Vitamins and Minerals

Given the quality of the modern Western diet, cost of fresh fruits and vegetables, and health complications associated with vitamin and mineral deficiencies, taking a daily multivitamin/mineral supplement that provides 100% of the RDA for most micronutrients is a sensible public health recommendation.

Within the photo gallery towards the bottom of this page are a variety of different posters and charts that review the signs and symptoms of individual vitamin and mineral deficiencies as well as food sources of select nutrients.

Vitamin and Mineral Deficiencies

Vitamin and mineral deficiencies are still common throughout much of the word and result in a wide variety of health complications and disorders. Factors and conditions that contribute to vitamin and mineral deficiencies include, but are not limited to, the following:

• Inadequate intake of nutrient-dense foods
• Excessive consumption of ultra-processed foods
• Frequent dieting attempts including low carb and ketogenic diets
• Eating disorders and disordered eating patterns
• Inadequate sun exposure
• Use of certain medications (e.g., oral contraceptives or “birth control”)
• Gastrointestinal disease
• Bariatric surgery
• Excessive alcohol consumption
• Increased nutrient requirements (e.g., pregnancy)

Your family physician can monitor your vitamin and mineral status via yearly laboratory testing.

General Recommendations

• Adopt a plant-based diet with an emphasis on a variety of different plant-based foods.
• Consume at least 5 to 6 servings of fresh fruits and vegetables each day.
• Avoid high-dose supplements. In general, supplements that exceed 100% of the RDA for most nutrients are not recommended due to risk of adverse health effects (e.g., toxicity).
• No multivitamin/mineral supplement provides 100% of the daily value for magnesium, calcium, or the omega 3 fatty acids – not even high-dose products. As such, no single supplement will meet 100% of your daily requirements for these nutrients.
• All populations should ensure adequate vitamin D status via regular exposure to the sun and/or use of a dietary supplement.
• In general, men and postmenopausal women should opt for a dietary supplement free of iron unless he/she has a history of iron deficiency anemia.
• Pregnant and Breastfeeding Women: Take a daily multivitamin/mineral supplement with 100% of the RDA for most nutrients including iodine and vitamin B9.
• Dietary supplement requirements vary from person-to-person based upon age, sex, pre-existing medical conditions, and of course – dietary and lifestyle behaviors.

Fat Soluble Vitamins

• Vitamin D: Daily intakes that exceed the RDA for vitamin D (2,000 – 10,000 IU per day) are considered safe.
• Vitamin A: Choose a supplement that does not exceed 2500 IU of vitamin A. Ideally, opt for a product that supplies vitamin A in the form of beta-carotene. If unavailable, look for a product that supplies at least 50 percent as beta-carotene.
• To enhance absorption of fat soluble vitamins, consume foods high in the fat-soluble vitamins (i.e., vitamins A, D, E, K, and the carotenoids) with a source of dietary fat and protein (e.g., peanut butter).
• Lycopene: Good sources of lycopene include tomatoes, guava, and watermelon.

Omega 3 Fatty Acids

• Individuals who do not regularly consume fatty fish should consider taking 1,000-2,000 mg of combined EPA and DHA, omega 3 fatty acids several times per week.
• To ensure your supplement provides adequate EPA and DHA, review the supplement facts.
• The terms “omega 3” and “fish oil” are not synonymous with EPA and DHA and most over-the-counter “fish oil” supplements are not high in EPA and DHA.
• If you are prone to bleeding or take an anticoagulant, consult your physician first.

Vitamin B12

Vitamin B12, also called cobalamin, is a water-soluble vitamin synthesized by bacteria and algae. Food sources of vitamin B12 include animal products and fortified foods. A few plant-based foods such as certain types of dried purple laver (nori) and mushrooms contain substantial amounts of vitamin B_12. 

While it is true that vegans living in countries where hygiene practices are not as strict as our own are known to maintain vitamin B12 status without dietary supplementation because they are regularly exposed to microorganisms/algae in their environment (e.g., contamination from the soil), vegans and vegetarians living in the Western world must supplement with vitamin B12 in order to prevent deficiency.

Vegetarians who consume milk and/or eggs still require vitamin B12 supplementation as these foods are inadequate in vitamin B12. In fact, vitamin B12 deficiency is common among all populations and I frequently see it in omnivores as well.

Vitamin B12 requirements can easily be met by taking a daily multivitamin or an individual vitamin B12 supplement. If taking an individual supplement, consider taking 1,000 mcg once or twice weekly to maintain vitamin B status. If treating a deficiency, consider taking 2,000 mcg daily for 14 days before switching to the aforementioned regimen. In general, high-dose vitamin B12 supplementation is not necessary and should be avoided as it can result in additional health complications.

Additional Resources

• Office of Dietary Supplements: Home
• Office of Dietary Supplements: Vitamin and Mineral Fact Sheets
• Office of Dietary Supplements: Botanical Fact Sheets
• USDA Nutrient Database: Food Sources of Nutrients

Posters and Charts

Except where otherwise noted, content on this site is licensed under a CC BY-NC-ND 4.0 license. This means you are free to use my work for personal use (e.g., save the file to your computer or share via social media) as long as you do not modify the image or use the image for commercial purposes ($).

References:

Mueller CM, ed. The A.S.P.E.N. Adult Nutrition Support Core Curriculum, 2nd ed. American Society for Parenteral and Enteral Nutrition, Silver Spring, MD. 2012:284-297.

Gottschlich MM, ed. The A.S.P.E.N. Nutrition Support Core Curriculum: A Case-Based Approach-The Adult Patient, 2nd ed. Silver Spring, MD: A.S.P.E.N., 2007:323-339

Corkins MR, Balint J, Bobo E, Plogsted S, Yaworski JA. The A.S.P.E.N Pediatric Nutrition
Support Core Curriculum. 2010.

Linus Pauling Institute at Oregon State University. http://lpi.oregonstate.edu/mic

WHO. Guideline: Fortification of Food-Grade Salt with Iodine for the Prevention and Control of Iodine Deficiency Disorders. Geneva: World Health Organization, 2014

Zimmermann MB and Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol 2015; 3: 286–95

Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA. 2002;287(23):3116-3126.

Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA. 2002;287(23):3127-3129.

Rizzo G, Laganà AS, Rapisarda AM, et al. Vitamin B12 among Vegetarians: Status, Assessment and Supplementation. Nutrients. 2016;8(12):767. Published 2016 Nov 29. doi:10.3390/nu8120767

Watanabe F, Yabuta Y, Bito T, Teng F. Vitamin B₁₂-containing plant food sources for vegetarians. Nutrients. 2014;6(5):1861-73. Published 2014 May 5. doi:10.3390/nu6051861