatty Acids. In An Evidence-Based Approach to Dietary Phytochemicals. New York, NY: Thieme; 2006: 78-99
3. Davis BC, Kris-Etherton PM. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr. 2003 Sep;78(3 Suppl):640S-646S. Review.
Maintaining adequate levels of essential vitamins and minerals is extremely crucial for good health. This has also been highlighted by Havard School of Public Health in their Food Pyramid. It is common in the general population, especially the elderly to have suboptimal intake of some vitamins which is a risk factor for chronic diseases. On top of it, micronutrient adequacy has the potential to extend lifespan – recent research has found that multivitamin use is associated with longer telomere length in women (an indicator of a slower rate of aging) and this has also been highlighted in my previous article.
Of course, in addition to vitamins and minerals, a diet full of colorful natural plant foods is still needed because multivitamins cannot and will not replace your daily intake of healthy natural food. But the truth is that there are some nutrients that are lacking even in an ideal diet and deficiencies in certain nutrients can undermine your health causing various chronic diseases. On top of that, we cannot be sure that we are getting the precise optimal amounts of vitamins and minerals from our diet everyday – especially since absorption efficiency and utilisation of nutrients varies from person to person. For example, someone who has gastrointestinal issues like inflammatory bowel disease (IBD) will have decrease absorption of nutrients, so just having a healthy diet will not be sufficient. A high quality multivitamin can fill these gaps, ensuring that we get adequate amounts of essential micronutrients.
Some vitamins and minerals are often lacking even in a healthy diet:
Vitamin D is definitely at the top of the list. It was once thought to be important only for bone health, now scientists have found that Vitamin D has important actions in almost every cell in the human body, regulating the expression of over 200 different genes, including the ones related to apoptosis and immune modulation (1). Insufficient vitamin D levels are associated with several cancers, diabetes, cardiovascular disease, depression, and autoimmune diseases. Today, a lot of people suffer from insufficient Vitamin D levels with nearly 1/3 of Australian adults suffering Vitamin D deficiency according to a recent study by Deakin University. Since many of us live in cool climates and work indoors, and because of the potential risks of skin damage and skin cancer with sun exposure, supplementing is the best choice for achieving adequate vitamin D levels. In my experience, 2000 IU has been an appropriate dose to bring most people into the favorable blood 25(OH)D range of 50-75nmol/L. For extra assurance, I’ve also utilized Vitamin D3 because of its high biological value, the most effective form for raising 25(OH)D levels (2).
Vitamin B12 is required for important biological functions like red blood cell production, nervous system function, and DNA synthesis. Insufficient B12 levels are also associated with increased risk of Alzheimer’s disease (3). Deficiency in B12 can cause a variety of health problems including elevated homocysteine (a cardiovascular risk factor), anemia, depression, confusion, fatigue, digestive issues, and nerve damage (4).
Vitamin B12 is unique in that it is made only by microorganisms. Today, we live in a sterile polluted environment where our food is scrubbed (generally with chemicals) ‘clean’ of any soil and B12 possibility and due to the fact that our produce is washed and often transported far before we eat it (soil contains B12-producing microorganisms), most of us are unable to get sufficient B12 from plant foods alone. B12 deficiency is common, especially in vegans who don’t supplement and in the elderly (ability to absorb B12 decreases with age) and about 20% of adults over the age of 60 are either insufficient or deficient in vitamin B12 (5). Supplementation with vitamin B12 is important for most people, and absolutely required for most vegans to achieve sufficient B12 levels.
Iodine is required by the body to make thyroid hormones. A recent study of vegans estimated that only about 40% of the daily requirement for iodine was commonly met on a vegetarian or vegan diet (6). Another study concluded that 80% of vegans, 25% of vegetarians, and 9% of conventional eaters are iodine-deficient (7). Most plant foods are low in iodine due to soil depletion. The chief source of iodine in the typical diet is iodised salt. Since salt should be avoided for general good health, it is important to supplement with iodine to maintain adequacy.
Zinc is essential for immune function, growth, and reproduction, and supports hundreds of chemical reactions. Zinc is abundant in whole plant foods but is not readily absorbed. Beans, whole grains, nuts, and seeds contain zinc, but also contain substances that inhibit zinc absorption (8). A recent study of vegetarians found a high prevalence of zinc deficiency, and zinc requirements for those on a completely plant-based diet are estimated to be about 50% higher than the US RDI (9).
1: Hyppönen E. Vitamin D and increasing incidence of type 1 diabetes-evidence for an association? Diabetes Obes Metab. 2010 Sep;12(9):737-43. doi: 10.1111/j.1463-1326.2010.01211.x.
2: Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hyppönen E, Berry J, Vieth R, Lanham-New S. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012 Jun;95(6):1357-64. doi:10.3945/ajcn.111.031070. Epub 2012 May 2.
3. Hooshmand B, Solomon A, Kåreholt I, Leiviskä J, Rusanen M, Ahtiluoto S, Winblad B, Laatikainen T, Soininen H, Kivipelto M. Homocysteine and holotranscobalamin and the risk of Alzheimer disease: a longitudinal study. Neurology. 2010 Oct 19;75(16):1408-14. doi: 10.1212/WNL.0b013e3181f88162.
4. Office of Dietary Supplements, National Institutes of Health. Dietary Supplement Fact Sheet: Vitamin B12
5. Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009 Feb;89(2):693S-6S. doi: 10.3945/ajcn.2008.26947A. Epub 2008 Dec 30.
6.:Waldmann A, Koschizke JW, Leitzmann C, Hahn A. Dietary intakes and lifestyle factors of a vegan population in Germany: results from the German Vegan Study. Eur J Clin Nutr. 2003 Aug;57(8):947-55.
7. Krajcovicová-Kudlácková M, Bucková K, Klimes I, Seboková E. Iodine deficiency in vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183-5.
8. Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 2003;78(suppl):633S–9S.
9. de Bortoli MC, Cozzolino SM. Zinc and selenium nutritional status in vegetarians. Biol Trace Elem Res. 2009 Mar;127(3):228-33. doi:
10.1007/s12011-008-8245-1. Epub 2008 Oct 25.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research