Sally Walder BSc Biochemistry - University of Warwick PhD Developmental Biology - University College London

‘Most people don't need to take vitamin supplements and are able to get all the vitamins and minerals they need by eating a healthy, balanced diet.’

Calcium’s roles include muscle function, nerve transmission, intracellular signalling and hormonal secretion…

Over the long term, inadequate calcium intake causes osteopenia which if untreated can lead to osteoporosis. The risk of bone fractures also increases, especially in older individuals. When calcium intake is low or ingested calcium is poorly absorbed, bone breakdown occurs as the body uses its stored calcium to maintain normal biological functions…

‘Calcium supplements with or without vitamin D marginally reduce total fractures …….They also cause kidney stones, acute gastrointestinal events, and increase the risk of myocardial infarction and stroke. Any benefit of calcium supplements on preventing fracture is outweighed by increased cardiovascular events.’ Bolland MJ, Grey A, Reid IR. Calcium supplements and cardiovascular risk: 5 years on. Therapeutic Advances in Drug Safety. 2013;4(5):199-210. doi:10.1177/2042098613499790. ‘Calcium supplements with or without vitamin D marginally reduce total fractures …….They also cause kidney stones, acute gastrointestinal events, and increase the risk of myocardial infarction and stroke. Any benefit of calcium supplements on preventing fracture is outweighed by increased cardiovascular events.’ Bolland MJ, Grey A, Reid IR. Calcium supplements and cardiovascular risk: 5 years on. Therapeutic Advances in Drug Safety. 2013;4(5):199-210. doi:10.1177/2042098613499790.

Vitamin D is essential for the absorption of calcium… and magnesium helps draw calcium from blood and tissues back to the bones….

Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body… energy production structural development of bone DNA synthesis nerve impulse conduction muscle contraction normal heart rhythm Magnesium

Symptoms of Magnesium Deficiency headaches insomnia muscle weakness depression vertigo fatigue abnormal heart rhythm muscle cramps and spasms anxiety irritability

Types of Magnesium Blood Test: Serum Test Red Blood Cell Test

Symptoms of Iron Deficiency Anaemia: tiredness and lack of energy shortness of breath noticeable heartbeats (heart palpitations) pale skin

What’s a vitamin?

Megaloblastic Anaemia Megaloblastic anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that can't function properly.

Symptoms of Megaloblastic Anaemia (B12/Folate) Extreme tiredness Lack of energy Pins and needles Tongue soreness Mouth ulcers Muscle weakness Disturbed vision Psychological problems, which may include depression, confusion and memory issues

Causes of Vitamin B12 and Folate Deficiency Very poor or restricted diet… Medication – certain medications, including anticonvulsants and proton pump inhibitors can affect how much of these vitamins your body absorbs

Pernicious anaemia – where your immune system attacks healthy cells in your stomach, preventing your body from absorbing vitamin B12 from the food you eat; this is the most common cause of vitamin B12 deficiency in the UK

Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Approximately half of UK adults have a serum 25-hydroxyvitamin D concentration of less than 40 nmol/l.

Vitamin D Deficiency Symptoms (Adult) Osteoporosis Muscle aches and pains (myalgia) Weakness and Fatigue Thyroid issues

US National Institute of Health: ‘Vitamin D intakes of 5,000 IU/day achieved serum 25(OH)D concentrations between 100–150 nmol/l, but no greater. Applying an uncertainty factor of 20% to this intake value gave an upper limit of 4,000 IU which the FNB applied to children aged 9 and older and adults.’

Problems with 100% RDA… Malabsorption Differences in RDA Interaction with food and medication

To Summarise… Magnesium and Iron – diet is the best source, though you may wish to take a supplement Calcium – aim to supply your body’s calcium needs through diet alone B vitamins - supplement if diet is poor but be aware of the possibility of malabsorption Vitamin D – supplement when regular (sensible) sun exposure isn’t possible