Special Health Report

Making Sense of
Vitamins and Minerals
Choosing the foods and nutrients you need to stay healthy

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MAKING SENSE OF VITAMINS AND
MINERALS
SPECI A L HE A LT H REPORT
Contents
Medical Editor
Howard D. Sesso, ScD, MPH Vitamins and minerals: The basics. . . . . . . . . . . . . . . . . . . . 2
Associate Epidemiologist, Brigham and Vitamins vs. minerals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Women’s Hospital
Water-soluble vitamins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Associate Professor of Medicine, Division of
Preventive Medicine, Harvard Medical School Fat-soluble vitamins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Executive Editor Major minerals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Anne Underwood Trace minerals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Writers
Daniel Pendick, Nancy Monson Understanding the federal guidelines. . . . . . . . . . . . . . . . . . 6
Copy Editor
Robin Netherton
Recommended Dietary Allowances . . . . . . . . . . . . . . . . . . . . . . . 6
Creative Director
Judi Crouse Making sense of scientific studies . . . . . . . . . . . . . . . . . . . 14
Production/Design Manager
Susan Dellenbaugh Cast of characters: From vitamin A to zinc. . . . . . . . . . . . . 16
Illustrator Vitamin A and carotenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Scott Leighton
B vitamins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Director, Digital Marketing
Tonya Phillips Vitamin C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Published by Harvard Medical School Vitamin D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
David Roberts, MD Vitamin E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Dean for External Education
Vitamin K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Urmila R. Parlikar
Associate Director, Digital Health Products Calcium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
IN ASSOCIATION WITH Magnesium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Belvoir Media Group, LLC, 535 Connecticut Avenue, Potassium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Norwalk, CT 06854-1713. Robert Englander, Chairman Selenium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
and CEO; Timothy H. Cole, Chief Content Officer; Philip
L. Penny, Chief Operating Officer; Greg King, Chief Zinc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Marketing Officer; Ron Goldberg, Chief Financial Officer; Tom
Canfield, Chief Circulation Officer.
Copyright © 2022 by Harvard University. Permission is
Beyond vitamins: Bioactives, probiotics, antioxidants,
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SPECIAL SECTION: Does your diet deliver the daily
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 Dear Reader,
Welcome to the revised and updated edition of Making Sense of Vitamins and Minerals: Choos-
ing the foods and nutrients you need to stay healthy. In the current version of the report, we
provide the latest information to help you meet your nutritional needs—ideally by eating a
healthy diet rather than taking supplements. Given the long list of vitamins and minerals you
should consume every day, the goal of obtaining everything through your diet alone may seem
daunting, but it’s not as hard as it may appear. Globalization has created unprecedented access
to a highly diverse food supply, replete with nutrient-rich fruits and vegetables that past genera-
tions did not have in such abundance. At the same time, however, a plethora of nutritionally
poor foods and beverages (which also did not exist in times past) compete for your attention,
bolstered by savvy labeling and purported health claims. As a result, it’s more important than
ever to be your own health advocate and to learn how to make wise nutritional choices.
Part of the challenge is learning to evaluate the constant barrage of new studies that you hear
about in the media. Out of context, headlines may make individual findings appear more con-
clusive than they really are. This report will help you make sense of the research and provide
you with the latest, most practical dietary strategies to ensure you get adequate, but not exces-
sive, amounts of vitamins and minerals for your optimal health. We explain the many roles that
vitamins and minerals play in your body, and list good food sources for each one, along with
the recommended minimum and maximum amounts you should consume.
Among other things, you will learn
• what to look for when reading nutrition labels for foods and supplements
• why you might not be getting enough vitamin B12 from your diet
• the role of probiotics and prebiotics in keeping you healthy
• the benefits of good nutrition for your immune function and healthy brain aging.
Where do supplements fit in? They remain as adjuncts to a healthy diet, not replacements for
nutritious food. Although most American adults take at least one vitamin and mineral supple-
ment daily, the evidence remains inconclusive as to whether most of them confer long-term
health benefits. This report will help you decide whether or not to make them part of your
dietary strategy.
Yours in health,

Howard D. Sesso, Sc.D., M.P.H.

Medical Editor

Harvard Health Publishing | Harvard Medical School | 4 Blackfan Circle, 4th Floor | Boston, MA 02115
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 Vitamins and minerals: The basics

E very day, your body produces new skin, muscle, often proved fatal. Even today in many low-income
and bone cells. It makes tens of thousands of rich countries, people with limited access to a healthy
red blood cells that carry nutrients and oxygen to and diverse food supply frequently suffer from nutri-
every part of your body, and it produces multitudes of ent-deficiency diseases, such as scurvy, rickets, or
white blood cells to fight invaders. Your nerves send pellagra.
electrical signals skipping along thousands of miles By contrast, people in the United States rarely
of brain and body pathways, and your tissues formu- develop true vitamin and mineral deficiencies—in
late protein and fatty acid chemical messengers that which the lack of a single nutrient leads directly to
shuttle from organ to organ, issuing the orders that a specific ailment—thanks to our extensive supply
orchestrate and sustain your life. of food and the fortification of many common food
To do all this, your body requires many differ- products with key nutrients. That said, eating less than
ent raw materials. These include nearly 30 vitamins optimal amounts of important vitamins, minerals, and
and minerals that are considered “essential,” mean- other compounds can still contribute to a number of
ing that your body cannot manufacture them in suf- major illnesses, such as heart disease, type 2 diabe-
ficient amounts on its own. Acting in concert, these tes, cancer, and osteoporosis. Hence, concern about
compounds perform thousands of roles in the body, “nutritional insufficiency”—a controversial topic—is
ranging from shoring up bones and healing wounds to a major driver of both the U.S. dietary guidelines and
boosting your immune system, converting food into the mass marketing of over-the-counter supplements.
energy, and repairing cell and tissue damage. So how can you make sure you’re fulfilling your
The essential vitamins and minerals are often nutrient needs? Unfortunately, a welter of conflict-
called micronutrients because your body needs only ing studies has led to general confusion—and all too
tiny amounts of them. (This is in contrast to the many studies prompt new marketing claims that may
macronutrients—carbohydrates, fats, and protein— or may not be upheld by later research. In fact, the
which the body requires best way to get vitamins
in large amounts for and minerals is from a
energy, metabolism, and well-rounded diet, with
other functions.) Yet plenty of fruits, veg-
failing to get even those etables, legumes, whole
small quantities virtu- grains, and lean sources
ally guarantees disease. of protein, along with
For example, British healthy fats, such as nuts
sailors learned centu- and olive oil.
© urfinguss | Getty Images

ries ago that living for We’ll explore all

months without fresh of this in this report.
fruits or vegetables—the But first, it may help to
main sources of vitamin review some important
C—caused the bleeding Nearly 30 “essential” vitamins and minerals enable the body to carry information about vita-
gums and listlessness out myriad tasks — such as making rich red blood cells to deliver mins and minerals and
of scurvy, a disease that nutrients and producing white blood cells to fight invaders. their roles in the body.

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 vesting it from your own bones. Vitamin C helps you
absorb iron. However, the interplay of micronutrients
isn’t always cooperative. For example, too much vita-
min C can block your body’s ability to assimilate the
essential mineral copper.
There are a few other distinctions to be aware of.
Vitamins are subdivided into two categories—water-
soluble and fat-soluble—with implications for your
diet. Minerals, too, are subdivided into major miner-
© AMR Image | Getty Images

als and trace minerals, depending on how much you

need of each. This chapter will explore these concepts
in greater depth.

Water-soluble vitamins — those that can dissolve in water — are

packed into the watery portions of fruits and vegetables. Oranges, Water-soluble vitamins
for example, are a good source of vitamin C. Water-soluble vitamins—those that can dissolve in
water—are packed into the watery portions of the foods
Vitamins vs. minerals you eat. They are absorbed directly from the digestive
What distinguishes a vitamin from a mineral? A vita- tract into the bloodstream as food is broken down or as a
min, simply put, is an organic substance—one pro- supplement dissolves. (For this reason, you should con-
duced by a plant or an animal—that is required in sume water-soluble vitamin supplements with food and
small amounts for human life. (The first syllable, vit-, a beverage to ensure full absorption.) Because much of
comes from the Latin word for “life.”) With the excep- your body consists of water, many of the water-soluble
tion of vitamin D, vitamins cannot be synthesized in vitamins circulate easily in your body. One exception is
the body and must come from food. They are there- vitamin B6, which is mostly stored in muscle tissue.
fore considered essential micronutrients. Your kidneys continuously regulate levels of water-
A mineral is an inorganic element—one that soluble vitamins, shunting excesses out of the body
comes originally from rocks, soil, or water (though it in your urine. Because
may enter your diet through a plant that has absorbed of this, the risk of harm
it from the environment, or an animal that has eaten from consuming supple- Water-soluble
such a plant). There are many minerals, but only cer- ments that contain large vitamins
tain ones are necessary for human health. doses of these vitamins is B vitamins:
Another difference is that vitamins have com- relatively small in most • Thiamin (vitamin B1)
plex structures that can be broken down by heat, air, cases. However, there • Riboflavin (vitamin B2)
or acid. Minerals are simpler elements that hold on are some exceptions. • Niacin (vitamin B3)
to their chemical structures. That means minerals For example, exces- • Pantothenic acid
can easily find their way into your body through the sive vitamin B6 (many (vitamin B5)
plants, fish, animals, and fluids you consume. It’s more times the recommended • Pyridoxine (vitamin B6)
difficult to shuttle vitamins from food into your body, daily amount of 1.3 mil- • Biotin (vitamin B7)
because cooking, storage, and simple exposure to air ligrams for adults) can • Folate, folic acid
can inactivate these more fragile compounds. damage nerves, caus- (vitamin B9)
Despite their structural differences, vitamins and ing numbness and mus- • Cyanocobalamin
minerals often work together. For example, vitamin D cle weakness (see “B (vitamin B12)
enables your body to pluck calcium from food that is bonanza: Boon or bust?” Vitamin C
passing through your digestive tract, rather than har- on page 21).

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 Although most water-soluble vitamins tend to Water-soluble vitamins perform many tasks in the
pass out of the body quickly, some can stay for long body. One of the most important is helping to free the
periods of time. You probably have several years’ sup- energy found in the food you eat. Thiamin, riboflavin,
ply of vitamin B12 in your liver. Even the body’s stores niacin, pantothenic acid, and biotin—all of them B
of vitamin B9 (folate or folic acid) and vitamin C can vitamins—engage in various aspects of energy pro-
last more than a couple of days. Generally, though, duction. Vitamins B6, B9, and B12 metabolize amino
water-soluble vitamins should be replenished every acids (the building blocks of proteins) and help cells
few days. multiply. And one of many roles played by vitamin C
is to help make collagen, which knits together wounds,
supports blood vessel walls, and forms a base for teeth
Figure 1: Absorption of fat-soluble vitamins and bones.

 1
Fat-soluble vitamins
As the name implies, fat-soluble vitamins can be dis-
solved by fat solvents and oils. In contrast to water-
soluble vitamins, which travel freely via the blood-
 4 stream and are excreted in urine, fat-soluble vitamins
require special help to move around the body. After
Liver
Fat-soluble being consumed in the diet, they gain entry to the
vitamin with Stomach
 5 bloodstream via lymph channels in the intestinal wall
protein cover
(see Figure 1, at left). Most fat-soluble vitamins travel
through the body only under the escort of special fat-
 2 binding proteins, which act as carriers to allow these
 3 vitamins to interact with water-rich blood and cells.
Blood The fat-soluble vitamins work in close coordina-
vessel
tion to keep many parts of your body in good repair.
Fat-soluble
Small intestine vitamin with
For example, vitamins A, D, and K are necessary
Lymph vessel protein cover for bone formation. Vitamin A also helps keep cells
healthy and protects your vision—but without vitamin
1. Food containing fat-soluble vitamins is ingested.
E, the fourth fat-soluble vitamin, your body would
2. The food is broken down by stomach acid and then travels to have difficulty absorbing and storing vitamin A. Vita-
the small intestine, where it is digested further. Bile, made in the
min E also acts as an antioxidant, potentially helping
liver, flows into the small intestine, where it breaks down fats in
the food. That allows fat-soluble vitamins and other nutrients to to protect your cells and even your DNA against dam-
be absorbed through the wall of the small intestine. age from unstable molecules called free radicals (see
“Antioxidants: Beyond the hype,” page 36).
3. Upon absorption, fat-soluble vitamins enter the lymph vessels
before making their way into the bloodstream. In most cases, Fat-soluble vitamins are
fat-soluble vitamins must be coupled with a protein in order to stored in your fat tissues and
travel through the body, which is why it is best to get them from your liver, which together act Fat-soluble
food (or in the case of supplements, to take them with food). as the main holding pens for vitamins
4. These vitamins are used throughout the body, but excess these vitamins and release • Vitamin A
amounts are stored in the liver and fat tissues. them into the body as needed. • Vitamin D

5. As additional amounts of these vitamins are needed, your body To some extent, you can think • Vitamin E
taps into the reserves, and the liver releases them into the of these vitamins as time- • Vitamin K
bloodstream. release nutrients. Your body

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squirrels away any excess you consume and doles it out body rids itself of the surplus sodium. Likewise, too
gradually to meet your needs. Because these vitamins much phosphorus can hamper your ability to absorb
are stored for long periods, however, dangerous levels magnesium. These sorts of imbalances are usually
can build up. As a result, toxicity from fat-soluble vita- caused by overloads from supplements, not food
mins is much more common than for water-soluble sources.
vitamins. However, this is more likely to happen if you
take high doses of fat-soluble vitamin supplements
over a prolonged period of time. It’s very rare to get Trace minerals
too much of any single vitamin just from food. A thimble could easily contain all the trace miner-
als normally found in your body. Yet their contri-
butions are just as important as those of the major
Major minerals minerals. Trace minerals carry out a diverse set of
The body needs and stores relatively large amounts of tasks. Iron, for example, is best known for ferrying
the major minerals—calcium, chloride, magnesium, oxygen throughout the body, while fluoride strength-
phosphorus, potassium, sodium, and sulfur. Calcium ens bones and wards off tooth decay. Zinc helps your
and phosphorus each account for more than a pound blood clot, enables you to taste and smell, and bolsters
of your body weight. One of the key tasks of the major your immune response. Copper helps form several
minerals is maintaining the proper electrical bal- enzymes, one of which assists with iron metabolism
ance of all the cell membranes in your body—a vital and the creation of hemoglobin, which carries oxygen
property for cell signaling and the transport of nutri- in the blood. The other trace minerals perform equally
ents and messengers into and out of cells. Sodium, vital jobs, such as helping to block damage to body
chloride, and potassium take the lead in doing this. cells and forming parts of key enzymes or enhancing
Three other major minerals—calcium, phosphorus, their activity.
and magnesium—have similar activities and are also Trace minerals interact with one another, some-
important for healthy bones. Sulfur helps stabilize times in ways that can trigger imbalances. Too much
protein structures, including some of those that make of one can cause or contribute to a deficiency of
up hair, skin, and nails. another. For example, a minor overload of manganese
Major minerals travel through the body in vari- can worsen an iron deficiency. By the same token, too
ous ways. Potassium, for example, is quickly absorbed little of a mineral can lead to health problems. When
into the bloodstream, where it circulates freely and the body has too little iodine, thyroid hormone pro-
is excreted by the kidneys, much like a water-soluble duction slows, causing sluggishness and weight gain as
vitamin. In contrast, calcium requires a carrier for well as other health concerns. The problem worsens if
absorption and transport. the body also has too little
Having too much of one major mineral can result selenium.
in a deficiency of another. However, the differ- Trace minerals
Calcium binds with excess ence between “just enough” • Chromium
Major minerals sodium in the body and is and “too much” of the trace • Copper
• Calcium excreted when the body minerals is often relatively • Fluoride
• Chloride needs to lower the sodium small. Generally, food is a • Iodine
• Magnesium level. That means that safe source of trace min- • Iron
• Phosphorus if you ingest too much erals, but if you take sup- • Manganese
• Potassium sodium through table plements, it’s important • Molybdenum
• Sodium salt or processed foods, to make sure you’re not • Selenium
• Sulfur you could end up losing greatly exceeding recom- • Zinc
needed calcium as your mended levels. 

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 Understanding the federal guidelines

Recommended Dietary Allowances

T he field of nutrition is filled with confusing terms
found on the labels of foods you purchase—Rec-
ommended Dietary Allowances (RDAs), Daily Values
In 1941, the U.S. Food and Nutrition Board published
the first in a series of reports on Recommended Dietary
(DVs), dietary reference intakes (DRIs), and more. Allowances (RDAs). These reports were directly
However, few people aside from nutritionists really inspired by concern about nutrient deficiencies, which
understand the differences between these terms. To in the early 20th century were still relatively common
help you sort through it all, this chapter traces the his- in the United States, and which the government and
tory of the terms and explains why the different values nutrition experts worried could be worsened by food
are used in different situations. shortages caused by the Great Depression and World

Alphabet soup: Understanding RDAs, DRIs, DVs, and other values

M ost Americans recognize the abbreviation RDA. But how

do RDAs differ from DRIs and DVs? And what are ULs
and AIs? Here’s some help.
subgroups — to consume daily for an extended period.
Exceeding the UL does not mean that harmful effects will
always occur; rather, the more you exceed the UL, the greater
Recommended Dietary Allowance (RDA): This value refers the risk of adverse effects.
to the average minimum daily amount of a specific nutrient Estimated average requirement (EAR): This is the daily
needed to prevent clinical nutrient deficiency in almost all amount of a nutrient that is estimated to prevent clinical
healthy people in a particular group defined by age and nutrient deficiency in half of all healthy people in a particular
sex. RDAs were developed to address only a selected set of group defined by age and sex. EARs are used as the basis for
nutrients and nutrient deficiency diseases, and are now just RDAs, and as such, apply to a relatively limited set of nutrients
one category of measurements included in the broader dietary and their corresponding nutrient deficiency diseases.
reference intakes.
Daily Value (DV): This reference number, developed by the
Dietary reference intake (DRI): Introduced in 1997, DRI FDA, is designed to help consumers determine if a food
values were established to support guidelines for a broad contains a lot or a little of a specific nutrient, based on the DRI
range of nutrients and minerals, not only to prevent nutrient for that nutrient. It may be similar to the RDA or AI for that
deficiencies, but also to enhance health and reduce the nutrient, but not always. DVs — which are used on Nutrition
risk of chronic diseases such as osteoporosis, cancer, and Facts panels — don’t account for your age, sex, or other
cardiovascular disease. The DRIs include RDAs, AIs, ULs, and factors affecting your daily calorie needs. They’re based on
EARs (see the next three entries). The DRIs are what underlie the highest average daily allowance value and are presented
the U.S. dietary guidelines and food labeling regulations. as percentages of total daily intake, calculated for an average
Adequate intake (AI): This value is individual eating 2,000 calories a day.
determined as a range of recommended Note: Another point of confusion
intake (rather than just a minimum), and can be the units used for measuring
is used for nutrients — such as vitamin K, S
R D A DRI various vitamins and minerals. Amounts
T

manganese, and potassium — for which may be presented as milligrams (mg),

B P
© Malte Mueller | Getty Images

there is not a corresponding clinical

N AI micrograms (mcg), or international units
F

deficiency disease. EA R
UL (IU). To convert one to another, consult
Tolerable upper intake level (UL): DV W this calculator: www.health.harvard.edu/
X

This is the maximum amount of a iu-converter. An additional unit, called

nutrient that is considered safe for micrograms of dietary folate equivalents
individuals — including those in sensitive (mcg DFE), is used to measure vitamin B9.

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War II. The RDAs in turn were used as the foundation intakes (DRIs). The DRIs are intended to be evidence-
for the first U.S. Dietary Guidelines for Americans. based standards that go beyond amending single-
These guidelines are revised every five years to reflect nutrient deficiencies: they also suggest the amounts
advances in nutrition knowledge. of nutrients needed for preventing complex chronic
This process—setting RDAs based on concern diseases and enhancing health.
about potential nutrient deficiencies, and then bas- To help people apply guidelines for selected vita-
ing the dietary guidelines on these standards—has mins and minerals to their daily food choices, the
continued with relatively little change since the 1940s. FDA created the Nutrition Facts panel that appears on
Although this has contributed to success at largely almost all packaged foods (see Figure 2, below).
eliminating nutrient deficiencies in the United States, When you read nutrition labels, bear in mind
it has also had unintended consequences. The isolated that the limited information on vitamin and mineral
focus of the RDAs on single nutrients—which works content is only one factor to consider. Other factors—
so well for preventing diseases like rickets or scurvy such as the extent of food processing, the quality of the
that are caused by a lack of single nutrients—has ques- carbohydrates, and the types of fat—are just as impor-
tionable relevance for staving off heart disease, cancer, tant, if not more important. To glean all this from the
and other chronic diseases. Nutrition Facts panel requires a little interpretation.
The establishment of RDAs is now a highly com- For example, to assess carbohydrate quality, a rule of
plex—and expensive—process. New RDAs, or even a thumb is to look for no more than 10 grams of total
revised value for an existing RDA, can be determined carbohydrate for every 1 gram of fiber (a 10-to-1 ratio
by only one private, nonprofit agency—known as the or lower). In the label shown in Figure 2, there are 37
Health and Medicine Division of the National Acad- grams of carbohydrate and 4 grams of fiber, making
emies of Sciences, Engineering, and
Medicine—and only after it receives
a special commission and special Figure 2: A sample Nutrition Facts panel
funding from the U.S. government. Nearly every packaged food or beverage
The process is lengthy and pricey, you toss into your shopping cart has
taking up to three years and millions a printed Nutrition Facts panel, which
of dollars to revise a single RDA. As a highlights certain basic information
about the food, such as serving size and
result, such revisions are infrequent.
calories per serving. The amounts of fat,
The most recent RDA revision—for cholesterol, sodium, carbohydrate, and
vitamin D and calcium—was pub- protein per serving are given both in
lished in 2011. grams or milligrams and as percentages
Because RDAs were designed to of Daily Values (reference numbers
prevent clinical nutrient deficien- designed to show if a food contains
a lot or a little of a specific nutrient).
cies, they apply only to a limited set
Beyond that, there is limited information
of nutrients and their corresponding about vitamins and minerals. Labels
nutrient deficiency diseases. To cre- must list the amounts of vitamin D,
ate guidelines for appropriate intakes calcium, iron, and potassium per serving,
of other nutrients, other criteria have and manufacturers can opt to include
been developed, such as adequate information on other vitamins and
intakes, or AIs (see “Alphabet soup: minerals if they want to. Listings for
Vitamins A and C used to be required,
Understanding RDAs, DRIs, DVs,
but the FDA determined that the
and other values,” page 6). Together, likelihood of deficiency in these vitamins
these sets of criteria for nutrient con- was low and the benefit of increased
sumption are called dietary reference consumption was unclear.

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the ratio 37 to 4, or slightly less than 10 to 1. Looking younger, or for a woman who is pregnant or nurs-
for a 10-to-1 ratio is not a perfect rule of thumb, but it ing, ask your doctor about what’s appropriate.
helps to capture the overall quality of the carbohydrate • The recommended amount for each nutrient is
in any product. If you really want to maximize carbo- either an RDA (if there is a deficiency disease, such
hydrate quality, aim for a 5-to-1 ratio—in other words, as rickets, associated with it) or an AI (for most
no more than 5 grams of carbohydrate for every 1 other nutrients; see “Alphabet soup,” page 6).
gram of fiber. • Pay attention to the column that lists the UL, which
But even more important than the carbohydrate is the tolerable upper intake level. This is the maxi-
quality or fat content of one particular food is your mum daily amount of a nutrient considered safe
overall dietary pattern. If you eat a diverse range of if consumed regularly. Beyond that limit, there is
whole, minimally processed foods—fruits, vegetables, a rising risk for side effects, some of which can be
nuts, whole grains, fish, vegetable oils, and dairy— serious. An upper limit hasn’t been established for
there’s little need to become a nutrition label math- every nutrient; however, it’s important to realize
ematician. Such a diet already delivers high-quality that very large amounts of these nutrients could still
macronutrients (fats, carbs, and protein), as well as be harmful. Food sources of nutrients are almost
vitamins and minerals in sufficient amounts. never a problem. People run into trouble mostly
Tables 1 (below) and Table 2 (page 11) can give through taking high doses of supplements.
you a better understanding of how particular vitamins • A good food source, as determined by the FDA,
and minerals work in your body, how much of each indicates a food that contains 10% to 19% of the
nutrient you need every day, and what types of food to RDA or AI of a specific nutrient.
eat to ensure that you are getting an adequate supply. • Vitamins A, D, and E are often measured in inter-
When reading the tables, note the following: national units (IU) in addition to another unit like
• The recommendations vary by age and sex. These milligrams or micrograms. What constitutes an IU
tables apply to adults ages 19 and over. If you is different for each nutrient, because it indicates an
are looking for recommendations for someone amount with a certain biological effect. 

Table 1: Vitamins: Recommended intake, uses in the body, and sources

The following recommendations are based largely on guidelines from the Health and Medicine Division of the National
Academies of Sciences, Engineering, and Medicine. Recommended amounts may be expressed in milligrams (mg), micrograms
(mcg), international units (IU), or micrograms of dietary folate equivalents (mcg DFE), depending on the nutrient. Unless otherwise specified,
values represent those for men (M) and women (W) ages 19 and older.
GOOD FOOD SOURCES
VITAMIN AND BENEFITS RDA OR AI* UL* (listed most to least) DID YOU KNOW?
Vitamin A (retinol, retinal, and retinoic RDA 10,000 Sources of preformed Large amounts of supplemental, or
acid — three active forms of vitamin IU (3,000 vitamin A: beef liver, ricotta preformed, vitamin A (but not beta
M: 3,000 IU
A in the body — are retinoids, called mcg) cheese, Atlantic herring, carotene) can be harmful to bones.
(900 mcg)
“preformed” vitamin A; the body can also fortified milk and cereals
In current smokers, beta carotene
easily convert a precursor, beta carotene, W: 2,333 IU
Sources of beta carotene: supplements may raise the risk of lung
to vitamin A as needed) (700 mcg)
sweet potatoes, spinach, cancer.
• Essential for vision carrots, pumpkin,
cantaloupe, peppers,
• Keeps tissues and skin healthy
mangoes
• Plays an important role in bone growth
Thiamin (vitamin B1) RDA Not Fortified cereals, pork Thiamin deficiency can occur with
known chops, rice, trout, black chronic, heavy alcohol consumption,
• Helps convert food into energy M: 1.2 mg
beans, mussels, tuna, acorn leading to a condition called Wernicke-
• N
 eeded for healthy skin, hair, muscles, W: 1.1 mg squash Korsakoff syndrome.
and brain

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Table 1 continued
GOOD FOOD SOURCES
VITAMIN AND BENEFITS RDA OR AI* UL* (listed most to least) DID YOU KNOW?

Riboflavin (vitamin B2) RDA Not Beef liver, fortified cereals Most Americans get the RDA for
Helps convert food into energy known and oats, yogurt, milk, beef, riboflavin, mostly from milk and milk-
• M: 1.3 mg
clams, almonds, cheese based beverages.
• N
 eeded for healthy skin, hair, blood, and W: 1.1 mg
brain Riboflavin is destroyed by light, which
is why most milk is sold in opaque
containers.

Niacin (nicotinic acid, vitamin B3) RDA 35 mg Fortified cereals, baker’s Niacin occurs naturally in food and
yeast, salmon, tuna, beef, can also be made by your body from
• Helps convert food into energy M: 16 mg
lamb, peanuts and peanut the amino acid tryptophan, with the
• E ssential for healthy skin, blood cells, W: 14 mg butter, chicken, veal, help of B6.
brain, and nervous system mushrooms, turkey

Pantothenic acid (vitamin B5) AI Not Wide variety of foods, The name pantothenic comes from
known including fortified cereals, the Greek word pantothen, meaning
• Helps convert food into energy 5 mg
beef liver, mushrooms, “from all sides”— a nod to its wide
• H
 elps make lipids (fats), sunflower seeds, chicken, availability in many foods. Deficiencies
neurotransmitters, steroid hormones, tuna, avocados are very rare.
and hemoglobin

Vitamin B6 (pyridoxal, pyridoxine, RDA 100 mg Chickpeas, beef liver, tuna, Vitamin B6 has been promoted as a
pyridoxamine) salmon, chicken breast, treatment for carpal tunnel syndrome
Ages 19 to
fortified cereals, potatoes, and premenstrual syndrome, but
• A
 ids in lowering homocysteine levels; 50: 1.3 mg
turkey, banana, marinara studies do not support any benefit for
not clear whether it reduces heart
M, ages sauce, ground beef, waffles, these conditions.
disease risk
51+: 1.7 mg bulgur, cottage cheese,
• H
 elps convert tryptophan to niacin and winter squash
W, ages
serotonin, a neurotransmitter that plays
51+: 1.5 mg
key roles in sleep, appetite, and moods
• Helps make red blood cells
• Influences cognitive abilities and
immune function

Biotin (vitamin B7) AI Not Organ meats such as beef Your body needs very little biotin.
known liver and eggs are good Some is made by bacteria in the
• H
 elps convert food into energy and 30 mcg
sources; also found in gastrointestinal tract. However, it’s
synthesize glucose
lesser concentration in not clear how much of this the body
• H
 elps make and break down some fatty fish, pork, hamburgers, absorbs.
acids sunflower seeds, sweet
• Needed for healthy bones and hair potatoes, and almonds

Vitamin B9 (folate, folic acid, folacin) RDA 1,000 mcg Beef liver, spinach, black- It’s easier to absorb B9 from
DFE eyed peas, fortified supplements and fortified grain
• Vital for new cell creation 400 mcg
grains and cereals, rice, products than from foods where it
DFE
• H
 elps prevent brain and spinal birth asparagus, spaghetti, occurs naturally.
defects when taken early in pregnancy romaine lettuce, avocado,
Deficiencies very early in pregnancy
May reduce risk for colon cancer broccoli, mustard greens,
• can lead to birth defects, and women
green peas, kidney beans,
may not know they are pregnant in
peanuts, wheat germ
the first weeks of pregnancy. Some
research suggests that all women
of childbearing age should get 800
mcg per day. You can get this amount
through a healthy diet and a daily
multivitamin.

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Table 1 continued
GOOD FOOD SOURCES
VITAMIN AND BENEFITS RDA OR AI* UL* (listed most to least) DID YOU KNOW?
Vitamin B12 (cyanocobalamin) RDA Not Clams, beef liver, fortified Many people, particularly older adults,
•A
 ids in lowering homocysteine levels; 2.4 mcg known cereals, fish (such as are deficient in vitamin B12 because
not clear whether it lowers heart disease trout, salmon, tuna, and they have trouble absorbing this
risk haddock), beef sirloin, milk, vitamin from food.
yogurt, cheese, ham, eggs Vitamin B12 occurs naturally only in
•A
 ssists in making new cells and
breaking down some fatty acids and animal food sources, so vegetarians
amino acids and vegans should eat a fortified
breakfast cereal or take a supplement
•P
 rotects nerve cells and encourages
to ensure that they get enough.
their normal growth
A lack of vitamin B12 can cause
•H
 elps make red blood cells
memory loss, dementia, and numbness
in the arms and legs.
Vitamin C (ascorbic acid) RDA 3,000 mg Red peppers, oranges and Megadoses of vitamin C do not
•H
 elps make collagen, a connective M: 90 mg orange juice, grapefruit appear to help prevent the common
tissue that knits together wounds and and grapefruit juice, cold, and they may cause diarrhea.
W: 75 mg kiwifruit, green peppers,
supports blood vessel walls Large-scale randomized controlled
Smokers: broccoli, strawberries, trials of vitamin C have not found an
•H
 elps make the neurotransmitters
add 35 mg brussels sprouts, tomato effect on cardiovascular disease and
serotonin and norepinephrine
juice, cantaloupe, cabbage, cancer.
•A
 cts as an antioxidant, neutralizing cauliflower, potatoes,
unstable molecules that can damage tomatoes, spinach, green
cells peas
•R
 equired for healthy immune function
Vitamin D (calciferol) RDA 4,000 IU Cod liver oil, swordfish, Some Americans, especially African
•H
 elps the body absorb dietary calcium Ages 1 to (100 mcg) salmon, tuna, fortified Americans, don’t get enough of this
70: 600 IU milk, cereals, and juices, nutrient.
•H
 elps maintain normal blood levels
(15 mcg) sardines, beef liver, eggs The major source of vitamin D is
of calcium and phosphorus, which
strengthen bones sunlight, not diet. (Your skin naturally
Ages 71+:
makes vitamin D when exposed to the
•H
 elps form teeth and bones 800 IU
sun.)
•S
 upports healthy immune function (20 mcg)
Vitamin D has been suggested to have
a wide range of benefits on health
outcomes, yet clinical trials have not
yet produced definitive results.
Vitamin E (alpha tocopherol) RDA 1,500 IU Wheat germ oil, sunflower Vitamin E does not prevent wrinkles.
•A
 cts as an antioxidant, neutralizing 22 IU (1,000 seeds and oil, almonds, The extent of its benefits for
unstable molecules that can damage (15 mg) mg) safflower oil, hazelnuts, preventing cardiovascular disease is
cells peanut butter and peanuts, unclear.
corn oil, spinach
•P
 rotects vitamin A and certain lipids
from damage
Vitamin K (phylloquinone, menadione) AI Not Collards, turnip greens, Intestinal bacteria make a form of
•A
 ctivates proteins and calcium essential M: 120 mcg known spinach, kale, broccoli, vitamin K that accounts for half of
to blood clotting soybeans and soybean oil, your requirements.
W: 90 mcg carrot juice, edamame,
•N
 eeded for healthy bones If you take the anticoagulant warfarin
pumpkin, pomegranate (Coumadin), keep your vitamin K
juice, okra, salad dressing, intake consistent.
pine nuts, blueberries,
iceberg lettuce, chicken
breast, grapes, vegetable
juice cocktail, canola oil,
cashews, carrots, olive oil
*RDA = Recommended Dietary Allowance; AI = adequate intake; UL = tolerable upper intake level.

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 Table 2: Minerals: Recommended intake, uses in the body, and sources
GOOD FOOD SOURCES
MINERAL AND BENEFITS RDA OR AI* UL* (listed most to least) DID YOU KNOW?

Calcium RDA Ages 19 Yogurt, cheese, Adults absorb roughly 30% of

to 50: sardines, milk, soymilk, calcium they ingest, but this can
• B uilds and protects bones and M, ages 19 to 70: 1,000
2,500 mg fortified juices, tofu, vary depending on the source.
teeth mg
salmon, frozen yogurt,
Ages 51+: Some physicians recommend
• H
 elps with muscle contractions M, ages 71+: 1,200 mg and leafy green
2,000 mg that pregnant women get more
and relaxation, blood clotting, and vegetables such as
W, ages 19 to 50: 1,000 calcium than the current RDA.
nerve impulse transmission turnip greens, kale,
mg Ask your own doctor for advice.
• P lays a role in hormone secretion and broccoli (but not
W, ages 51+: 1,200 mg spinach or Swiss chard,
and enzyme activation
which have binders
• M
 ay help maintain healthy blood that lessen absorption)
pressure

Chloride AI 3,600 mg Salt (sodium chloride), Chloride, sodium, and potassium

soy sauce, processed help your body maintain the
• B alances fluids in the body Ages 19 to 50: 2,300 mg
foods, seaweed, rye, proper balance of water.
• A
 component of stomach acid, Ages 51 to 70: 2,000 mg tomatoes, lettuce,
essential to digestion celery, and olives
Ages 71+: 1,800 mg

Chromium AI Not known Broccoli, potatoes, Most foods provide just small
apples, orange juice, amounts of chromium (less than
• E nhances the activity of insulin M, ages 19 to 50: 35 mcg
whole-grain bread, 2 mcg per serving).
• H
 elps maintain normal blood M, ages 51+: 30 mcg beef, garlic, basil
glucose levels
W, ages 19 to 50: 25 mcg
• H
 elps free energy from glucose
W, ages 51+: 20 mcg

Copper RDA 10,000 mcg Liver, shellfish, nuts, The body absorbs more than
seeds, whole-grain half of dietary copper, and
• P lays an important role in iron 900 mcg
products, beans, deficiency is not known to occur
metabolism
prunes, cocoa in adults.
• H
 elps make red blood cells

Fluoride AI 10 mg Water that is Excessive amounts of fluoride

E ncourages strong bone formation fluoridated, toothpaste are harmful to children.
• M: 4 mg
with fluoride, tea
• K eeps dental cavities from starting W: 3 mg
or worsening

Iodine RDA 1,100 mcg Seaweed, fish, yogurt, To prevent iodine deficiencies,
P art of thyroid hormone, which iodized salt, enriched some countries add iodine to
• 150 mcg
helps set body temperature and bread, shrimp, ice salt, bread, or drinking water.
influences nerve and muscle cream, pasta, eggs,
function, reproduction, and growth tuna

• P revents goiter and a thyroid

disorder in newborns

Iron RDA 45 mg Fortified breakfast Many women of childbearing

H
 elps hemoglobin in red blood cereals, oysters, beans, age don’t get enough iron.
• M, ages 19 to 50: 8 mg
cells and myoglobin in muscle cells dark chocolate, beef
Eating meat, fish, or poultry
M, ages 51+: 8 mg liver, lentils, spinach,
ferry oxygen throughout the body with beans or dark leafy greens
W, ages 19 to 50: 18 mg tofu, sardines,
• N
 eeded for chemical reactions in can increase your absorption
chickpeas, tomatoes,
the body and for making amino W, ages 51+: 8 mg of vegetable sources of iron.
beef, potatoes, nuts
acids, collagen, neurotransmitters, Foods rich in vitamin C can also
and hormones increase iron absorption.

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Table 2 continued
GOOD FOOD SOURCES
MINERAL AND BENEFITS RDA OR AI* UL* (listed most to least) DID YOU KNOW?

Magnesium RDA 350 mg Nuts, spinach, cereal, Many Americans don’t get the
(Note: This soymilk, black required amounts.
• N
 eeded for many chemical M, ages 19 to 30: 400 mg
upper limit beans, edamame,
reactions in the body Most magnesium in the body
M, ages 31+: 420 mg applies to peanut butter, bread,
is found in bones. If your blood
• W
 orks with calcium in muscle supplements avocados, potatoes,
W, ages 19 to 30: 310 mg levels are low, your body may
contraction, blood clotting, and and rice, yogurt, fortified
W, ages 31+: 320 mg tap these reserves to correct the
regulation of blood pressure medicines, breakfast cereals
problem.
• H
 elps build bones and teeth such as
laxatives, not
to dietary
magnesium.)

Manganese AI 11 mg Pineapple, nuts, whole If you take supplements or have

grains, legumes, manganese in your drinking
• H
 elps form bones M: 2.3 mg
spinach, sweet water, be careful not to exceed
• H
 elps metabolize amino acids, W: 1.8 mg potatoes, tea the upper limit. People with liver
cholesterol, and carbohydrates damage or who have a lot of
manganese in their diet should
be especially vigilant.

Molybdenum RDA 2,000 mcg Organ meats, whole Molybdenum deficiencies are
grains, green leafy rare.
• P art of several enzymes, one of 45 mcg
vegetables, milk, beans
which helps ward off a form of
severe neurological damage in
infants

Phosphorus RDA Ages 19 to Salmon, yogurt, milk, Phosphorus deficiencies are rare.
70: 4,000 halibut, turkey, chicken, Certain drugs (including some
• H
 elps build and protect bones and 700 mg
mg beef, lentils, almonds, diuretics, ACE inhibitors, and
teeth
cheese, peanuts, eggs, antacids) bind with phosphorus,
Ages 71+:
• P art of DNA and RNA whole-grain bread, keeping the body from
3,000 mg
• H
 elps convert food into energy carbonated cola absorbing it and causing bone
loss, weakness, and pain.
• P art of phospholipids, which carry
lipids in blood and help shuttle
nutrients into and out of cells

Potassium AI Not known Apricots, lentils, Food sources do not cause

prunes, squash, raisins, toxicity, but high-dose
• B alances fluids in the body 4,700 mg
potatoes, kidney beans, supplements might.
• H
 elps maintain steady heartbeat orange juice, soybeans,
People with type 1 diabetes and
and send nerve impulses bananas, milk, spinach
those taking certain drugs—
• N
 eeded for muscle contractions such as ACE inhibitors, certain
• M
 ay lower blood pressure diuretics, or nonsteroidal anti-
inflammatory drugs—should
• M
 ay improve bone health speak with their doctor before
increasing potassium intake.

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Table 2 continued
GOOD FOOD SOURCES
MINERAL AND BENEFITS RDA OR AI* UL* (listed most to least) DID YOU KNOW?

Selenium RDA 400 mcg Brazil nuts, tuna, A single 1-ounce serving of
halibut, sardines, ham, Brazil nuts can contain almost
• A
 cts as an antioxidant, neutralizing 55 mcg
shrimp, pasta, beef twice the RDA of selenium.
unstable molecules that damage
steak, turkey, beef
cells
liver, chicken, cottage
• H
 elps regulate thyroid hormone cheese, brown rice,
activity eggs, fortified cereals,
whole-wheat bread,
oatmeal, spinach, milk,
yogurt

Sodium AI 2,300 mg Salt, soy sauce, The 2,300-mg upper limit

processed foods such is roughly equivalent to the
• B alances fluids in the body Ages 19 to 50: 1,500 mg
as cereals, bread, hot amount of sodium in 1 teaspoon
• H
 elps send nerve impulses Ages 51 to 70: 1,300 mg dogs, cheese spreads, of table salt.
N
 eeded for muscle contractions Ages 71+: 1,200 mg tomato juice, canned
• Americans typically report
soups, macaroni and
• Increases blood pressure in salt- consuming 2,300 to 4,700 mg
cheese, corned beef
sensitive people; even modest a day (and the real total may be
hash, pretzels, ham,
reductions in sodium intake can higher, as this does not include
potato chips, sunflower
lower blood pressure salt added at the table).
seeds

Zinc RDA 40 mg Oysters, beef, crab, Zinc lozenges may slightly

fortified cereals, shorten the duration of the
• R equired for making proteins and M: 11 mg
lobster, pork chops, common cold.
DNA
W: 8 mg baked beans, chicken,
• S upports immune system function yogurt, cashews

*RDA = Recommended Dietary Allowance; AI = adequate intake; UL = tolerable upper intake level.
NOTE: Sulfur is considered a major mineral, but there is no formal RDA, DV, AI, or UL for it. Therefore, we have not included it in the table.

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 Making sense of scientific studies

E ven the most promising finding about a vitamin

or mineral must work its way through a hierarchy
of studies before scientists can draw firm conclusions
the past that may be related to the condition. These
studies may be tainted by problems called selec-
tion bias (when the cases aren’t similar enough to
about it. It’s wise to read carefully and consider the the controls) or recall bias (when people remem-
weight of the evidence before you rush off to buy the ber things differently from how they actually
latest food or supplement to garner headlines. When happened).
it comes to diet and nutrition, each type of study faces • Cohort studies (such as the Nurses’ Health Study)
a special set of challenges and limitations. begin when researchers identify a large group of
Laboratory studies are done in test tubes or people who are initially free of a particular condi-
animals. They can suggest how and why a vitamin, tion, ask about current risk factors, and then fol-
mineral, or bioactive compound might work, but the low participants prospectively (over time) to see
findings don’t automatically translate to the human who develops the condition and who does not.
body. Because participants are routinely questioned about
Observational studies (also called epidemiologi- their diet and lifestyle before developing the condi-
cal studies) are done in large populations of people— tion, cohort studies have a stronger observational
sometimes 100,000 or more—and can run for decades. design. However, they often rely on self-reports
Scientists collect data at regular intervals. By compar- from dietary questionnaires—which can be subjec-
ing people who stay healthy with those who fall ill, tive and less accurate.
researchers try to identify factors that could account Metabolic or feeding studies typically involve a
for the differences. Such studies can be very power- small number of volunteers who eat specially prepared
ful, since they follow what people actually do in their meals for short time periods. These studies are rigor-
lives over many years. But they cannot prove cause ous and closely controlled, but are too brief to show
and effect, only correlations. For example, people who actual effects on disease over the long term. Instead,
eat blueberries might be healthier because they live researchers use them to examine short-term changes
healthier lives in general, not in risk factors, such as high
because they eat blueberries. blood pressure or cholesterol.
Scientists try to adjust for such Randomized controlled
“confounding” factors, but still trials are typically considered
cannot draw firm conclusions. the gold standard. The research-
Different types of obser- ers randomly assign partici-
vational studies have different pants to either receive some
© victoriya89 | Getty Images

limitations: form of dietary modification

• In case-control studies, re- (a particular diet, food, or sup-
searchers first identify people plement) or serve as controls
with a particular condition (remaining on their usual diet
(cases), then select similar or taking a dummy pill, called
Epidemiological studies establish a correlation, but
people who don’t have that they do not prove cause and effect. People who eat a placebo). This enables scien-
condition (controls), and blueberries might be healthy because they have tists to see whether the dietary
ask everone about factors in healthy lifestyles, not because they eat blueberries. change makes a difference. The

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© Martin Barraud | Getty Images

Randomized controlled trials are considered the gold standard. Researchers randomly assign participants to either receive some form of
dietary modification (a food, diet, or supplement) or serve as controls (with no change or a placebo). They then compare the outcomes.

same approach is used in testing drugs. However, the that needs to be answered and then selecting studies to
results in nutritional studies are often not as simple as include based on clearly expressed criteria such as rel-
those in drug trials, because a food or a diet contains evance to the question and how they were conducted.
thousands of active ingredients, not just one. While Rigorously applying those selection criteria is the “sys-
these trials can measure endpoints like changes in tematic” aspect of the review. The goal is to answer the
cholesterol levels, they are typically too short to dem- question using only the most relevant and high-qual-
onstrate long-term consequences, such as a reduction ity data available. Done well, systematic reviews offer
in heart disease. Lastly, these studies may involve par- a higher level of evidence than any individual study
ticipants who are in better or worse health than you or meta-analysis can. Poorly done, researchers apply
are, so they may not yield information that is relevant overly subjective opinions of the evidence at hand.
to you. In this Special Health Report, you will see refer-
Meta-analyses take previously published stud- ences to many systematic reviews of previously pub-
ies containing comparable data and assess all the evi- lished randomized trials. Some of the best and most
dence together, looking for patterns—in effect, they’re influential ones come from two organizations: the
studies of studies. A key strength of this approach is U.S. Preventive Services Task Force (USPSTF) and the
the ability to combine data from multiple studies to Cochrane Collaboration.
obtain a statistically stronger result. However, the • The USPSTF is an independent group of national
validity of the final conclusion still depends strongly experts who make treatment recommendations to
on the quality of the individual studies that go into primary care physicians based on strict methods
the meta-analysis—as the saying goes, “garbage in, and analyses of the available evidence.
garbage out.” Good meta-analyses attempt to include • The Cochrane Collaboration is a global network of
only well-conducted studies. Still, if the studies are health practitioners, researchers, patient advocates,
different from one another, the summary result may and others who publish comprehensive reviews of
be harder to interpret and generalize. scientific studies on a topic, both published and
Systematic reviews also combine multiple stud- unpublished, following a designated approach.
ies. They may or may not include meta-analyses of USPSTF recommendations and Cochrane reviews
data. (If they do, the title will specify “meta-analysis are influential because they offer a current progress
and systematic review.”) Researchers conduct system- report on what we know about a given health topic,
atic reviews by carefully defining a medical question based on the best evidence available. 

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 Cast of characters: From vitamin A to zinc

T his chapter features a broad overview of the best-

known vitamins and minerals. For each nutrient
described here, you’ll find the following information:
supplements is much less convincing. If you’re wor-
ried about lung cancer, for example, quitting smoking
will have a much greater impact on your health than
• The Recommended Dietary Allowance (RDA) or taking supplements.
adequate intake (AI) for people ages 19 and older Before taking a supplement that delivers more
(with sex and age differences noted when applica- than the recommended daily amount of any nutrient,
ble) and a brief description of the nutrient’s role in discuss your decision with your doctor. Your medical
the body. history, genetic profile, and medications may affect the
• A summary of the data linking the nutrient to pro- dosages and types of supplements you can safely take.
tection against various health problems. If a con-
dition is not listed, that means there is insufficient
evidence to support a connection. Vitamin A and carotenoids
• Recommendations about taking the nutrient in
RDA for men: 3,000 IU (900 mcg)
supplement form.
RDA for women: 2,333 IU (700 mcg)
• A table of selected food sources containing the
nutrient, with an emphasis on the best sources in “Eat your carrots, they’re good for your eyes!” This
commonly consumed foods. oft-heard advice is rooted in truth: carrots are rich
As a rule, your best strategy is to get vitamins and in beta carotene, which can be converted in the body
minerals from foods, not supplements. A vast amount into vitamin A. The most usable form of vitamin A,
of research has shown that you can cut your risk for retinol, is vital for the proper function of the retina,
chronic disease and disability by following a healthy the light-sensitive tissue lining the back of the eye. But
diet, as well as by exercising regularly, maintaining a that’s only one reason you need vitamin A (and should
healthy weight, and not smoking. The evidence for eat your carrots). In addition to its role in healthy
taking high-dose, individual vitamin and mineral vision, vitamin A aids bone growth and helps regulate
the body’s infection-fighting abilities.
Some of your vitamin A comes from compounds
like beta carotene that the body converts to vitamin A.
But most adults get far more of their vitamin A from
animal-based foods, including liver, milk, and eggs,
which contain preformed vitamin A. In addition, most
fat-free milk and dried nonfat milk solids are fortified
© minoandriani | Getty Images

with vitamin A to replace the amount lost when the

fat is removed. Many breakfast cereals are vitamin A–
fortified as well. According to the National Health and
Nutrition Examination Survey, a long-running study
of the health status of Americans, men and women
The best way to get your vitamins and minerals is from a healthy get slightly less than the amounts recommended, but
diet including fruits, vegetables, nuts, and fish. Supplements are an enough to serve their body’s needs.
adjunct to a healthy diet, not a replacement for nutritious food. Because vitamin A is a fat-soluble vitamin that’s

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 Selected food sources of vitamin A and cer because of smoking or exposure to asbestos, tak-
beta carotene* ing beta carotene supplements appears to increase the
chance of getting cancer. In one clinical trial, heavy
FOOD INTERNATIONAL UNITS (IU)
smokers took either a placebo or a daily supplement
Sweet potato, baked, flesh only, 34,600
1 large containing 30 mg of beta carotene plus 25,000 IU
Beef liver, pan-fried, 3 ounces 22,200
(7,500 mcg) of vitamin A. The planned six-year study
was stopped two years early because taking the sup-
Carrots, raw, chopped, 1 cup 21,400
plements, unexpectedly, had increased risk for lung
Spinach, frozen, boiled, ½ cup 11,500
cancer by 28%.
Cantaloupe, raw, balls, 1 cup 5,980 Subsequent trials in predominantly nonsmoking
Milk, nonfat, 1 cup, fortified 500 men and women did not find the same increase in
*Animal sources contain preformed vitamin A; plant sources contain beta carotene. risk, but instead found that taking supplements pre-
Source: USDA FoodData Central.
sented neither benefit nor risk for total and specific
types of cancer. Experts now advise people—espe-
stored in the body, it is possible to build up toxic lev- cially former and current smokers—not to take beta
els if you consume too much. It’s much less likely that carotene supplements for cancer prevention.
you’ll overdose on beta carotene, since the body slows
down the conversion to vitamin A when it already has Cardiovascular disease
enough. Beta carotene supplements do not reduce the risk of
Beta carotene is not the only natural substance developing cardiovascular disease. In one clinical
that the body can convert to vitamin A. It is just one trial—the Physicians’ Health Study, involving 22,071
in a large family of bioactive compounds known as male physicians in the United States—half of the par-
carotenoids. Found in many fruits and vegetables, ticipants were given beta carotene supplements and
carotenoids are yellow, orange, and red pigments that half were not. After 12 years of supplementation,
make carrots orange, for example, and tomatoes red. no differences between the two groups—positive or
Although more than 600 carotenoids have been iden- negative—emerged for heart attack, stroke, cancer,
tified, most nutrition research has focused on alpha or overall death rates. A two-year study of the effects
carotene, beta carotene, lycopene, lutein, zeaxanthin, of beta carotene supplementation on 39,876 women,
and beta cryptoxanthin. The carotenoids may con- who were healthy at the start of the trial, also found no
tribute to health in multiple ways. Alpha carotene and short-term benefit or harm related to cardiovascular
beta cryptoxanthin, for example, can be converted to disease, cancer, or death.
vitamin A in the body, just like beta carotene. These
are called provitamin A carotenoids. Many of the Eye diseases
carotenoids also appear to function as antioxidants. Healthy eyes depend on vitamin A as well as carot-
People in the United States obtain one-quarter to enoids that aren’t transformed into vitamin A. Lutein
one-third of their vitamin A from carotenoids—most and zeaxanthin are the only carotenoids found in the
commonly from carrots, cantaloupe, sweet potatoes, retina, the light-sensing layer of cells in the back of the
and spinach. There is no RDA for beta carotene or eye, where they are believed to help protect against
other carotenoids. damaging short wavelengths of light. Intake of spin-
ach and kale, two lutein-rich vegetables, has also been
Cancer linked to a moderately lower risk of cataracts (the
Epidemiological studies suggest that people who eat clouding of the normally clear lens of the eye).
foods rich in beta carotene and vitamin A are less The Age-Related Eye Disease Study (AREDS)
likely to develop many types of cancer, especially found that taking a dietary supplement, which
lung cancer. However, in people at risk for lung can- included beta carotene, slowed the progression of a

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retinal disease called age-related macular degenera- Recommendations
tion (AMD), a condition that leads to blurred, dis- • If you take a multivitamin, make sure most or all of
torted sight and blind spots in the visual field. In the the vitamin A comes in the form of beta carotene and
AREDS trial, researchers tested a formulation consist- not retinol or retinyl compounds (the preformed ver-
ing of vitamin C (500 mg), vitamin E (400 IU), beta sions of vitamin A). These can be toxic at high levels.
carotene (15 mg), copper (2 mg), and zinc (80 mg) • If you are taking a multivitamin to improve your
in 3,640 people ages 55 to 80 years old with varying eye health, look for a formulation that contains
stages of AMD. (Copper was added to the mix because amounts of vitamins C and E, zinc, copper, lutein,
high levels of zinc may cause copper deficiency.) and zeaxanthin similar to those found in the
While not a cure, the formulation slowed progression AREDS2 formulation.
to wet AMD (a more advanced from of the disease) by • Recommendations from the U.S. Preventive Ser-
about 25%. vices Task Force advise against the use of beta caro-
Some slightly altered formulations were tested in tene supplements to prevent either cardiovascular
the subsequent AREDS2 trial. Because taking beta disease or cancer.
carotene supplements may raise lung cancer risk
among smokers, the researchers replaced it with a
combination of lutein (10 mg) and zeaxanthin (2 mg). B vitamins
They also tested versions of the supplement mix that The B vitamins (see “The B list,” below left) perform
contained omega-3 fatty acids (1,000 mg), both with a wide range of important functions throughout the
and without the change in carotenoids. This time, the body, such as helping to convert food into energy and
results showed that lutein and zeaxanthin were a safe maintain the immune system, healthy skin, blood
and effective alternative to beta carotene for AMD, cells, the brain, and the nervous system. Many Ameri-
but omega-3s had no effect on eye health. In addi- cans, especially the elderly, don’t meet the RDAs for
tion, none of the formulations tested in the AREDS three B vitamins—B6, B9, and B12. These Bs have gar-
trials reduced the overall risk of developing cataracts nered the most attention from public health officials
or needing cataract surgery, except among people with and researchers, so we, too, will zero in on them.
very low lutein and zeaxanthin in their diets.
Vitamin B6 (pyridoxine)
RDA, ages 19 to 50: 1.3 mg
The B list
RDA for men, ages 51 and older: 1.7 mg
The B vitamins consist of eight distinct vitamins that help
RDA for women, ages 51 and older: 1.5 mg
cells function optimally:
• vitamin B1: thiamin
• vitamin B2: riboflavin Selected food sources of vitamin B6
• vitamin B3: niacin or nicotinic acid FOOD MILLIGRAMS (MG)
• vitamin B5: pantothenic acid Chickpeas, canned, 1 cup 1.1
• vitamin B6: pyridoxal, pyridoxine, pyridoxamine Beef liver, pan-fried, 3 ounces 0.9
• vitamin B7: biotin
Tuna, yellowfin, fresh, cooked, 3 ounces 0.9
• vitamin B9: folate, folic acid
Salmon, sockeye, cooked, 3 ounces 0.6
• vitamin B12: various cobalamins; commonly
cyanocobalamin in vitamin supplements. Chicken breast, roasted, 3 ounces 0.5

Missing from the list above are B4, B8, B10, and B11, which Breakfast cereal, fortified with 25% of the 0.4
were once thought to be important to human health, DV for vitamin B6, 1 serving
but were later discovered to be nonessential to humans. Banana, 1 medium 0.4
Therefore, they are no longer considered vitamins. Source: USDA FoodData Central.

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 Selected food sources of vitamin B9 Figure 3: H
 ow the new Nutrition Facts panel
MICROGRAMS OF
DIETARY FOLATE
lists folate
FOOD EQUIVALENTS (MCG DFE) Vitamin B9 — which
Beef liver, braised, 3 ounces 215 includes both
naturally occurring
Spinach, boiled, ½ cup 131
folate and
Black-eyed peas (cowpeas), boiled, 105 supplemental folic
½ cup
acid — is not one
Breakfast cereal, fortified with 25% of 100 of the vitamins
the DV for folic acid, 1 serving that manufacturers
Spaghetti, enriched, cooked, ½ cup 93 are required to list
on the Nutrition
Rice, white, medium-grain, cooked, 90
½ cup Facts panel, but
they can do so at
Asparagus, boiled, 4 spears 89
their discretion.
Brussels sprouts, frozen, boiled, ½ cup 78 When they do, the
Source: USDA FoodData Central.
FDA now requires
them to give the
total amount of
Your body needs vitamin B6 to break down pro- the vitamin (listed
tein and build red blood cells. This vitamin occurs under the single
naturally in a variety of foods, including meat, poultry, term folate) in mcg A
B
DFE, a standardized
fish, and some fruits and vegetables, and is added to
measure that takes
some fortified cereals. Most younger people meet the into account the
RDA for B6, but one survey showed that many peo- different properties
ple over 60 don’t: men got 1.2 mg daily instead of the of the two forms (A). The portion of that total that comes just
recommended 1.7 mg, and women got 1.0 mg daily from folic acid is then listed separately in mcg (B).
instead of 1.5 mg.
cornmeal, pastas, rice, and other grain products with
Vitamin B9 (folate, folic acid) folic acid. Since 1998, when the rule went into effect,
folic acid intake has risen substantially, and the inci-
RDA: 400 mcg DFE
dence of neural tube defects has fallen.
The terms folic acid and folate refer, respectively, to the A word about labeling: Because folic acid is
synthetic and natural forms of vitamin B9. In either absorbed into the body more quickly than folate, the
form, this nutrient plays a role in the synthesis, repair, FDA has replaced the old RDA of 400 mcg of folate
and function of DNA, the genetic material found in all with a new RDA of 400 micrograms of dietary folate
cells. Beef liver, leafy green vegetables, and dried beans equivalents (mcg DFE) that accounts for both in a
are good sources. Some Americans, including a fair single formula. It is this new measurement that is
number of women of childbearing age, don’t get enough now given on Nutrition Facts or Supplement Facts
of this vitamin. That’s worrisome, because having insuf- panels—if a manufacturer wants to include the infor-
ficient levels just before and during the early stages of mation, which is not required by law. If a product
pregnancy increases the risk of having a baby with a such as cereal contains both folate (from the grain)
neural tube defect—a serious malformation of the spine, and folic acid (from supplementation by the manu-
skull, or brain, such as spina bifida or anencephaly. facturer), the total is given in mcg DFE, and the
To address this concern, FDA regulations require amount that comes from folic acid is listed under-
food manufacturers to fortify breads, cereals, flours, neath in mcg (see Figure 3, above).

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Vitamin B12 (cyanocobalamin) stomach acid in order to absorb B12 from supplements
or fortified foods, you can avoid a deficiency by get-
RDA: 2.4 mcg
ting enough B12 from these sources. A B12 deficiency
Vitamin B12, which is required for proper brain func- can cause pernicious anemia (see Figure 4, below
tion and a host of chemical reactions within the body, left). This condition is usually treated with monthly
is found naturally only in animal foods such as fish, injections of B12.
meat, poultry, eggs, and milk. Many fortified cereals
contain a synthetic form. Vegans, who avoid all ani- Heart disease
mal-based foods, need to ensure they get enough of Starting in the mid-1980s, numerous studies noted
this vitamin through fortified foods or supplements. a link between an increased risk of cardiovascular
About 6% of people ages 60 and older are deficient in disease and high blood levels of homocysteine, an
vitamin B12, and nearly one in five is borderline defi- amino acid associated with inflammation of blood
cient. As you age, it often becomes harder to absorb vessels (including those that supply the heart and
enough B12 from food. This problem usually reflects brain). Many people with high homocysteine levels
reduced production of stomach acid, which liberates are deficient in vitamin B6, B9, or B12 or a combina-
B12 from food. But since your body doesn’t need this tion of these. Supplements with these vitamins can
reduce homocysteine levels within weeks, but this
does not reduce heart attacks or deaths from heart dis-
Figure 4: B12 deficiency and anemia ease, according to clinical trials. A 2017 review by the
Cochrane Collaboration of 15 clinical trials found no
evidence that lowering homocysteine with B vitamin
supplementation prevented heart attacks and strokes
or reduced the risk of dying during the various trials
included in the review.
Normal
red blood Cancer
cells
Understanding the relationship between cancer and
B vitamins—B9 in particular—has proved complex.
There’s evidence that people with low blood levels of
B9 are more prone to a variety of cancers, possibly
because B9 deficiency contributes to abnormal DNA
synthesis. Some observational studies have shown
Pernicious that people who consume more B9 in their diets are
anemia less likely to develop colon cancer. Other research has
linked greater consumption of B9 to a lower risk for
breast cancer, at least among women who drink alco-
hol and have low B9 levels.
However, randomized controlled trials have not
provided definitive evidence that taking folic acid
In rare cases, low vitamin B12 levels can cause pernicious anemia, a supplements prevents cancer. Most trials show either
condition in which the bone marrow produces red blood cells that no benefit or a small protective effect. And while ade-
are both larger and less numerous than normal. Symptoms can
quate amounts of folic acid supplements appear to
include yellowish skin, fatigue, shortness of breath, and headaches.
Numbness or tingling in the hands and feet and trouble keeping stifle the formation and spread of early tumors, too
balance are common. Confusion, depression, and memory loss can much may speed up the growth of existing tumors,
also occur and are sometimes chalked up to Alzheimer’s disease. especially in certain parts of the body. Some studies

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 have linked folic acid supplementation to a higher risk
B bonanza: Boon or bust?
of cancer of the colon, breast, or prostate.

Cognitive decline P resumably because of their role in helping cells

use energy, B vitamins are often added to energy
drinks and nutrition bars — sometimes in extremely high
Numerous studies have tested the theory that B vita-
amounts. An 8.4-ounce can of Red Bull, for example,
min supplements might protect the aging brain from contains 250% of the Daily Value* (DV) for vitamin B6.
the toxic effects of high homocysteine, an amino acid And a single 2-ounce bottle of 5-Hour Energy includes a
linked to inflammation of blood vessels. High homo- whopping 2,353% of the DV for vitamin B6 and 20,833%
cysteine in the blood—potentially caused by inad- of the DV for vitamin B12 — and the label even suggests
you can drink two bottles per day. Various brands of
equate B vitamin intake—has been linked to greater
bottled water, such as Vitaminwater, contain up to four B
risk for mental decline and Alzheimer’s disease. Since vitamins in amounts approaching 100% of the DV. These
B vitamins tend to lower homocysteine, does supple- megadoses do nothing to enhance any bodily functions,
menting with folic acid and other B vitamins prevent and because B vitamins are water-soluble, they’re not
cognitive decline and dementia? So far, research find- stored in the body, so any extra is excreted in the urine.
ings have been inconsistent. *As described on Nutrition Facts panels, percent Daily Values are based on a
2,000-calorie diet. Your needs may be higher or lower depending on your
In a combined systematic review and meta-analy- body size and activity level.
sis published in 2020, researchers analyzed data from
eight clinical trials that tested whether giving older
adults B vitamin supplements decreased the chance of Recommendations
later mental decline. The scientists found no evidence • For most people, the best source of RDA-appro-
that the supplements made a difference, although it’s priate levels of B vitamins is a reasonably balanced
well established that adequate levels of B vitamins sup- diet, combined with a multivitamin-multimineral
port the healthy functioning of the nervous system. supplement if there are broader concerns about an
So far, the long-term picture remains unclear. You overall healthy diet. Be wary of energy drinks and
may need to take B vitamin sup- bars that may provide more B vitamins than neces-
plements if you have trouble sary (see “B bonanza: Boon or bust?” above).
getting enough through • Vitamin B6: Avoid supplements that contain more
your diet, but otherwise than the RDA for this vitamin, as too much can
they do not have any proven harm the nerves. Though the body eventually
benefit for brain health. excretes what it doesn’t need, the danger thresh-
old varies from one individual to the next, and the
excess can cause damage before it leaves the body.
© bonchan | Getty Images

Selected food sources of vitamin B12

• Vitamin B9: Beware of getting too much of this
FOOD MICROGRAMS (MCG)
micronutrient from supplements and fortified
Clams, cooked, 3 ounces 84.1
foods. Most multivitamins contain 400 mcg DFE,
Beef liver, pan-fried, 3 ounces 70.6 but many fortified breakfast cereals also contain
Trout, rainbow, wild, cooked, 3 ounces 5.4 that much. Add a few other enriched grain prod-
Salmon, sockeye, cooked, 3 ounces 4.5 ucts and you could be over your daily limit. If you
Tuna fish, light, canned in water, 3 ounces 2.5 take a daily multivitamin, avoid foods fortified with
Breakfast cereal, fortified with 100% of 2.4 300 to 400 mcg DFE of folic acid.
the DV for vitamin B12, 1 serving • Vitamin B12: Vegans, who avoid all animal-based
Cheeseburger, double patty, with 2.0 foods, and elderly people, who may have trouble
condiments, 1 sandwich
absorbing vitamin B12 from food, should consider
Milk, low-fat, 1 cup 1.2
eating a vitamin B12–fortified breakfast cereal or
Source: USDA FoodData Central.
taking a supplement.

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Vitamin C Selected food sources of vitamin C
RDA for men: 90 mg FOOD MILLIGRAMS (MG)
RDA for women: 75 mg Red sweet pepper, raw, chopped, ½ cup 95
Smokers: add 35 mg Grapefruit juice, ¾ cup 70
In the body, vitamin C is crucial for making collagen, Orange juice, ¾ cup 68
which lends structural support to tendons, ligaments, Orange, 1 medium 68
bones, and blood vessels. This vitamin is also a potent Kiwifruit, 1 medium 64
antioxidant, which is why smokers, who are exposed Green sweet pepper, raw, chopped, ½ cup 60
to more free radicals, are advised to consume extra
Broccoli, cooked, ½ cup 51
vitamin C (see “Antioxidants,” page 36). Most people
Source: USDA FoodData Central.
meet the RDA via their diets. Citrus fruits are rich
in vitamin C, but a small red sweet pepper contains
roughly a third more than a medium-sized orange. Study II, which followed 14,641 men
who took 500 mg of vitamin C
Upper respiratory infections daily for a decade, found no
Vitamin C is perhaps best known for claims that it difference in the number
can prevent and treat the common cold—an idea first of heart attacks, strokes,
promoted in the 1970s by Nobel laureate Linus Paul- or deaths from cardiovas-
ing. But the evidence for this has come up short. A cular disease compared with
major Cochrane Collaboration review found no con- men who took placebos. Results were similar in the

© bergamont | Getty Images

clusive proof that taking 200 mg or more of vitamin C Women’s Antioxidant Cardiovascular Study (WACS),
daily made the common cold less common, although which included 8,171 female health professionals with
it may slightly shorten the duration of symptoms. a history of cardiovascular disease or several risk fac-
Many experts who insist on the cold-defying power of tors for it. Women who took 500 mg of vitamin C per
vitamin C state that even higher amounts are needed day, along with 600 IU of vitamin E and 50 mg of beta
to achieve this effect. However, so far there is no evi- carotene every other day, did not see any decrease in
dence from randomized controlled trials to support cardiovascular events during nine years of follow-up.
this assertion.
Eye diseases
High blood pressure and heart disease Vitamin C is an antioxidant (see “Antioxidants:
Vitamin C supplements might have a modest effect Beyond the hype,” page 36), and in the eye, it is
on blood pressure, according to a meta-analysis of thought to help protect against damage from free rad-
data from 29 small randomized controlled trials that icals generated by exposure to sunlight. Over time,
compared vitamin C against a placebo. Research- too much sun exposure can lead to cataracts and
ers found that people who were given a median dose increase the risk of age-related macular degeneration
of 500 mg per day of supplemental vitamin C had a (AMD), both of which can severely impair vision.
drop in systolic blood pressure of 3.8 millimeters of Eating plenty of antioxidant-rich fruits and veg-
mercury (mm Hg) over the short term. Among par- etables seems to make people less likely to develop
ticipants who had a diagnosis of high blood pressure cataracts. The role of supplements is less clear. One
(hypertension), the drop appeared to be greater, at observational study found that people who con-
nearly 5 mm Hg. sume about eight to 10 times the RDA of vitamin C,
However, there is little evidence that vitamin C through both foods and supplements, were less likely
lowers the risk of heart disease, despite preliminary to develop cataracts than people who consumed the
research hinting that it might. The Physicians’ Health RDA. However, a Cochrane Collaboration review of

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nine clinical trials—involving 117,272 people ages 35 typically fortified with vitamin D and contain only
or older—found no evidence that taking antioxidant small amounts. Some brands of yogurt are fortified,
supplements containing beta carotene or vitamins C and so are some juices and breakfast cereals. For older
or E at levels above the RDA prevented cataracts. adults to meet the RDA of 800 IU, they would have to
As for AMD, vitamin C is included in the dietary drink at least a quart of fortified milk per day.
supplement that was shown in the AREDS and AREDS2 Fortunately, food is not the only source of vitamin
trials to prevent progression of AMD to its most dam- D. Exposing your skin to sunshine—more specifi-
aging form (see “Eye diseases,” page 17). But taking cally, ultraviolet B (UVB) rays—enables the body to
vitamin C supplements has not been demonstrated to make vitamin D, which is why it’s also known as the
lower the chance of developing AMD over all. “sunshine vitamin.” Most of us aren’t getting nearly as
much as our ancestors did, however.
Recommendation Humans first evolved near the equator in Africa,
• A healthy diet supplies the vitamin C you require. where the sun shines directly overhead for much of
Taking vitamin C supplements in amounts sub- the year. They wore little or no clothing and therefore
stantially higher than the RDA offers no apparent probably produced tens of thousands of IU of vita-
health benefits but is probably harmless. min D each day. Heavy pigmentation protected the
deeper layers of their skin from sun-induced damage.
As some groups of humans migrated away from the
Vitamin D equator, they developed lighter skin, which enabled
faster vitamin D production in conditions with less
RDA, ages 1 to 70: 600 IU (15 mcg)
direct sunshine.
RDA, ages 71 and older: 800 IU (20 mcg)
However, since then, our habits have changed,
This fat-soluble vitamin is unique because its primary leading to less sun exposure. For centuries, people typ-
natural source is sunlight, not food. In fact, it’s found ically spent plenty of time outdoors during much of
naturally in only a few foods. What’s more, fatty fish, the year. But in the last 300 years, more people began
the leading food source of vitamin D, isn’t something working indoors, and in the last 100 years, began rid-
most Americans eat daily. Milk, which doesn’t natu- ing in cars and greatly reduced their daily time out-
rally contain vitamin D, has been fortified with it since side. All of this reduced the amount of vitamin D their
the 1930s to help fill the gap; however, dairy products bodies naturally produced.
made from milk (such as cheese and ice cream) aren’t In the past few decades, putting on sunscreen
before heading outdoors has also become more com-
Selected food sources of vitamin D mon. In sharp contrast to the trend favoring the
FOOD INTERNATIONAL UNITS (IU)
“healthy tan” in the mid-20th century, many Ameri-
cans now intentionally avoid the sun in order to pre-
Cod liver oil, 1 tablespoon 1,360
vent skin cancer—a valid concern, given that UV
Salmon (sockeye), cooked, 3 ounces 570
radiation is an established risk factor for most of the
Swordfish, cooked, 3 ounces 566
estimated 3.5 million skin cancers that occur each year
Yogurt, fortified with 15% of the DV 120 in the United States. But it also lessens the amount of
for vitamin D, 6 ounces
vitamin D produced in the skin.
Milk, nonfat, calcium fortified, 1 cup 116
Where you live, the season of the year, and the
Orange juice, fortified, ¾ cup 79 time of day are also factors. The sun’s rays are most
Tuna fish, white, canned in water, 68 direct between 10 a.m. and 3 p.m. However, the far-
drained, 3 ounces
ther you live from the equator, the less UVB radiation
Egg, 1 large 50
you receive, and it is UVB that prompts your body to
Source: USDA FoodData Central.
produce vitamin D. People who live north of about 37°

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latitude (imagine a line extending from San Francisco, All of these changes mean that some of us may
Calif., to Richmond, Va.) make little if any vitamin D be getting less vitamin D than our bodies need. How-
from sunlight from November to March, even if they ever, true vitamin D deficiency—a level low enough to
stay outside all day. This phenomenon has to do with cause the bone disease rickets—is far less common in
the angle of the sunlight: during the winter months, the United States than vitamin D insufficiency, mean-
the northern hemisphere tilts away from the sun, ing a blood level that falls below the normal range (see
increasing the angle at which the sun’s light reaches “How much vitamin D do you need?” below). It is easy
North America. When this happens, more UVB radia- to make up shortfalls through supplements, food, and
tion is absorbed by the ozone layer, lessening or elimi- modest sun exposure (see “Recommendations,” page
nating the amount that can reach a person’s skin. 26, and “Selected food sources of vitamin D,” page 23).

How much vitamin D do you need?

D espite widespread assertions in the popular and

scientific press that many Americans are deficient in
vitamin D, the term “deficiency” isn’t strictly accurate. The
Based on the evidence for bone benefits, however, the IOM
panel increased the RDA for vitamin D to 600 IU for people
up to age 70 and to 800 IU for those over 70. That’s a fairly
official definition of a vitamin deficiency means that specific sizable boost over the previous recommendations of 200 IU
health problems stem solely from the lack of (or inability to per day through age 50, 400 IU for ages 51 to 70, and 600
use) a specific nutrient. An actual deficiency of vitamin D IU for ages over 70. The IOM also raised the safe upper limit
results in the bone disease known as rickets, which is rare of daily intake for most age groups from 2,000 to 4,000 IU.
in the United States.
But ultimately, the amount of vitamin D that makes it into
On the other hand, lower-than-optimal levels of certain your bloodstream — whether from food, supplements, or
vitamins, including vitamin D, may increase your risk of sun exposure — is likely more important than how much
numerous health problems, even though they are not solely you’re consuming. There again controversy reigns. While
responsible for these problems. “Insufficiency” may be a some people argue for much higher levels, the IOM report
better term for these lower levels. concluded that vitamin D blood levels above 20 ng/ml are
adequate for maintaining healthy bones, and that most
The most clearly established benefit of vitamin D is that
people in the United States have values in that range.
it helps the body absorb calcium and therefore promotes
healthy bones. However, beginning in the 1980s, a steady Other organizations, including the American Association
drumbeat of studies produced findings linking low blood of Clinical Endocrinologists, assert that values between 30
levels of D with a variety of chronic health problems, and 50 ng/ml have potential health benefits beyond bone
leading some researchers to argue that the RDA for D was health, so the issue is still not resolved. However, the IOM
way too low. The confusion and controversy surrounding report cautioned that exceptionally high levels of vitamin
optimal vitamin D intake and blood values prompted the D have not been proven to confer additional benefits and
U.S. and Canadian governments to request that the Institute have been linked to health problems, challenging the
of Medicine (IOM, now called the Health and Medicine notion that “more is better.”
Division of the National Academies of Sciences, Engineering,
Most healthy adults without
and Medicine) review the evidence
symptoms related to vitamin D
on vitamin D and calcium and
deficiency do not need to have
update the RDAs.
their blood levels measured.
The long-awaited report, Dietary People who should consider
Reference Intakes for Calcium and vitamin D testing are those with
Vitamin D, was published in 2011. medical conditions that affect fat
The IOM concluded that evidence absorption (including weight-
for benefits other than improved loss surgery) and people who
bone health came from studies that Vitamin D helps the body absorb calcium, making routinely take anticonvulsant
could not be considered reliable it an important part of any strategy to keep bones medications, glucocorticoids, or
and provided often-conflicting strong (above left). This can help prevent the bone- other drugs that interfere with
results. thinning disease osteoporosis (above right). vitamin D activity.

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Forms of vitamin D Preventing falls
Vitamin D comes in two forms: D3 (cholecalciferol) In addition to strengthening bones, vitamin D supple-
and D2 (ergocalciferol). D3, the form made naturally mentation could hypothetically reduce the risk of fall-
by the body in response to sunlight, is also the form ing and, hence, of suffering fractures. Low blood levels
most often used to fortify milk and other foods, such of D have been linked to muscle weakness and poorer
as breakfast cereals. D2 is made from plant material. muscle function, both of which make falls more likely.
Vitamin supplements contain either D3 or D2. If you However, a 2018 review of 20 clinical trials by the
take supplements, some experts recommend choos- USPSTF found insufficient evidence to recommend
ing one that contains D3. However, a definitive gov- that adults over age 65 take vitamin D to prevent falls,
ernment analysis (see “How much vitamin D do you unless they already have osteoporosis or low vitamin
need?” on page 24) concluded that D2 is just as effec- D levels. By contrast, the review found clear evidence
tive as D3 at the recommended dosage levels. that regular exercise reduces falls and fall-related
injuries.
Osteoporosis and fractures
One of vitamin D’s most important and best-known Cardiovascular disease and high blood pressure
roles is to signal the intestines to absorb calcium into Observational studies have linked low vitamin D lev-
the bloodstream. Without sufficient vitamin D, your els to a higher risk for cardiovascular disease or high
body will break down bone to get the calcium it needs, blood pressure. However, more rigorous studies have
no matter how much calcium you consume. Thus, the failed to substantiate this connection. Two large ran-
goal of ensuring adequate intake of both calcium and domized controlled trials of vitamin D supplementa-
vitamin D is to prevent the bone-thinning disease tion at comparatively low doses of 400 IU—including
osteoporosis and the fractures that can result from it. one that was part of the large Women’s Health Initia-
Many older adults take daily vitamin D and cal- tive—showed no benefit in reducing the likelihood of
cium supplements for this purpose. But does it work? heart disease or stroke. Even very large doses (an ini-
It depends on your age, your overall risk for fractures, tial dose of 200,000 IU, followed by 100,000 IU taken
and the amounts of vitamin D and calcium you take, orally once a month) failed to reduce cardiovascular
according to a 2018 systematic review of clinical trials risk more than a placebo in a three-year randomized
by the U.S. Preventive Services Task Force (USPSTF). controlled trial published in JAMA Cardiology.
The organization reviewed 11 clinical trials of supple- A 2019 meta-analysis combined data from 21
mentation with vitamin D and calcium for 51,419 randomized controlled trials involving older adults
adults over 50 living independently (as opposed to (average age 66) who received either vitamin D supple-
residing in assisted living or full-time nursing facili- ments over a wide range of doses or a placebo. In the
ties). The USPSTF review found insufficient evidence end, taking vitamin D did not reduce the risk of major
to determine the balance of risks and benefits of tak- cardiovascular problems such as heart attack or stroke,
ing vitamin D and calcium supplements to prevent heart-related death, or death regardless of cause.
fractures at the amounts older adults are generally Observational studies have also linked low vita-
advised to take: 600 to 800 IU of vitamin D, and 1,000 min D levels to high blood pressure, a major risk
to 1,200 mg of calcium. factor for heart attacks, heart failure, and stroke. How-
This doesn’t mean that you should stop taking ever, a review of 46 clinical trials involving 4,541 par-
vitamin D. But it does suggest that supplements may ticipants found that vitamin D supplements were not
not always deliver the benefits you hope for—at least effective for controlling blood pressure.
in the generally recommended amounts. You and your
doctor may feel that it’s prudent to follow the general Cancer
guidelines, even if the current clinical trial evidence Higher blood levels of vitamin D are linked to a
has some soft spots or gaps. lower risk of colon cancer in observational studies—

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although most of the differences in blood vitamin D feasible and you don’t consume much vitamin D
levels were related to sunlight exposure, not dietary in your diet, then consider a daily multivitamin
intake from food or supplements. or separate supplement to meet the recommended
Randomized trials, however, have yet to find ben- dietary intake of 600 to 800 IU per day. (Many mul-
efits for vitamin D supplementation when it comes to tivitamins now contain 1,000 IU.)
cancer risk. For instance, one trial that examined vita- • If you do take more than 1,000 IU daily in the form
min D and calcium supplementation over four years of oral supplements, be sure to stay well below the
in relation to the incidence of cancer in older women safe upper limit of 4,000 IU. The potential benefits
found the combination didn’t significantly lower the of higher amounts remain controversial.
risk of cancer. And re-analysis of data from the Vita- • At all costs, avoid indoor tanning. The Skin Cancer
min D Assessment (VIDA) trial, which was conducted Foundation calls it “a proven human carcinogen.”
in New Zealand, also found no protective benefit
against cancer from consuming high doses of vitamin
D once a month for four years. Vitamin E
A large trial called VITAL (the Vitamin D and
RDA: 22 IU (15 mg)
Omega-3 Trial) was primarily designed to find out if
vitamin D and omega-3 fatty acid supplements pre- Your body needs vitamin E. It acts as an antioxidant
vent cardiovascular disease, but also checked to see if and plays a role in immune function and blood clotting.
the supplements reduced the risk of invasive cancer of But you probably don’t need a lot of it. Multiple studies
any kind (including colon cancer). The trial included and clinical trials have shown no beneficial effects from
25,871 participants over 50 years old. They were ran- vitamin E supplements for heart disease, cancer, or
domly assigned to one of four groups—taking 2,000 IU cognitive decline (see “Mind and memory,” page 27),
of vitamin D, 1,000 mg of fish oil, both supplements, making a strong case for avoiding these amber-colored
or placebos. In the end, vitamin D supplementation capsules altogether. Also, there is a hypothetical risk for
did not lower the risk of developing breast, prostate, or bleeding associated with very large amounts of supple-
colorectal cancers (though there was a hint of an over- mental vitamin E, so if you do take supplements, stay
all reduction in cancer deaths). Nor did omega-3 fatty well below the safe upper limit of 1,500 IU per day.
acid supplements protect against these cancers. Vitamin E exists in eight different chemical forms in
plants. Alpha tocopherol is the most biologically active
Recommendations and second most available form of vitamin E in the diet,
• When possible, get your vitamin D from foods and whereas gamma tocopherol is the most common dietary
from modest sun exposure, making sure to avoid a form of vitamin E but is not as biologically active.
sunburn. (According to the Skin Cancer Founda- Nuts, seeds, and vegetable oils (as well as salad
tion, just five sunburns in your lifetime are enough dressings and margarines made from these oils) are the
to double your risk for melanoma.) Generally, five to
10 minutes of sun exposure on some or most days to
Selected food sources of vitamin E
the arms, legs, or back without sunscreen will enable
FOOD MILLIGRAMS (MG)
you to make enough of the vitamin without over-
doing your exposure. If you live north of the 37th Wheat germ oil, 1 tablespoon 20.3
parallel, which broadly cuts the United States in half Sunflower seeds, dry roasted, 1 ounce 7.4
horizontally, you can only get adequate sun expo- Almonds, dry roasted, 1 ounce 6.8
sure to make vitamin D during the summer months. Sunflower oil, 1 tablespoon 5.6
If you live south of it, the sun is strong enough for
Safflower oil, 1 tablespoon 4.6
this purpose almost year-round.
Source: USDA FoodData Central.
• If getting enough sun-generated vitamin D is not

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 these and other findings, the USPSTF recommends
against taking vitamin E supplements to prevent car-
diovascular disease.

Cancer
Some observational studies have linked higher vitamin
© alexxx1981 | Getty Images

E intake with lower risks of breast and prostate can-

cers. However, a series of major clinical trials failed to
find an anti-cancer benefit to vitamin E supplements.
These included the Alpha-Tocopherol, Beta-Carotene
Sunflower seeds and oil are among the best sources of vitamin E. Cancer Prevention (ATBC) Study, the HOPE-TOO
Your body needs vitamin E for immune function and blood clotting, trial, the Physicians Health Study II, and the Women’s
as well as its role as an antioxidant. Health Study.
One major trial actually found that vitamin E
best food sources of vitamin E. The National Health supplementation slightly increased the risk of cancer.
and Nutrition Examination Survey suggests that most The Selenium and Vitamin E Cancer Prevention Trial
Americans don’t get the RDA for vitamin E, but these (SELECT) was designed to test whether 200 mcg of
estimates likely underestimate actual intake because selenium and 400 IU of vitamin E, taken alone or in
people typically don’t recall how much fat (often vege- combination, could lower the risk of prostate cancer
table oils) they add during cooking or don’t know how in nearly 35,000 men. Contrary to expectations, the
much is in the prepared foods they consume. fewest cases of prostate cancer occurred in the pla-
cebo group. For this reason, the USPSTF recommends
Heart disease against taking vitamin E supplements for the purpose
As is the case with many vitamins, observational stud- of preventing cancer.
ies provided the first suggestion of a potential ben-
efit—in this case, that people with higher vitamin E Mind and memory
intakes were less likely to develop heart disease. But Despite some promising early suggestions that large
multiple clinical trials have failed to show that vitamin amounts of vitamin E might slow the progression of
E supplementation can help to reduce the burden of Alzheimer’s disease, later research provided mixed
cardiovascular disease. results. A 2017 Cochrane review found only one mod-
For example, the HOPE-TOO (Heart Outcomes erately strong study suggesting that vitamin E slows
Prevention Evaluation—The Ongoing Outcomes) functional decline in people with Alzheimer’s. And
trial included almost 4,000 people, ages 55 and older, the review found no evidence that large amounts slow
with vascular disease or diabetes. Half were randomly the progression of disease from mild cognitive impair-
selected to take 400 IU of vitamin E daily, and the oth- ment (MCI) to full-blown dementia or improve men-
ers to take a placebo. After seven years, vitamin E had tal functioning in people with either MCI or dementia.
not provided any more protection against heart dis- That said, it is common for doctors to offer treatment
ease or cancer than the placebo. In addition, the vita- with daily amounts of up to 2,000 IU of vitamin E for
min E takers were more likely to have developed heart mild to moderate dementia based on the possibility
failure and to have been hospitalized for it. that it may help and the overall lack of effective treat-
Similarly, the Physicians’ Health Study II found no ments for dementia at present.
benefit from 400 IU of vitamin E taken every other
day for preventing heart disease, stroke, or death from Eye diseases
heart disease. In fact, vitamin E appeared to increase People whose diets include about 30 IU of vitamin E
the risk of bleeding (hemorrhagic) stroke. Based on daily—well over the recommended daily amount—

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appear to have about a 20% lower risk of developing the drug interferes with the way vitamin K helps pro-
age-related macular degeneration (AMD), a leading duce clotting proteins. The more vitamin K you con-
cause of vision loss in people over 60, compared with sume, the more warfarin you need in order to reach
people who get less than the RDA, according to obser- the desired anti-clotting levels.
vational studies. However, in the Physicians’ Health
Study II, long-term alternate-day use of vitamin E Fractures
alone or in combination with daily vitamin C had no A limited number of observational studies have
appreciable effect on the risk of either AMD or cata- looked for links between low vitamin K and the risk of
racts. And in the SELECT trial, long-term daily sup- bone fractures. Some studies, but not all, have found
plementation with either vitamin E or selenium alone a connection. In a meta-analysis combining data from
or in combination did not prevent cataracts. five large prospective studies involving 80,962 par-
That said, vitamin E does play an important role ticipants, people with the highest levels of vitamin
in AMD care. The AREDS and AREDS2 studies found K in their systems had a 22% lower risk of fractures
that a nutritional supplement containing 400 IU of than people with the lowest levels. However, this isn’t
vitamin E and other nutrients slowed the progression strong enough evidence to justify boosting your vita-
from moderate to advanced AMD by about 25%. How- min K levels with supplements in hopes of improving
ever, neither trial found that the supplements reduced bone strength or preventing fractures.
the risk of cataracts or stalled their progression.
Recommendations
Recommendations • Try to meet your daily requirement for vitamin K
• Do not take vitamin E supplements in hopes of pre- from the foods you eat.
venting heart disease, cancer, cataracts, or AMD • If you take warfarin and a multivitamin, check to
(although vitamin E plays a role in treatment for see if the multivitamin contains vitamin K, which
people who already have AMD). is found in some preparations in amounts ranging
• If you take a multivitamin, make sure it does not from 10 mcg to 80 mcg. For people who usually
contain more than 100 to 200 IU of vitamin E. get a fair amount of vitamin K from food, the extra
vitamin K found in a multivitamin is probably not
enough to affect your daily warfarin requirement.
Vitamin K But if you get little or no vitamin K in your diet,
even a small amount (25 mcg) could upset the bal-
AI for men: 120 mcg
ance between vitamin K and warfarin and require
AI for women: 90 mcg
a higher daily dose of the drug. Consult your clini-
This relatively unknown vitamin got its name from cian for more detailed advice.
koagulation, the German word for coagulation (blood
clotting), because vitamin K is necessary for that pro- Selected food sources of vitamin K
cess. Vitamin K also plays an important role in bone
FOOD MICROGRAMS (MCG)
remodeling (the body’s continual process of renewing
Collards, frozen, boiled, ½ cup 530
bone tissue). Moreover, vitamin K helps regulate the
Turnip greens, frozen, boiled, ½ cup 426
body’s excretion of calcium in urine.
Spinach, raw, 1 cup 145
Vitamin K is found in green leafy vegetables, soy-
Kale, raw, 1 cup 82
beans, and commonly used cooking oils. People who
Broccoli, chopped, boiled, ½ cup 81
shy away from salads and other greens may be low in
Soybeans, roasted, ½ cup 43
this vitamin. If you take the blood-thinning medica-
tion warfarin (Coumadin), it’s important to keep your Edamame, frozen, prepared, ½ cup 21
Source: USDA FoodData Central.
vitamin K intake about the same every day, because

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 Calcium Selected food sources of calcium
RDA for men, ages 19 to 70: 1,000 mg FOOD MILLIGRAMS (MG)
RDA for men, ages 71 and older: 1,200 mg Yogurt, plain, low-fat, 1 cup 415
RDA for women, ages 19 to 50: 1,000 mg Mozzarella, part skim, 1.5 ounces 333
RDA for women, ages 51 and older: 1,200 mg
Milk, nonfat, 1 cup 316
Mention calcium, and most people think of bones. It’s Soymilk, calcium fortified, 1 cup 301
true that calcium builds strong bones and teeth, but Orange juice, calcium fortified, ¾ cup 274
it also helps muscles to contract, blood to clot, and Tofu, soft, made with calcium sulfate, ½ cup 138
nerves to send signals to one another.
Turnip greens, fresh, boiled, ½ cup 99
People who eat a couple of servings a day of dairy
Source: USDA FoodData Central.
products along with some fruits and vegetables prob-
ably get close to the RDA of this common mineral.
Still, doctors often advise women to take calcium and tures in otherwise healthy adults. (For
vitamin D supplements to prevent osteoporosis—the more information, see “Osteoporosis
bone-weakening disease that is a common cause of and fractures,” and “Preventing falls,”
© fcafotodigital | Getty Images

fractures and is far more prevalent among women both on page 25.)
than men.
The IOM’s 2011 report Dietary Reference Intakes High blood pressure
for Calcium and Vitamin D found that most people get and heart disease
adequate amounts, with the exception of girls ages 9 Some research suggests
to 18, who have higher requirements for this mineral. a low calcium intake may contribute to high blood
The report also concluded that some postmenopausal pressure (hypertension), but calcium’s exact role is
women who take calcium supplements to protect unknown. One theory holds that a lack of calcium
against osteoporosis might be getting too much. in the diet predisposes your body to retain sodium,
Some experts believe that the RDAs for calcium which raises blood pressure. For this reason, it may
may be higher than necessary, given that very high be especially important that salt-sensitive people with
calcium intake from supplements doesn’t necessar- high blood pressure get enough calcium. (Nearly half
ily protect against major fractures. Some studies have of all people with high blood pressure are salt-sensi-
also linked supplemental calcium to a higher risk for tive, meaning their blood pressure rises in relation to
prostate cancer. the amount of salt in their diet.)
Efforts to control blood pressure with calcium
Fractures supplements have had mixed results. Studies found
Although calcium is clearly important for sturdy that calcium supplements successfully reduced blood
bones, evidence that a high calcium intake can prevent pressure in pregnant women with elevated blood pres-
fractures isn’t as strong you might think. For exam- sure. But clinical trials involving people with essential
ple, observational results from the Physicians’ Health hypertension (that is, hypertension with no known
Study and Nurses’ Health Study showed that people cause) have been largely disappointing. For most peo-
with low milk intake (one glass or less per week) were ple, calcium supplements either made no difference
no more likely to break a hip or forearm than people or reduced blood pressure only slightly—by an aver-
who drank two or more glasses per week. age of 1 to 2 mm Hg for systolic blood pressure (the
The USPSTF has concluded, based on a system- first and higher number in a blood pressure reading).
atic review of relevant clinical trials, that there is not Although some people taking the supplements experi-
enough evidence to say whether calcium and vitamin enced larger reductions in blood pressure, there seems
D supplements taken together can prevent bone frac- to be no common denominator, such as race or sex,

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among those who achieved such improvements. eat other dairy and calcium-rich foods—you may
Most importantly, calcium supplements have want to consider a supplement at a lower amount,
raised the risk for heart attacks in some randomized although the evidence that this actually prevents
trials. A meta-analysis of nine randomized controlled fractures is not strong.
trials suggested that people who were assigned to take • If you take calcium carbonate supplements, which
calcium supplements had about a 25% higher risk of include antacid pills like Tums and Rolaids, take
heart attacks, compared with those taking a placebo. them just after a meal, since they require stomach
acid to be absorbed.
Cancer • Calcium citrate isn’t as dependent on stomach acid,
Many observational studies show that people whose so it can be taken any time. Calcium citrate is pre-
diets are rich in calcium and dairy products tend to ferred if you take medications that reduce stom-
have a lower risk of colon cancer. Less certain are find- ach acid—for instance, esomeprazole (Nexium),
ings that suggest some protective effect against lung lansoprazole (Prevacid), omeprazole (Prilosec), or
and breast cancers. And some observational studies cimetidine (Tagamet).
have linked calcium and dairy intake to higher risks of • The body can absorb only about 500 to 600 mg of
ovarian cancer and prostate cancer. For example, data calcium at a time, so divide your dose if you take
from the Health Professionals Follow-up Study showed more than that amount.
that men who got more than 2,000 mg of dietary cal-
cium a day were almost three times as likely to develop
advanced prostate cancer as men who got less than Magnesium
500 mg of dietary calcium a day. The Nurses’ Health
RDA for men, ages 19 to 30: 400 mg
Study investigators noted that milk, which is a major
RDA for men, ages 31 and older: 420 mg
source of calcium, might contain another substance
RDA for women, ages 19 to 30: 310 mg
that raises ovarian cancer risk. The risk, if it is real, is
RDA for women, ages 31 and older: 320 mg
probably not caused by calcium itself—since calcium
supplements seem safe for women—but by the high If you eat whole-grain bread and your tap water is
levels of natural hormones or lactose found in milk. “hard”—meaning it contains relatively high levels of
minerals—you probably consume
Kidney stones more magnesium than a per-
The Women’s Health Initiative included a randomized son who favors white bread
clinical trial of calcium and vitamin D supplements and drinks “soft” water. Why?
among more than 36,000 postmenopausal women The refining process used to make
ages 50 to 79. For seven years, half the women took white flour strips away the mag-
daily doses of 1,000 mg of calcium carbonate and 400
IU of vitamin D3, and half took a placebo. Among Selected food sources of magnesium © rimglow | Getty Images
the women taking active pills, 449 developed kid- FOOD MILLIGRAMS (MG)
ney stones, compared with only 381 in the placebo Almonds, dry roasted, 1 ounce 80
group—an increased risk of 17%.
Spinach, boiled, ½ cup 78
Cashews, dry roasted, 1 ounce 74
Recommendations
Cereal, shredded wheat biscuits, 2 large 61
• Since calcium supplements may increase the risk of
Soymilk, plain or vanilla, 1 cup 61
heart attacks, kidney stones, and (in men) prostate
Peanut butter, smooth, 2 tablespoons 54
cancer, try to get adequate calcium from your diet.
• If you aren’t meeting the recommended intake Edamame, shelled, cooked, ½ cup 50
Source: USDA FoodData Central.
of calcium—say, because you don’t drink milk or

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nesium-rich germ and bran of the wheat, along with
several other nutrients (see Figure 5, at right). And Figure 5: The grain drain
hard water, which is more common in the Midwest-
ern and Southwestern states, contains more magne-
sium than soft water. Magnesium is also found in nuts, Refined wheat flour Whole wheat

legumes (beans and peas), and seeds, as well as many Vitamin E

vegetables. Vitamin B6
Many American adults don’t get recommended Magnesium

amounts of magnesium, which is key for proper mus- Riboflavin

cle, nerve, and immune function. Magnesium also Niacin

plays a role in maintaining normal blood sugar and Fiber

Zinc
blood pressure.
Potassium

Iron
Diabetes
Copper
Magnesium may influence the release and control of Selenium
insulin, the hormone that regulates blood sugar levels. Vitamin B12
People with type 2 diabetes (the most common form Folate
of the disease) have high blood sugar levels because 0 20 40 60   80 100%

their bodies have become resistant to insulin or are

not producing enough insulin. They also frequently
Important nutrients disappear when whole wheat or other grains
have low magnesium levels. In observational studies are refined. As this baker’s dozen shows, the losses can be dramatic.
such as the Nurses’ Health Study and Health Profes- For example, refined wheat flour has only 5% of the vitamin E of
sionals Follow-up Study, researchers found a higher whole-wheat flour and roughly 10% of the B6.
incidence of type 2 diabetes among men and women
with low magnesium intakes. sure. The analysis found that magnesium supplements
Does this mean taking magnesium supplements at a median amount of 368 mg per day for a median
could help people with diabetes control their blood duration of three months lowered blood pressure by
sugar better? Randomized controlled trials of mag- roughly 2 mm Hg for both systolic and diastolic pres-
nesium supplementation have yielded conflicting sure, compared with a placebo. In early 2022, the FDA
results. One, which tested high-dose (300-mg) liq- approved a qualified health claim for magnesium,
uid magnesium supplements in people with diabetes allowing manufacturers to say that there is some evi-
and low initial magnesium levels, suggested the min- dence that magnesium may reduce the risk of high
eral helps improve blood sugar control. But another, blood pressure, although the evidence is inconsistent.
which tested even higher doses (600 mg), showed no There are other problems associated with low
such benefit. The American Diabetes Association has magnesium. Blood levels that are below the normal
stated that there is not enough evidence to justify tak- range—typically seen in people with kidney disease
ing magnesium supplements to improve blood sugar or people taking drugs like diuretics that lower mag-
in people with diabetes. nesium levels—are clearly related to a higher risk of
heart electrical disturbances and death. Various obser-
High blood pressure and heart disease vational studies have also linked low intake of magne-
Research suggests a potential role for magnesium sium to a higher risk for cardiovascular disease.
supplements in maintaining healthy blood pressure. A
meta-analysis in the journal Hypertension combined Recommendations
data from 34 randomized controlled trials involving • Try to get sufficient magnesium from healthy foods,
2,028 participants with and without high blood pres- such as nuts, spinach, whole grains, and beans. If

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 necessary, consider a multivitamin as a backup Hypertension) diet, which emphasizes potassium-
source. (Most popular multivitamin brands only rich fruits, vegetables, and low-fat dairy products.
contain 10% to 30% of the RDA for magnesium.) In a major trial, a diet rich in all three of these food
• Magnesium supplements should be considered groups lowered blood pressure by an average of 5.5
only if your diet contains little to no magnesium mm Hg and 3.0 mm Hg. It worked even better in
or if you take medications that lower your magne- people with high blood pressure, reducing systolic
sium; in that case, consult your doctor before start- pressure by as much as 11 mm Hg and diastolic pres-
ing use. sure by 5.5 mm Hg. The DASH diet provides three
• Magnesium supplements appear to modestly lower times more potassium than the average American
blood pressure, but do not take high amounts for diet. However, it also increases the intake of other
this purpose without a doctor’s guidance. blood pressure–lowering nutrients, such as magne-
sium and calcium, so the effect cannot be attributed
solely to potassium. This is just one of many reasons
Potassium to maintain a healthy overall dietary pattern such as
the DASH plan.
AI: 4,700 mg

Potassium is necessary for the normal functioning Stroke

of all cells. It regulates the heartbeat, ensures proper High blood pressure is a leading risk factor for stroke,
function of the muscles and nerves, and is vital for so it’s no surprise that higher potassium is also asso-
synthesizing protein and metabolizing carbohydrates. ciated with a lower stroke incidence. One prospec-
Thousands of years ago, when humans roamed the tive study that followed nearly 44,000
earth gathering and hunting, potassium was abundant men for eight years found that men who
in the diet, while sodium was scarce. The so-called consumed the highest amounts of dietary
Paleolithic diet delivered about 16 times more potas- potassium (a median of 4,300 mg per day)
sium than sodium. were 38% less likely to have a stroke as
Today, most Americans get barely half of the rec- those whose median intake was just
ommended amount of potassium in their diets. The 2,400 mg per day. A similar pro-
average American diet contains about twice as much spective study that followed more
sodium as potassium, because of the preponderance than 85,000 women for 14 years
of salt in processed or prepared foods, not to mention found a more modest association
the dearth of potassium in those foods. This imbal-
ance—low potassium intakes combined with high

© delihayat | Getty Images

Selected food sources of potassium
sodium—is thought to be a major contributor to high
FOOD MILLIGRAMS (MG)
blood pressure, which affects one in three American
Apricots, dried halves, ½ cup 755
adults.
Bananas are often touted as a good source of Lentils, cooked, 1 cup 731
potassium, but other fruits (such as apricots, prunes, Acorn squash, mashed, 1 cup 644
and orange juice) and vegetables (such as squash and Prunes, dried, ½ cup 635
potatoes) also contain this often-neglected nutrient. Potato, baked, flesh only, 1 medium 610
Raisins, ½ cup 600
High blood pressure Banana, 1 medium 422
The American Heart Association recommends diets
Milk, low-fat, 1 cup 397
with foods rich in potassium to help keep blood
Orange juice, ¾ cup 295
pressure in a healthy range. One way to get more
Source: USDA FoodData Central.
potassium is the DASH (Dietary Approaches to Stop

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between potassium intake and the risk of strokes. The the high plains of northern Nebraska and the Dakotas
FDA allows the following statement to appear on food are rich in selenium, and people living there have the
labels: “Diets containing foods that are a good source highest selenium intakes in the United States. People
of potassium and that are low in sodium may reduce who snack on Brazil nuts may also have high selenium
the risk of high blood pressure and stroke.” levels, because just an ounce of these nuts contains as
much as 10 times the RDA for selenium—a value so
Recommendations high that you shouldn’t eat them on a regular basis.
• Try to eat more colorful produce. Higher potassium Meats, fish, breads, and other nuts are the most com-
consumption from foods, especially fruits and veg- mon sources of selenium in the American diet, and
etables, may lower blood pressure and the risk of most people get the RDA. In one observational study,
heart disease and strokes. researchers used toenail clippings (which provide a
• Never take potassium supplements without a doc- good measure of selenium intake over time) to assess
tor’s prescription, as this can easily lead to danger- factors that influence long-term average selenium
ously high (and potentially fatal) blood potassium levels in the body. Greater regular cigarette smoking
levels, especially in people with advanced kidney was related to lower selenium levels, and people with
disease. a higher body mass index (BMI) had higher selenium
• Pay attention to the potassium content of salt sub- levels.
stitutes, since it can be high.
Cancer
Observational studies have found a link between
Selenium greater dietary selenium intake and a lower risk of
colorectal, prostate, lung, bladder, skin, esophageal,
RDA: 55 mcg
and stomach cancers. A 34-year follow-up of a Swed-
Selenium is a trace mineral known for its antioxi- ish cohort study called ULSAM found that smokers
dant properties (see “Antioxidants: Beyond the hype,” with low selenium levels at age 50 had higher rates of
page 36). It also helps regulate thyroid function and prostate cancer later in life.
the immune system. Very low intakes cause selenium However, the evidence that taking selenium
deficiency, and very high doses can be toxic. True sele- supplements prevents cancer is mixed or inconclu-
nium deficiency and toxicity are rare in the United sive. A study of people with nonmelanoma skin can-
States, however. cer who took a 200-mcg selenium supplement daily
The amount of selenium in foods varies widely, as found that it did not affect skin cancer recurrence
it depends on the selenium content of the soil where rates, although it did lower cases and deaths from all
plants are grown or animals are raised. For example, cancers combined. Notably, the Selenium and Vita-
min E Cancer Prevention Trial (SELECT) found no
reduced risk of cancer from long-term selenium sup-
Selected food sources of selenium
plementation. (For more on this randomized trial,
FOOD MICROGRAMS (MCG)
see “Vitamin E,” page 26.) A Cochrane review found
Brazil nuts, 1 ounce 544
only limited evidence that selenium helps prevent
Mixed nuts, oil roasted, without peanuts, 421
stomach cancer.
salted, 3.5 ounces
Tuna, yellowfin, cooked, dry heat, 3 ounces 92
Diabetes
Halibut, cooked, dry heat, 3 ounces 47
The relationship between selenium intake and diabe-
Ham, roasted, 3 ounces 36
tes is unclear. Observational studies have suggested a
Cottage cheese, 1% milkfat, 1 cup 20 link between high selenium intake and a greater risk
Source: USDA FoodData Central.
for diabetes. That’s potentially concerning, consider-

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ing the relatively high levels of selenium in the soil in
Selected food sources of zinc
some U.S. regions and the widespread use of multi-
FOOD MILLIGRAMS (MG)
vitamin supplements containing selenium. However,
Oysters, cooked, breaded and fried, 3 ounces 74.0
a number of clinical trials have found the opposite—
Crab, Alaskan king, cooked, 3 ounces 6.5
that greater selenium intake is associated with a lower
risk for diabetes. So the evidence remains inconsistent Beef, chuck roast, braised, 3 ounces 5.8
and inconclusive. Beef patty, broiled, 3 ounces 4.1
Lobster, cooked, 3 ounces 3.4
Eye disease Baked beans, canned, plain or vegetarian, 2.9
½ cup

© MarkGillow | Getty Images

In the eye health analysis report from the SELECT
trial, long-term daily supplementation with selenium Breakfast cereal, fortified with 25% of the 2.8
DV for zinc, 1 serving
either alone or in combination with vitamin E did not
Pork chop, loin, cooked, 3 ounces 1.8
prevent cataracts.
Source: USDA FoodData Central.

Recommendation
• There are no known benefits to taking individual common cold, although
selenium supplements. If you want to take supple- with important cave-
mental selenium, consider it as part of a daily mul- ats. Zinc lozenges
tivitamin-multimineral supplement. or nasal sprays
reduced the dura-
tion of cold symptoms
Zinc by about two days, and symptoms were somewhat
less severe over all. However, the products prevented
RDA for men: 11 mg
upper respiratory infections in only one out of 20
RDA for women: 8 mg
people.
Found in cells throughout the body, zinc helps your
immune system fight off bacteria and viruses, which Cancer
explains why it has been investigated as a potential An observational study in older men in Sweden found
treatment for the common cold. Your body relies on that high dietary zinc consumption was associated
zinc for wound healing as well as the ability to taste with a lower risk of death from prostate cancer among
and smell. However, zinc is one of the micronutrients those men who were already diagnosed with this can-
with a small difference between an adequate dose and cer. A meta-analysis of seven studies found that the
a harmful one. If you routinely take excessive amounts highest dietary intakes of zinc were linked to lower
of zinc, it can lead to side effects such as a depressed risk of pancreatic cancer. Zinc may fight cancer via
immune system, hair loss, and temporary interference its antioxidant properties or by supporting a healthy
with the ability to taste and smell. Most Americans immune response.
already get the RDA for zinc from their diets, since
the mineral is found in seafood, meat, fortified cereals, Recommendations
beans, poultry, and dairy products. Therefore, supple- • If you try zinc lozenges to shorten the duration of
ments aren’t generally needed. a cold, read the label to be sure you’re not taking
more than the safe upper limit (40 mg a day), par-
The common cold ticularly over an extended period of days.
A systematic review and meta-analysis of 28 high- • If you take a multivitamin, don’t take an additional
quality clinical trials, published in 2021 in BMJ Open, zinc supplement. Most already contain the RDA
provides limited evidence for using zinc to fight the for zinc. 

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 Beyond vitamins: Bioactives, probiotics,
antioxidants, and more

W e hope that it’s clear by now that a well-stocked

pantry and refrigerator with a representative mix
of wholesome foods should be a big part of your strat-
hot peppers, the pungent whiff of garlic, the enticing
smell of curry, the deep orange hue of carrots, and the
red blush on tomatoes all come from bioactives.
egy for staying healthy. Not only do the foods you eat Plants develop these compounds for their own
supply essential vitamins and minerals, they also con- purposes, including defense against predators. But
tain many other components that can be beneficial, many of these substances appear to be beneficial for
such as the ones below. people, too. The results of certain studies are now
well known—the lutein in dark leafy greens may help
protect against specific eye ailments; the lycopene in
Bioactives tomatoes may help defend against prostate disease;
Even the most humble fruits and vegetables are replete the proanthocyanidins in cranberries may help ward
with compounds called phytochemicals that affect the off urinary tract infections; the flavan-3-ols found in
plants’ flavor, color, scent, and other properties. In tea, cocoa, berries, and grapes may have a role in the
recent years, many of these compounds have become prevention of cardiovascular disease. Many serve as
known as bioactives, because they also have physio- antioxidants (see “Antioxidants: Beyond the hype,”
logical effects on the human body. The searing bite of page 36). Others have anti-inflammatory properties.
Still others activate your body’s natural detoxification
systems.
There are thousands of bioactives in your fruits
and vegetables, and in many cases, they work in net-
works, so taking a few in supplement form will not
necessarily deliver the best results. Instead—you
guessed it—try to get them from your food. Here’s a
bonus: you’ll get plenty of vitamins and minerals, too.

Probiotics and prebiotics

Probiotics and prebiotics are a hot topic in nutrition
these days because of their connection to the gut
microbiome. Your large intestine contains 100 trillion
© AndreyPopov | Getty Images

“good” bacteria that are essential to your health. These

beneficial microbes help maintain healthy bowel func-
tion, fending off ailments like inflammatory bowel
disease and Salmonella and E. coli infections. They
may even play a role in regulating weight, liver func-
A well-stocked refrigerator and pantry, chock-full of wholesome tion, and mood.
foods, should be a big part of your strategy for staying healthy, All people start out with a colony of these benefi-
giving you vitamins, minerals, bioactives, probiotics, and omega-3s. cial microorganisms in their gut, courtesy of physi-

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cal contact with their with most fermented
mothers—in the womb, foods in packages—the
during the birth pro- microbes will be dead.
cess, and via breast- In addition, most pick-

© robynmac | Getty Images

feeding. But you take les and sauerkraut are
in others—known as canned and pickled in
probiotics—through hot vinegar solutions
food. The microbes that with high acidity that
turn milk into yogurt Prebiotics are foods rich in the insoluble fibers that your beneficial combines with heat to
and kefir are among gut bacteria like to feed on. These include whole-grain breads, sweet kill live, active bacte-
the most helpful pro- potatoes, corn, beans, peas, and lentils. ria. The best solution
biotics, but they can is to buy from delis
be destroyed during processing. When you buy com- where they do the pickling themselves or natural food
mercial yogurt and kefir, look for the words “live and stores that carry fermented foods. Or make your own;
active cultures” on the label, to make sure the manu- you can find clear and easy instructions in books and
facturer has tested production methods and knows online.
the bacteria can survive. There are also probiotic supplements on the mar-
Fermented foods are another good source, under ket, of course. But it’s not easy to sift through them
the right circumstances. Beneficial microbes turn cab- and find exactly what you need. Usually these prod-
bage into sauerkraut, cucumbers into sour pickles, ucts contain just a few bacterial strains, compared
soybeans into miso, and sweetened tea into kombu- with 3,000 or so strains in your gut. And not all gut
cha. But if the products have been pasteurized—as bacteria are alike. Different ones play different roles

Antioxidants: Beyond the hype

A ntioxidants are a very broad category that includes

many bioactive compounds, as well as certain vitamins
and minerals — for example, vitamins C and E and the
of vitamin C. Cooking oils extracted from soybeans and
other sources provide the antioxidant vitamin E. Among
the scores of other antioxidants in plant foods are the
minerals copper, zinc, and selenium. For a while, they were carotenoids (such as lycopene in tomatoes and lutein in
a nutritional fad, and a vast array of food labels touted kale) and the flavonoids (such as flavanols and epicatechins
“antioxidants!” in big, bold letters. The fad has died down, in cocoa, anthocyanins in blueberries, quercetin in apples
but has not completely disappeared. You can still find and onions, and catechins in green tea).
potato chips that boast “antioxidants and vitamin C,” Many observational studies have linked a variety of
making them sound almost like health food. health benefits to diets rich in antioxidant-packed fruits
“Antioxidant” is a general term for any compound that and vegetables. Such benefits include lower risks of
can counteract unstable molecules called free radicals that cardiovascular disease, cancer, age-related eye disease, and
damage DNA, cell membranes, and other parts of cells. memory impairment.
Free radicals are produced as a natural result of many But your body doesn’t rely solely on plants to supply
normal body processes, like converting food into energy and antioxidants. It also makes its own, including the powerful
defending you against bacteria and viruses. This means you antioxidants ALA and glutathione.
are continuously exposed to free radicals. To keep things
Where does that leave supplements? Randomized placebo-
in check and prevent damage to body tissues, you need an
controlled trials do not generally support the extravagant
adequate supply of antioxidants.
claims made for supplemental antioxidants. It is better to
Plants produce abundant antioxidants. For example, obtain your antioxidants from a well-rounded diet. If you
broccoli, spinach, and tomatoes contain alpha lipoic really want to benefit from antioxidants, walk past the
acid (ALA). Spinach, avocados, and asparagus contain supplement aisle and go straight to the produce section or
glutathione. Citrus fruits famously deliver large helpings the nearest farmer’s market.

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in the body, so if you’re trying to treat a specific con- Several observational studies have reported a
dition, like irritable bowel syndrome or diarrhea, you potential link between intake of omega-3 fatty acids
need to find the right ones with documented benefits from food or supplements and lower risk for cardio-
for that condition. In 2020, the American Gastroen- vascular disease. For example, research based on data
terological Association released guidelines for the from the Physicians’ Health Study found that men
use of probiotics. These experts concluded that good who ate fish once a week were half as likely to die sud-
evidence for taking probiotic supplements exists for denly from a heart attack as men who ate fish less than
only a handful of conditions. For general health, once a month. Among the potential explanations for
look for brands that contain both Lactobacillus and this finding are the favorable effects of omega-3s on
Bifidobacterium. blood pressure, heart rate, cholesterol, and inflamma-
Another way to nurture your gut bacteria is to tion, and their likely role in maintaining normal heart
make sure your diet includes prebiotics—foods rich rhythm and blood vessel function.
in the insoluble fibers that the bacteria themselves According to both the U.S. Dietary Guidelines and
like to feed on. These fibers are found in abundance the American Heart Association, everyone should try
in whole-grain products such as oatmeal and whole- to eat fish, especially oily fish like salmon, sardines, or
grain breads, as well as in vegetables like asparagus, herring, at least twice a week. However, a Cochrane
leeks, onions, and garlic, and starchy vegetables like review published in 2020 cast doubt on the value of
sweet potatoes and corn. Beans, lentils, and peas are fish oil supplements for preventing cardiovascular dis-
also good sources. ease. The review looked at 86 clinical trials, most of
Finally, stick with whole foods. The beneficial which raised participants’ omega-3 intake using sup-
bacteria in your gut can be depleted if you eat a lot of plement capsules, although some did so with dietary
sugar, saturated fat, and processed foods. changes. The review found that raising intake of
omega-3s has “little or no effect” on serious events like
heart attacks and strokes, and “probably” has no effect
Omega-3 fatty acids on the risk for dying of heart disease or of having a
Omega-3s are a group of essential fatty acids; “essen- stroke or heart-rate irregularities.
tial” here refers to vital nutrients the body cannot This doesn’t necessarily mean you should rule
manufacture for itself and must obtain from food. out taking omega-3 supplements if you can’t get suffi-
Omega-3s are believed to be particularly beneficial for cient amounts from food. Some people, after all, sim-
the cardiovascular system. Omega-3s are abundant ply don’t like seafood, the richest source. But it does
in certain fatty fish and other seafood. They are also mean that the evidence that you will ultimately ben-
available in much smaller quantities from plant-based efit, and how much you benefit, may be less than you
foods, such as walnuts, flaxseed, and canola oil. would prefer. 

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 SPECIAL SECTION

Does your diet deliver the

daily recommended dose?
I
t’s easy to look up the recommended daily allowance for oil, fish, yogurt, beans, and nuts
every vitamin and mineral based on your age and sex. (For (plus wine in moderation) provides
vitamins, see Table 1, page 8, and for minerals, see Table 2, a wide array of vitamins and min-
erals (see “How Mediterranean is
page 11, or visit the USDA’s website, which you can reach via
your diet?” on page 39). Numerous
www.health.harvard.edu/RDA.) But how much of each of these studies affirm the disease-fighting
nutrients are you actually getting from the foods you eat every powers of this approach.
day—and do they meet your daily needs? The first U.S.-based study of
the diet confirmed that the more
Focus on food guide to healthy eating. This eating closely people followed the Medi-
There are several ways to approach pattern, with its emphasis on veg- terranean eating style, the lower
healthy eating. One is to analyze etables, fruits, whole grains, olive their risk of dying from either heart
the nutrient content of everything
you eat. The other, which we pre-
fer, is to focus on the big picture: Examples of nutrient-dense foods
eating a balanced diet that con-
tains a variety of colorful fruits and
vegetables, whole grains, beans,
I n contrast to potato chips, which contain a lot of calories but not a lot of
nutrients, a baked sweet potato delivers a bounty of nutrients with relatively few
calories. (Just be sure to avoid adding excessive toppings, such as marshmallows,
nuts, dairy products, seafood, or you’ll pile on empty calories.) Following are some other nutrient-rich foods.
lean meats, and poultry. When You’ll notice that these are all unprocessed or minimally processed foods.
choosing what to eat, emphasize • Almonds, cashews, • Brussels sprouts • Lentils, peas
nutrient-dense foods, which are peanuts • Cantaloupe, kiwi, • Mushrooms (crimini,
packed with vitamins and miner- • Avocados papaya shiitake)
als and have relatively few calories • Barley, oats, quinoa, • Chard, collard greens, • Onions, leeks, garlic
(see “Examples of nutrient-dense brown rice kale, mustard greens, • Salmon, halibut, cod,
 eans (garbanzo,
B spinach scallops, tuna
foods,” at right). •
kidney, navy, pinto) • Chicken, turkey • Seeds (flax, pumpkin,
• Bell peppers • Eggs sesame, sunflower)
Try the Mediterranean diet
• Berries (blackberries, • Lean beef, lamb, • Tomatoes
One way to get plenty of vitamins
blueberries, raspberries, venison • Yogurt
and minerals from food is to use strawberries)
the Mediterranean diet as your

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 Does your diet deliver the daily recommended dose? | SPECIAL SECTION

disease or cancer. The Spanish How Mediterranean is your diet?

PREDIMED clinical trial of 7,447 Does your diet measure up? Give yourself one point for each “Yes.” If you score 6 or higher,
men and women ages 55 to 80 at you’re eating like an Aegean.
high risk for cardiovascular disease YES NO
found that a Mediterranean-style Vegetables (other than potatoes), 4 or more servings a day
diet—primarily through the con- Fruits, 4 or more servings a day
sumption of extra-virgin olive oil Whole grains, 2 or more servings a day
and mixed nuts each day—reduced Beans (legumes), 2 or more servings a week
heart attack, stroke, and death by
Nuts, 2 or more servings a week
about 30% compared with a stan-
Fish, 2 or more servings a week
dard low-fat diet over the course
Red and processed meat, 1 serving or less a day
of almost five years. An observa-
tional study examining the relative Dairy foods, 1 serving or less a day
importance of each component More unsaturated fat (olive oil and other liquid vegetable oils)
than saturated fat (butter, palm oil, bacon fat, etc.)
of the Mediterranean diet sug-
TOTAL
gested that its life-extending ben-
efits stemmed mainly from eating
plenty of vegetables, fruits, nuts, weight. Usually the most effective for weight loss, and has been rec-
legumes, and olive oil; eating little weight-loss diet for you is one you ognized as a healthy eating plan
meat; and drinking a glass or two can stick with over the long haul. that is easy to follow and adopt.
of wine with meals. Like the Mediterranean diet,
Another bonus: Research Or … try the DASH diet the DASH diet emphasizes the
suggests that people are able to The DASH (Dietary Approaches to consumption of vegetables, fruits,
maintain a healthy weight on the Stop Hypertension) diet was cre- fat-free or low-fat dairy products,
Mediterranean eating pattern. ated in the 1990s to help people whole grains, fish, poultry, beans,
However, it’s unclear whether a lower their blood pressure. It has seeds, nuts, and “good” fats, such as
Mediterranean-style diet is more also been shown to help reduce vegetable oils. The dietary plan also
effective than any other for losing cholesterol levels, can be adapted recommends reducing the intake
© dulezidar | Getty Images

One way to get plenty of vitamins and minerals from food is to use the Mediterranean diet as your guide to healthy eating. The first U.S.-based
study of the diet confirmed that the more closely people followed this eating style, the lower their risk of dying from heart disease or cancer.

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 SPECIAL SECTION | Does your diet deliver the daily recommended dose?

Getting the most from foods

W hether you’re a gourmet chef or a novice in the haps heart disease. There is no rea-

© Maksym Rudoi | Getty Images

kitchen, you can learn to squeeze the most nutritional son to include these in your diet.
benefit from your diet. Choosing nutritious foods is the most important step, but
the following tips can help you preserve the nutritional content of your foods:
Skip the sugary drinks—and even
artificially sweetened drinks, which
Don’t forgo frozen or canned. The fruits and vegetables stocked in
supermarket freezer aisles are usually picked ripe and flash frozen, which also have been associated with del-
captures their flavor and seals in nutrients. And larger stores carry everything eterious health effects. Have some
from old standards like frozen blueberries or chopped broccoli to newer additions unsweetened tea or sparkling water
like frozen turnip greens, gooseberries, and plantains. Canned fruits and
instead.
vegetables are also a good alternative, but make sure to choose products that
are canned in water and low in salt and sugar.
Steam, stir-fry, grill, or roast vegetables. Boiling veggies can lead to a loss of Minimize refined carbohydrates
nutrients into the cooking water. But don’t get caught up in little details of the Highly processed wheat, rice, and
“best” way to prepare vegetables. The key step is to buy them and eat them — other grains have the same effects
you’ll be doing your body a favor no matter how you prepare them. in the body as table sugar. So mini-
Wrap it up. Properly store or refrigerate any cut fruits or vegetables in order to mize your intake of white bread,
ensure that they will last and retain their key nutrients. Cap juice bottles.
French fries, most breakfast cere-
Cook it well. Foods such as meat, fish, and poultry must be cooked well in order
als, and most high-carbohydrate
to destroy dangerous microorganisms. If you grill your food, be sure not to char
it, in order to avoid formation of cancer-causing compounds. packaged and processed foods,
such as pretzels and chips. Instead,
choose whole grains, high-fiber
of red meats, sodium, sweets, and mineral supplements from a bottle breakfast cereals, brown rice, steel-
sugar-containing beverages. For cannot encompass all the biologi- cut oats, and fruits and vegetables.
the particulars of the plan, go to cally active compounds teeming When choosing carbs, a good
www.health.harvard.edu/dash. in a well-stocked pantry. A simple rule of thumb is to be sure that
apple or floret of broccoli contains they have no more than 10 grams
Make healthy food choices scores of nutrients besides vitamins of carbohydrate for every gram of
Some essential nutrients are and minerals that might interact to dietary fiber (maximum 10-to-1
packed into every food, and cer- improve your health. For example, carbohydrate-to-fiber ratio). Even
tain foods—such as flour, cereal, broccoli contains bioactive com- better, if possible, aim for no more
and salt—are fortified with spe- pounds called isothiocyanates, than 5 grams of carbohydrate for
cific nutrients as well. Vitamin and which appear to have anti-tumor every gram of dietary fiber (maxi-
properties. mum 5-to-1 carbohydrate-to-fiber
Here are some rules of thumb ratio).
that will help you make good
choices. Choose healthy fats
© joebelanger | Getty Images

Fish, nuts, and vegetable oils con-

Limit liquid sugars tain healthy monounsaturated and
Liquid sugars, which are found polyunsaturated fats, which help
in soft drinks, sports drinks, fruit lower heart disease risk. Eat these
drinks, iced teas, and sweetened foods regularly and in moderation.
Highly processed wheat and other grains
have the same effect on the body as table waters, have no benefits for health Don’t focus on the amount of fat
sugar, so minimize your intake of doughnuts, and are clearly linked to a higher (for example, low-fat salad dress-
white bread, and most breakfast cereals. risk of obesity, diabetes, and per- ing), but rather the type of fat.

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 Does your diet deliver the daily recommended dose? | SPECIAL SECTION

Limit your consumption of satu- one way to get an extra serving of Be a big dipper. Try dipping
rated fat and cholesterol. vegetables. vegetables into hummus or another
Try something new. It’s easy bean spread, some spiced yogurt, a
Don’t forget fiber to get tired of apples, bananas, and bit of ranch dressing, or mashed
Eat plenty of foods that contain grapes. Try a kiwi, mango, fresh avocado mixed with diced toma-
dietary fiber (the edible, indigest- pineapple, or some of the more toes and onions. Dip fresh or dried
ible parts of plant foods). Good exotic choices now found in many fruit in melted dark chocolate.
sources include fruits, vegetables, grocery stores. The same goes for Spread it on. Slather peanut
whole grains, beans, and nuts. vegetables. You might find you love butter on a banana or slices of apple.
Fiber from grains helps lower the kale, leeks, or bok choy. Try mashed avocado as a sandwich
risk of heart disease. Your daily Blend in. A fruit smoothie (see spread, topped with spinach leaves,
fiber goal depends on your age and “Simple fruit smoothie,” page 42) tomatoes, and a slice of cheese.
sex, as follows: is a delicious way to start the day Start off right. Ditch your
• men ages 50 or younger: 38 or tide you over until dinner. You morning doughnut for an omelet
grams can add spinach to a fruit smoothie with onions, peppers, and mush-
• men over 50: 30 grams without sacrificing the sweet taste. rooms. Top it with some salsa to
• women ages 50 or younger: 25
grams
• women over 50: 21 grams. Figure 6: A diet out of balance
In general, Americans tend to consume too many nutrient-poor foods, like sugary drinks and
Favor fruits and vegetables other sweets, and not enough foods that are rich in vitamins, minerals, and other nutrients.
Most Americans don’t eat nearly Undesirable Desirable
the recommended amounts of intake (too low intake
or too high)
fruits and vegetables (see Fig-
ure 6, at right). Preparation time,
Vegetables
unfamiliarity, and old habits are
common hurdles. Here are some Fruit
Food group or dietary component

suggestions to break these barriers

Total grains
and boost your intake.
© Elena_Garder, © lukpedclub, © AVIcons | Getty Images

Set a goal. Start by eat- Dairy

ing one extra fruit or vegetable
Protien foods
a day. When you’re used to that,
add another and keep going. For Oils
example, add fruit to your break-
Added sugars
fast cereal every morning. Then
try eating a piece of fruit for an Saturated fats
after-lunch snack. Next, add at
Sodium
least one vegetable to your dinner
plate. 100 80 60 40 20 0 20 40 60 80 100
Be sneaky. Adding finely Percent of population below Percent of population at or
grated carrots or zucchini to pasta recommendation or limit above recommendation or limit
sauce, meat loaf, chili, or a stew is Source: Dietary Guidelines for Americans, 2015–2020.

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 SPECIAL SECTION | Does your diet deliver the daily recommended dose?

wake up your palate. Or boost your

© Yelyzaveta Matiushenko | Getty Images

morning cereal or oatmeal with a Simple fruit smoothie
handful of strawberries, blueber-
ries, or dried fruit. Makes: 1 serving
Drink up. Having a 6-ounce
glass of low-sodium vegetable juice T his is a great way to use bananas that are beginning
to get too ripe. (You can always cut ripe bananas into
thick slices, freeze in a plastic bag, and thaw when you’re ready to
instead of a soda gives you a full make another smoothie.)
serving of vegetables and spares • ¾ cup plain yogurt or kefir • ½ cup berries (fresh or
you 10 teaspoons or more of sugar. • ½ ripe banana frozen strawberries, blueberries, or
You can also make your own vege- • ½ cup pineapple juice other berry of your choice)
table juice with a blender or juicer. Optional: 1 tablespoon ground flaxseed (for healthy omega-3 fats).
Give them the heat treat-
Put all ingredients in a blender or food processor and blend to combine. You can
ment. Roasting vegetables is easy branch out by adding a dash of ground cinnamon, a splash of vanilla, some mint,
and brings out new flavors. Cut up or another flavoring.
onions, carrots, zucchini, aspara-
gus, turnips—whatever you have
on hand—coat with olive oil, add ing, food companies and grocers consideration your food prefer-
a dash of balsamic vinegar, and offer an ever-expanding selection ences and allergies or other health
roast at 350° until done. Grilling of prepared produce, including issues (such as lactose intolerance
is another way to bring out the ready-made salads, frozen stir-fry or celiac disease). Dietitians have
taste of vegetables. Use roasted or mixes, and take-along sliced apples access to computer programs and
grilled vegetables as a side dish, and dip. databases that ease the most dif-
put them on sandwiches, or add Improve on nature. Don’t ficult calculations, such as nutri-
them to salads. hesitate to jazz up vegetables with ent analyses of menus. You can ask
Let someone else do the spices, chopped nuts, balsamic your clinician for a referral (check
work. If peeling, cutting, and vinegar, olive oil, or a specialty oil to see if your insurance covers the
chopping are too time-consum- like walnut or sesame oil. Most cost of nutritional counseling), or
grocers carry several spice blends ask at a local hospital or medical
made specifically for vegetables. center.
Even a dash of grated Parmesan But if you have the time and
cheese can liven up the blandest the inclination to do the work
green beans. yourself, there are free online tools
and calculators that can help. Here
Decoding your diet are some questions you’ll need to
If you’re really curious to know ask and some of the websites where
© DronG | Getty Images

how your diet stacks up nutrition- you can find the answers.
wise, you have two options: hire a
professional or do it yourself. How many calories do I need?
A registered dietitian can It depends on your age, height,
Grilling and roasting are two good ways
to bring out the natural sweetness in scrutinize your current diet and weight, and activity level. You
vegeables, from peppers to onions. You can set up a plan that precisely meets can get a rough estimate of how
serve them as a side dish or on sandwiches. your nutritional needs, taking into many calories you need each day

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 Does your diet deliver the daily recommended dose? | SPECIAL SECTION

to maintain your weight simply by and focusing instead on the big pic-
multiplying your weight by a value ture: eating a balanced diet that is
ranging from 11 to 15, depending packed with nutrient-dense foods.
on whether you are short or tall,
sedentary or active, and so forth. Putting it into practice
For a more precise figure, try the Sometimes it seems that you
calculator at Calculator.net (www. can’t possibly meet all your daily
calculator.net/calorie-calculator. requirements for vitamins and
html). minerals from food without
vastly increasing the amount of
© Charday Penn | Getty Images

What should I eat? food (and calories) you consume.

For a list of nutrient-dense foods Rest assured, you can. The single
to try to incorporate into your diet, most important step you can take
go to the Aggregate Nutrient Den- to meet your goal is simply to
sity Index (ANDI), which you can increase your intake of fruits and
find at www.health.harvard.edu/ vegetables. If you look at “A typical
There are several ways to approach healthy
ANDI). It ranks foods according eating. One is to analyze the nutrient diet vs. a nutrient-dense diet” on
to the amount of micronutrients content of everything you eat. The other is page 44, you’ll see how one dieti-
they contain—vitamins, minerals, simply to eat a produce-rich diet. tian managed to make over the diet
and bioactives—per calorie. It was of a 52-year-old woman, boosting
created by Dr. Joel Fuhrman, who using the Nutrition Facts section her nutrient intake while actually
devised the concept of the “nutri- of the consumer website for Blue reducing the woman’s daily calorie
tarian” (micronutrient-rich) diet. Cross and Blue Shield of Massa- intake.
Because the ANDI score balances chusetts (www.ahealthyme.com/ Notice that this woman was
nutrient density against caloric Library/NutritionFacts). Another initially consuming the recom-
density, some healthy but higher- good source of information on mended daily amounts for only
calorie foods end up with lower the nutrients in specific foods about half the vitamins and miner-
rankings than you might have (including brand-name and fast- als (nine out of 20). That’s because
anticipated. food items) is Calorie King (www. her diet included less than half of
calorieking.com). Entering every- the recommended servings of veg-
How do I know if my diet thing you eat can be cumbersome, etables and no fruit at all. But once
provides what I need? but if you try it for just a few days, she switched to the nutrient-dense
To look up the nutrient content you’ll learn a lot about food qual- diet, which is rich in vegetables,
of specific foods—or to find out ity and how to get the best nutri- fruits, and lean protein, she began
which foods contain specific nutri- tional return on the calories you meeting all but one of her nutrient
ents—go to the USDA’s FoodData consume. goals, including 1,200 mg of cal-
Central database at https://fdc.nal. Alternatively, you can take a cium a day, thanks to foods such
usda.gov. You can also research the more relaxed approach—not wor- as nonfat dairy products and bok
nutrient content of various foods rying too much about the details choy (Chinese cabbage). 

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 SPECIAL SECTION | Does your diet deliver the daily recommended dose?

A typical diet vs. a nutrient-dense diet

I f you want to meet your vitamin and mineral requirements

through diet rather than supplements — by far the best way to
do it — your best bet is to adopt a nutrient-dense diet. But for
The “typical day’s menu” shows the kind of regimen the woman
was following before consulting di Bonaventura. The “nutrient-
dense menu” shows an example of a day’s intake after she
someone who hasn’t already been eating this way, it might not overhauled her eating to include more produce. Note that she
be obvious how to do that. The two menus below show how one boosted her nutrients into the recommended range without relying
52-year-old woman managed the shift, with the help of clinical on fortified food products or supplements. At the same time, she
dietitian Ellen di Bonaventura at Harvard-affiliated Massachusetts slashed calories from roughly 2,000 a day to just under 1,200 — a
General Hospital in Boston. level often recommended for female dieters.

A typical day’s menu Nutrient analysis of this menu

Breakfast The amounts of vitamins and minerals this woman consumed through
1 whole-wheat bagel Menu provides her diet are shown below, next to the recommended daily amounts in
1,959 calories: parentheses. Bold type denotes success in meeting or exceeding the RDA.
2 tablespoons light cream cheese
32% from fat
10 ounces coffee 43% from carbohydrate
Vitamin A, 529 mcg (700 mcg) Vitamin K, 137 mcg (90 mcg)
2 ounces skim milk 20% from protein Thiamin, 1.5 mg (1.1 mg) Calcium, 477 mg (1,200 mg)
6 ounces nonfat strawberry 5% from alcohol
Riboflavin, 1.8 mg (1.1 mg) Copper, 881 mcg (900 mcg)
yogurt
Lunch Dinner Niacin, 52 mg (14 mg) Iron, 13 mg (8 mg)
2 slices oatmeal bread 5 ounces grilled chicken Pantothenic acid, 4.6 mg (5 mg) Magnesium, 268 mg (320 mg)
1 tablespoon light mayonnaise marinated in 2 tablespoons
Vitamin B6, 1.3 mg (1.5 mg) Manganese, 5.1 mg (1.8 mg)
4 ounces tuna, canned in water Italian dressing
1 ounce chips ½ cup white rice Vitamin B9, 379 mcg DFE
Phosphorus, 1,148 mg (700 mg)
1 tablespoon margarine (400 mcg DFE)
12 ounces diet cola
Snack 1 cup broccoli florets Vitamin B12, 4.0 mcg (2.4 mcg) Potassium, 2,000 mg (4,700 mg)
1 oat-and-honey granola bar 5 ounces white wine Vitamin C, 44 mg (75 mg) Selenium, 179 mcg (55 mcg)
6 ounces black tea with 1 Dessert
Vitamin D, 280 IU (600 IU) Zinc, 7.2 mg (8 mg)
teaspoon milk and ½ teaspoon ½ ounce dark chocolate
sugar

A nutrient-dense menu Nutrient analysis of this menu

Breakfast The amounts of vitamins and minerals this woman consumed through her
Menu provides new diet are shown below, next to the recommended daily amounts in
8 ounces nonfat yogurt 1,155 calories: parentheses. Note that there is now only one nutrient shortfall — vitamin D,
½ cup sliced papaya 33% from fat which can be hard to obtain through food.
½ cup sliced kiwi 40% from carbohydrate You may not want such a calorie-restricted diet. For example, you might want
1 ounce (14 halves) walnuts 27% from protein to add healthy snacks of fruit or a handful of nuts. The point is that you can
8 ounces black coffee boost your nutrient intakes even while you’re reducing your calories.
4 ounces skim milk Vitamin A, 1,031 mcg (700 mcg) Vitamin K, 156 mcg (90 mcg)
Dinner
Lunch Thiamin, 1.3 mg (1.1 mg) Calcium, 1,222 mg (1,200 mg)
4 o unces broiled wild salmon
1 small whole-wheat pita and yogurt sauce (1 Riboflavin, 1.8 mg (1.1 mg) Copper, 900 mcg (900 mcg)
Green salad (1 cup dark green tablespoon Greek nonfat Niacin, 14 mg (14 mg) Iron, 11 mg (8 mg)
lettuce, 1 red or orange pepper, yogurt, 1 teaspoon lemon Pantothenic acid, 5.5 mg (5 mg) Magnesium, 355 mg (320 mg)
1 cup grape tomatoes, ½ cup juice, 1 clove chopped garlic) Vitamin B6, 2.23 mg (1.5 mg) Manganese, 2.8 mg (1.8 mg)
edamame beans, 1 tablespoon ¼ cup cooked barley
unsalted sunflower seeds) Vitamin B9, 556 mcg DFE
¼ cup cooked lentils with Phosphorus, 1,530 mg (700 mg)
(400 mcg DFE)
Salad dressing (1 tablespoon spices to taste
olive oil plus balsamic vinegar Vitamin B12, 10.6 mcg (2.4 mcg) Potassium, 4,700 mg (4,700 mg)
1 cup steamed baby bok choy
and pepper) Vitamin C, 383 mg (75 mg) Selenium, 90 mcg (55 mcg)
Water
Unsweetened iced tea or water Vitamin D, 480 IU (600 IU) Zinc, 8.6 mg (8 mg)

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 Getting too little

S erious deficiencies of most essential vitamins and

minerals are relatively rare in the United States.
More often, people get enough to avoid overt defi-
research suggests that the daily dose for women of
childbearing age should be 800 mcg DFE, not the 400
mcg DFE currently in most multivitamins. Combin-
ciency diseases such as scurvy or rickets, but because ing a healthy diet with a multivitamin should provide
of nutrient-poor diets, they get too little of some nutri- you with about 700 to 800 mcg DFE a day. Most pre-
ents to help ward off chronic health problems, such as natal multivitamin and mineral supplements in the
osteoporosis, cardiovascular disease, and some types United States contain 800 to 1,000 mcg of folic acid.
of cancer. How can you tell if you could be compromis-
ing your health by not getting enough? While defini- Medical conditions
tive proof is hard to come by, there are certain clues. Some digestive diseases can block absorption of vita-
min B12. Cystic fibrosis, chronic liver disease, and
Age short-bowel syndrome can impair the absorption of
According to the Framingham Heart Study, 30% of fat-soluble vitamins, such as vitamin E. Liver disease,
people ages 67 and over lack adequate vitamin B9, 20% kidney disease, or absorption problems can trigger a
do not get sufficient vitamin B6, and 20% to 25% do deficiency of vitamin K, which is necessary for blood
not get enough B12. The Baltimore Longitudinal Study clotting and may help keep bones healthy. Celiac dis-
on Aging found that most older men and women are ease, inflammatory bowel disease, and other conditions
deficient in calcium, zinc, iron, magnesium, and vita- that affect the small intestine can interfere with vitamin
min D. Malabsorption, poor diet, or other causes may D absorption. In addition, medications can interfere
underpin this pervasive problem. A lack of stomach with the absorption of some vitamins and minerals
acid—which often occurs among the elderly—makes (see “Medications and micronutrients,” page 46).
it hard to absorb calcium and vitamin B12 from food.
Genes
Sex People lacking a particular gene variant have a less-
Women who menstruate need more iron than do active form of an enzyme that helps the body use
men, postmenopausal women, and women who’ve vitamin B9 (folate, folic acid) and consequently have a
had a hysterectomy. Because most of the body’s iron higher risk for colorectal cancer if they take in too lit-
circulates in the blood as part of hemoglobin, men- tle of this vitamin. Other genetic abnormalities ham-
struating girls and women lose substantial amounts per the body’s ability to make and use vitamin D, thus
of iron during their monthly periods, which is why increasing the risk for bone fractures.
iron deficiency is a common problem for women of
childbearing age. For women ages 31 to 50, the rec- Vegetarian and vegan diets
ommended daily amount of iron is 18 mg. For adult Unlike other vitamins, B12 is almost exclusively found
men of any age and for women starting at age 50 (or in animal products (eggs, milk, fish, poultry, and
whenever menstruation ends), 8 mg a day is enough. meat). Vegans are at heightened risk for B12 deficiency,
Any woman who might get pregnant also needs which can inflict neurological damage and contribute
extra vitamin B9 (folate, folic acid). During the first to heart disease. Taking a multivitamin will solve the
three weeks of pregnancy, vitamin B9 is crucial to problem. Vegetarians who aren’t quite so strict—who
preventing birth defects of the brain and spine. Some avoid meat but eat milk and eggs—can get their B12

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that way. People who follow a plant-based diet should Alcohol lacks vitamins and minerals while deliv-
also eat plenty of deep-hued vegetables and fruits, to ering “empty” calories. And although the media have
ensure that they get enough essential vitamins and brought attention to the potential health benefits of
minerals, along with other healthful compounds. the bioactive compounds in red wine and other alco-
holic beverages, the promise is far greater than the
Alcohol consumption actual findings from research conducted to date.
Heavy drinking (at least several drinks per day) is A systematic analysis of the worldwide burden of
known to cause vitamin B9 (folate, folic acid) defi- alcohol use published in 2018 in The Lancet provides
ciency. It can also contribute to deficiencies of vita- additional evidence that alcohol should be kept to a
min A, thiamin, vitamin D, magnesium, calcium, and minimum: it found that alcohol use may increase the
potassium. And tissue studies show it may increase risk of various cancers and overall death rates, and
the need for niacin, vitamin C, and sometimes zinc. this risk increases as consumption rises. The only level
Even moderate drinking—no more than one of alcohol intake that was not associated with health
drink per day for women and two for men—may pose risks was zero consumption. The American Cancer
a problem. Women in the Nurses’ Health Study who Society now says “it’s best not to drink alcohol,” or, if
drank moderate amounts of alcohol and also took in you do, to stick to a limit of no more than one drink
relatively low amounts of vitamin B9 (folate, folic acid) per day for women and two drinks per day for men.
from their diets had a higher risk for breast cancer
compared with women who had higher intakes. The Blood loss
same pattern—moderate alcohol plus a low intake of When you lose blood, you lose iron, too. Women who
vitamin B9—has been linked to colon and pancreatic menstruate need extra iron (see “Sex,” page 45). So do
cancers, too. Experts advise even moderate drinkers to frequent blood donors—an estimated 3 to 4 mg more
step up their vitamin B9 intake—for example, by tak- per day for each unit of blood you donate during the
ing a regular multivitamin that contains folic acid. course of a year.  

Medications and micronutrients

S ome medications can interfere with the absorption of

certain nutrients or speed their excretion from the body.
You’re more likely to suffer from nutrient depletion and
your prescription drugs and supplements at one
pharmacy, especially if the store maintains computerized
customer records to track possible drug interactions.
worrisome interactions if you take several medications, The following classes of medications may cause nutrient
regularly drink alcohol, eat poorly, or have health problems depletion and, possibly, nutritional deficiencies. (If you take any
that increase your need for certain nutrients. of these medicines, ask your doctor whether you should adjust
It’s also true that certain nutrients in food and supplements your intake of any vitamins or minerals. Generally, occasional
can interfere with the medications you take. Prime examples use will not matter, but long-term use can make a difference.)
are calcium and iron, which bind to the antibiotic tetracycline • antacids • anti-ulcer drugs
so that both the nutrients and the drug simply pass through
• antibacterial agents • cholesterol-lowering
the body in an unusable form. Megadoses of vitamin C can
• antibiotics medications
acidify your urine, which curbs the excretion of acidic drugs,
such as aspirin. That means the aspirin will stay in your body • anticancer drugs • contraceptives
longer than usual. • anticoagulants • corticosteroids

Generally, when you begin using a medication, your • anticonvulsants • diabetes medications
pharmacist should warn you about any foods to avoid. But • antidepressants • diuretics
you should never take a dietary supplement without finding • laxatives
• antifungal agents
out whether it might interfere or interact with the medications
• anti-inflammatory agents • tranquilizers.
you take. Ask your pharmacist or doctor — not the clerk at a
health-food store — for this information. It helps to buy all • antimalarials

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 Getting too much

W hile getting too little of essential micronutrients which are considered the gold standard of research.
can harm your health over the long haul, getting And even these studies often have their limitations.
too much can have equally worrisome effects, many The bottom line is clear: Don’t take more than
of which show up more swiftly. Most concerning are the recommended dose of any micronutrient through
excesses of fat-soluble vitamins from supplements, supplements unless there is a good reason to do so,
which the body may stockpile to the point of toxic- such as specific advice from your doctor, dietitian,
ity. The ones most likely to cause harm are vitamins or other qualified health professional. It is especially
A, E, and K, as explained in this chapter. (D is also important to avoid taking too much of the following
fat-soluble, but excesses don’t tend to cause problems.) vitamins and minerals.
High amounts of nutrients from supplements—
usually from taking individual vitamin and mineral Vitamin A
supplements in addition to a powerful multivitamin— It can be easy to ingest 10,000 IU (3,000 mcg) of
are often at fault. It’s much harder to get dangerous vitamin A—more than three times the amount rec-
amounts of micronutrients from food, partly because ommended for men and four times the amount rec-
of the body’s natural checks and balances. When iron ommended for women—if you eat a lot of fortified
stores are full, for example, your body absorbs less cereal in addition to taking a multivitamin containing
iron from food unless a genetic disorder or other retinol or retinyl compounds every day.
problem interferes. Your body also slows the conver- Plenty of research shows that too much vitamin
sion of beta carotene to vitamin A when it already has A can reduce bone density, possibly leading to osteo-
enough vitamin A from supplements or food sources. porosis or hip fractures. Excess vitamin A can have
But it is still possible to overdo it. other effects as well. For example, a person suffering
Many consumers are spurred to take excessive from vitamin A “intoxication” can experience sei-
supplement doses by overenthusiastic news stories on zures, headaches, and blurred vision. Birth defects
the potential benefits of certain vitamins and miner- occur more often when pregnant women take more
als. Remember, though, than 10,000 IU of sup-
that the good news from plemental vitamin A. To
the latest study may be protect yourself, get most
refuted by other stud- or all of your supplemen-
ies. Promising test-tube tal vitamin A in the form
and animal studies often of beta carotene, and try
don’t pan out in people. to stick to the RDA for
And certain types of vitamin A.
© woraput | Getty Images

human studies offer more

definitive information Vitamin E
than others. Sometimes, Despite considerable and
exciting results from ini- consistent evidence from
tial observational studies It’s hard to get too much of the essential micronutrients from food, clinical trials showing
aren’t confirmed by ran- but very easy to get too much through supplements. Stick to the that vitamin E supple-
domized controlled trials, RDA unless you have specific advice from your doctor or dietitian. ments don’t help and may

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even be harmful (see “Vitamin E,” page 26), some Iron
people still take these supplements. If you take more Hemochromatosis is the medical term for too much
than 1,200 IU (800 mg) per day, you risk side effects iron in the body. A common genetic glitch called
such as bleeding, headache, fatigue, and blurred hereditary hemochromatosis leaves about 1.5 million
vision. Two clinical trials have also found evidence Americans prone to a glut of iron, although not auto-
that high intakes of vitamin E from supplements may matically doomed to it. Large amounts of iron sup-
raise the risk for hemorrhagic (bleeding) strokes. plements, multiple blood transfusions, drinking too
To be on the safe side, talk with your doctor before much alcohol, and some rare metabolic disorders can
taking more than the RDA for vitamin E to avoid also trigger an iron overload, which can damage body
increasing your risk of bleeding, especially if you also tissues and raise risks for infection, heart disease, liver
take the blood thinner warfarin (Coumadin). cancer, and arthritis over time.
In addition, taking large quantities of vitamin C
Vitamin K from supplements allows your body to absorb more
Because vitamin K can influence blood clotting, if you iron than it normally would accept and to release more
take warfarin it’s important to keep your vitamin K stored iron than necessary. This causes an upswing in
intake consistent from day to day. Discuss this with free iron, which attacks DNA, cell lipids, and protein.
your doctor if you are taking this medication. Free iron also rises when abnormally high levels of
iron accumulate in the body for other reasons.
Calcium (for men) Excess iron is not easily shed. More men than
Some large observational studies and clinical trials women suffer from an overabundance of iron; in fact,
have linked calcium supplement use to a higher risk of men are twice as likely to have iron overload than iron
cardiovascular disease, although others found no such deficiency.
association. In 2016, an expert panel convened by the The tolerable upper intake level for iron is 45 mg
American Society for Preventive Cardiology and the a day. A child can die from poisoning after taking as
National Osteoporosis Foundation concluded that few as five pills that each contain 200 mg of iron. Any
getting calcium from foods or supplements, with or supplements that contain iron—especially chewable
without vitamin D, neither increases nor decreases the children’s multivitamins that look like candy—should
risk for cardiovascular problems, based on moderate- be stored well away from children.
quality evidence.
Some observational studies have linked a high Zinc
intake of calcium (from foods as well as supplements) Getting enough—but not too much—of the trace
to increased risk of prostate cancer, though others mineral zinc is a bit of a balancing act. The RDA for
have tried and failed to find such a connection. In zinc is 8 mg for women and 11 mg for men, and the
some—but not all—studies, higher calcium intake upper limit for all adults is 40 mg. Because taking
was associated with greater risk for more aggres- large amounts of zinc for an extended period can have
sive, more advanced, or more lethal forms of prostate harmful effects, it’s best to get your zinc from food,
cancer. not supplements.
As there are many food sources of calcium avail- Your overall diet affects how much zinc your
able, men should avoid getting excessive calcium body typically absorbs from food. Interestingly, you
through supplements unless there are concerns about are likely to absorb less zinc if you choose a diet rich
insufficient intake—which would warrant a discussion in healthy whole grains and with very little animal
with a physician or a nutritionist. protein. 

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 So, should you take supplements?

I n the 1980s, many nutritionists and some physicians

began to recommend (and take) vitamin supple-
ments. However, as described earlier in this report, the
Observational studies have shown no consis-
tent benefits to taking multis for major clinical out-
comes such as cardiovascular disease and cancer. For
evidence for the health benefits of most supplements example, in the Nurses’ Health Study—a prospective,
is not strong. And taking individual supplements is 32-year observational trial of 86,142 women—the use
not generally advised unless your clinician or a dieti- of multis was not found to reduce the incidence of
tian recommends it. Notable exceptions are vitamin stroke or death, even in women with a poor-quality
D for bone health and folic acid during pregnancy, diet—the very women who should gain the most from
and older Americans and vegans should also consider taking supplements. And a 2018 systematic review
a B12 supplement. Although foods that contain vita- and meta-analysis of 179 studies found no proof that
min A and beta carotene, as well as vitamins B, C, and multivitamin-multimineral supplements prevent or
E, are clearly good for health, taking supplements of treat cardiovascular disease.
these vitamins has no proven health benefits. The upshot of this is that we need more high-quality,
What about a simple multivitamin-multimineral large-scale research to carefully evaluate any potential
supplement—a product that is designed to meet the benefits and risks of multivitamin-multimineral supple-
RDAs and to compensate for dietary shortfalls? “Mul- ments. The most recent example is the Cocoa Supple-
tis” are the most popular among all dietary supple- ment and Multivitamin Outcomes Study (COSMOS).
ments—half of Americans take them on a regular In a 3.6-year randomized controlled trial, researchers at
basis, shelling out more than $20 billion annually on Harvard Medical School and the Fred Hutchinson Can-
these products. On an individual basis, a daily multi- cer Center in Seattle recruited 12,666 women ages 65
vitamin won’t set you back that much: a year’s supply and older and 8,776 men 60 and older. The study was
of many popular brands costs about $30 to $50. designed to find out whether taking cocoa extract sup-
However, the composition of these tablets varies plements (500 mg per day of cocoa flavanols) or a com-
widely, with some containing all of the essential vita- mon multivitamin reduces the risk for heart disease,
mins and minerals, and some containing just a few of
them. And despite the widespread belief that multivi-
tamin-multimineral supplements will prevent chronic
diseases such as cancer and heart disease, the U.S. Pre-
ventive Services Task Force has concluded that there
isn’t enough evidence to support such claims.
© Janine Lamontagne | Getty Images

In the first large-scale, long-term randomized

controlled trial that tested the effects of a regular mul-
tivitamin—the Physicians’ Health Study II, which
involved 14,641 male doctors—men who took a daily
multi for over a decade had no less risk of having a
heart attack or stroke or dying of cardiovascular dis-
ease than those who did not take one. However, they When choosing a mutlivitamin, look for one with 100% of the DV
did have an 8% reduction in cancer and a 9% reduc- for vitamin D, vitamin B12, and folic acid. Higher amounts of other
tion in the development of cataracts. vitamins may do more harm than good.

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stroke, cancer, and other important age-related health Know before you buy
problems. In COSMOS, the cocoa flavanols reduced Shopping for any kind of supplement can be confus-
total cardiovascular disease by 10% (however, this was ing. A staggering array of multivitamins and other
not statistically significant). Of note, cocoa flavanols supplements crowd the shelves of pharmacies, gro-
reduced deaths from cardiovascular disease by 27%. cery stores, and specialty stores, and many more are
On the other hand, the cocoa supplementation had no now available over the Internet. Before you buy, it’s
effect on invasive cancer. The multivitamin, in contrast, wise to realize that some of these products may offer
had no overall effect on either cardiovascular disease or much more—or possibly less—than you really need to
cancer, but did raise blood levels of important nutrients enhance your health.
such as vitamin D and several B vitamins. Dietary supplements may legally contain vita-
The good news is that of all vitamin or mineral mins, minerals, herbs, amino acids, enzymes, organ
supplements you could take, a standard multivitamin- tissues, and a few other substances—in short, practi-
multimineral supplement has the fewest potential cally any ingredient promoted as a way to bolster your
downsides and the most potential benefits for your diet and, presumably, your health. The FDA does not
health. In addition, taking one is already part of some certify supplements for safety or effectiveness in the
official recommendations. The federal government’s same way it monitors drugs. Under the Dietary Sup-
Dietary Guidelines for Americans suggest that people plement Health and Education Act of 1994, the FDA
over age 50 consider a vitamin B12 supplement or a does not have the authority to approve supplements or
multi as a way to ensure adequate vitamin B12 intake. demand that manufacturers undertake rigorous stud-
And the CDC advises all women of childbearing age ies to prove their worth. The FDA doesn’t set potency
to take folic acid—typically included in a multi— or dosage standards, either.
because doing so lowers the risk of birth defects (see Manufacturers are left to police themselves. And
“Vitamin B9,” page 19). before a worrisome supplement can be pulled off the
When choosing a multi, look for an inexpen- market, the FDA has to prove that it creates a signifi-
sive preparation from a mainstream manufacturer to cant health risk. This can lead to problems, as dem-
ensure quality and consistency. It should contain 100% onstrated by a report from ConsumerLab.com, an
of the DV for vitamin D, vitamin B6, vitamin B12, and industry watchdog organization. The organization
folic acid. Extra vitamin D is unlikely to be harmful— tested the quality and contents of 27 leading multivi-
as noted earlier, many experts recommend 1,000 IU, tamin and multimineral products sold in the United
which is well above the DV, and is now found in many States and Canada. Almost half of the products did
formulations. But extra amounts of other vitamins not receive the group’s approval. Gummies had the
may do more harm than good. lowest quality of all products tested, often containing
What about supplements aimed at women, men, far more or far less of listed nutrients than the label
and seniors? While some of these formulas may be claimed. (Some variation in the amount of vitamins
helpful in certain cases, others are merely marketing and minerals in a product is to be expected because
gimmicks designed to enhance profits rather than supplements will slowly and naturally degrade over
your health. Products vary widely; read the labels to the course of their shelf life; pay attention to expira-
make sure you get what you need while staying within tion dates on the packaging.) Moreover, some tablet
safe limits for your age and sex. products did not disintegrate quickly enough for all
Don’t waste your money on high-potency, “all natu- nutrients to be absorbed in the gut.
ral,” or designer vitamins that tend to be more expensive While supplement manufacturers can’t legally
and less rigorously tested for safety. Above all, remem- claim to prevent, treat, or cure specific diseases, they
ber that your daily multi is not a substitute for a healthy can come pretty close. They are allowed to make
diet. It is, at best, an insurance policy covering shortfalls “structure-function” claims that sound impressive to
and may or may not provide long-term health benefits. most consumers. A product may “build strong teeth”

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 or “improve memory” or “boost the immune system.” claims plausible? Are the suggested dosages safe? The
Manufacturers can make these assertions without following advice should help answer these questions
supplying a stitch of proof to any agency. Your cue for and guide you as you make your choices.
healthy skepticism should be the words printed along- Consider your particular nutrient needs. Start
side: “This statement has not been evaluated by the by checking the label of your multivitamin-multi-
Food and Drug Administration.” mineral supplement, looking at the recommended
Certain health claims backed by substantial scien- amounts listed in Tables 1 and 2 on pages 8 and 11,
tific agreement and not limited to particular brands respectively, and assessing your diet (see “Decoding
can appear on supplement bottles. For example, sup- your diet,” page 42). Are you getting too little vitamin
plement manufacturers can advertise that “calcium D? Need extra calcium? Looking for lutein or other
helps protect against osteoporosis” and “folic acid may potentially beneficial phytochemicals? Your first line
prevent neural tube defects in fetuses,” because these of defense should be through food. Rearrange your
statements are borne out by science and have been diet to include more sources of the nutrients you’re
carefully evaluated (see “Understanding health claims lacking. For those nutrients that may be hard to get
on labels,” below). through food, such as vitamin D and calcium, con-
sider buying separate supplements.
Look for a seal of approval. Choose products that
Advice on choosing a supplement bear the U.S. Pharmacopeia Dietary Supplement Veri-
Buying supplements can raise many questions. Should fication Program (USP-DSVP) mark, which indicates
you choose supplements derived from natural ingre- that the supplement manufacturer has complied with
dients? Do brand-name supplements have any advan- certain standards. Supplements vetted by the USP-
tage over less expensive store brands? Are the health DSVP should contain the ingredients noted on the

Understanding health claims on labels

M any foods, beverages, vitamin and mineral supplements,

and other products tout impressive claims about their
potential health benefits. Unlike prescription medications,
A food or supplement
manufacturer must submit
a petition to the FDA
© kali9 | Getty Images

which must go through a series of safety and efficacy trials with sufficient research
before receiving FDA approval, foods and supplements do not to support the approval
routinely undergo the same level of scrutiny. Here are the four of that qualified health
types of health claims they make — and what they actually claim. While a qualified
mean. health claim must be
supported by some scientific evidence, it does not necessarily
Nutrient content claims describe the amount of a specific
meet the higher standard for significant scientific agreement.
nutrient in a food product — for example, free of saturated
As a result, qualified health claims must be accompanied by a
fat, high in vitamin C, or low in sugar. However, just because a
disclaimer — for example, “Whole grains may reduce the risk
food is low in saturated fat, that does not stop it from having
of type 2 diabetes, although the FDA has concluded that there
high levels of sugar, for example.
is very limited scientific evidence for this claim.”
Structure and function claims describe how dietary
Authorized health claims are a step above qualified health
components of a food product may affect structures or
claims and must have significant scientific agreement among
functions of the body. They tend to be general in nature. For
qualified experts, with publicly available scientific evidence
instance, a food with antioxidants may maintain cell integrity,
submitted to the FDA to back them up. These claims describe
but how does that translate to your overall health?
a relationship between a specific food, food component,
Qualified health claims describe how particular foods or or nutrient and a disease or health-related condition. For
nutrients affect specific health outcomes and offer greater example, “Diets low in sodium may reduce the risk of high
supportive evidence than structure and function claims. blood pressure, a disease associated with many factors.”

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label in the amounts and strengths stated. The prod- ciently in synthetic rather than natural forms. Vita-
uct should dissolve within 30 to 45 minutes so that the min K and folic acid are two examples. If you’re not
nutrients enter your bloodstream, rather than passing sensitive to specific ingredients, such as wheat, rice, or
through your body intact. It shouldn’t contain more lactose, there’s no need to pay more for allergen-free
than allowable levels of contaminants. Other product products. “High potency” isn’t a plus in cases when
safety organizations include ConsumerLab. more is not better.
com, which ranks herbs and supplements Keep it simple! If you feel compelled
based on quality and content, and NSF to take a handful of supplements each
International, a nonprofit organization that day, consider the bigger picture of how to
develops standards and certifies products improve or fine-tune your overall diet. Meet
related to public health, safety, and environ- with a nutritionist or start with your pri-
mental protection. mary care provider for guidance. You might
The U.S. Pharmacopeia
Consider safe levels. Supplements Dietary Supplement avoid the need for supplements all together.
vary widely in the amounts of nutrients Verification Program Avoid gummy vitamins, unless you
they contain, so take a moment to read the (USP-DSVP) mark cannot swallow pills. Gummies typically
label before deciding on a purchase. Much contain fewer vitamins and minerals and
like packaged foods, which have a Nutrition Facts in lower amounts than multivitamin tablets. Plus you
label, all dietary supplements have a Supplement Facts have to take them twice a day, and they have more cal-
label that lists the DVs of nutrients in a single serv- ories and added sugar.
ing. It also notes the actual amount of each nutrient Don’t pay more for unproven extras. Generally,
included. For trace minerals, such as iron, fluoride, if you’re hoping for phytochemical benefits, you’ll do
and zinc, it’s safest not to exceed the DV at all. Some better in the produce department than the supplement
experts even recommend getting these micronutrients aisle. There is virtually no evidence that herbs and
only through food. If you take individual supplements other nonvitamin ingredients added to supplements
(such as extra vitamin D tablets) as well as a multivi- are essential for your health. Supplements that list
tamin, be sure to total up the amounts you’re getting substances such as PABA (para-aminobenzoic acid)
from every source, including food. Fortified breakfast and ubiquinone (coenzyme Q10) are trading on good
cereals can bump up your intake of vitamins and min- press from research that shows them to be necessary
erals considerably. A single serving of certain break- for growth in bacteria or other life forms, rather than
fast cereals can deliver as much as or more than your substantial evidence from studies in people.
daily multivitamin. That may not be a problem with Beware of potentially dangerous interactions.
vitamin C, but it might pose health risks with iron or Pay attention to warnings on the label, and tell your
vitamin A. doctor and pharmacist what supplements you take
Consider price. Compare active ingredients on (see “Medications and micronutrients,” page 46).
the labels, then let price be your guide. Store brands Report any serious ill effects. Let your doctor
spend less on advertising than nationally known know about any side effects that you attribute to a sup-
brands and pass on the savings to the consumer. plement. He or she may pass along the information
Ignore marketing gimmicks. It doesn’t matter to FDA MedWatch, if appropriate. Or you can con-
whether vitamin C is derived from organic rose hips tact MedWatch directly at 800-FDA-1088 or through
or synthesized in large batches in a laboratory; your the website at www.fda.gov/safety/medwatch. Also
body will use the resulting product similarly. In fact, inform the manufacturer or distributor and the store
your body absorbs certain micronutrients more effi- where you purchased it. 

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 Resources
Organizations This is the umbrella group that includes the Health and Medicine
Division (formerly called the Institute of Medicine, or IOM), which
Academy of Nutrition and Dietetics oversees guidelines for nutrient intakes. You can purchase reports
120 S. Riverside Plaza, Suite 2000 on a variety of nutrition topics or read them for free online.
Chicago, IL 60606
800-877-1600 (toll-free) National Center for Complementary and Integrative Health
www.eatright.org 9000 Rockville Pike
This national organization of food and nutrition professionals has Bethesda, MD 20892
an extensive consumer website offering information on health, 888-644-6226 (toll-free)
food, and fitness. It includes consumer tips, nutrition fact sheets, www.nccih.nih.gov
and healthy recipes, along with information on how to get the Part of the National Institutes of Health, this government agency
vitamins and minerals you need through healthy food choices. is a great resource if you’re looking for publications and research
on dietary supplements, including herbal medicines. You can
American Cancer Society (ACS) speak to an information specialist from 10:00 a.m. to 4 p.m.
3380 Chastain Meadows Parkway NW ET, Monday through Friday (except federal holidays), or request
Kennesaw, GA 30144 information by filling out the online comment form or sending an
800-227-2345 (toll-free) email to [email protected].
www.cancer.org
This website of this pre-eminent cancer organization offers a U.S. Department of Health and Human Services
wealth of information on cancer risk, treatment, and research. Office of Disease Prevention and Health Promotion
Go to the “Stay Healthy” tab, then click on “Eat Healthy and Get 1101 Wootton Parkway, Suite 420
Active” to find the ACS recommendations for healthy eating and Rockville, MD 20852
exercise that can help reduce cancer risk. https://health.gov
This consumer website from the U.S. Department of Health and
American Heart Association (AHA) Human Services offers information on various aspects of a healthy
7272 Greenville Ave. lifestyle. Go to “Food and Nutrition,” then “Current Dietary
Dallas, TX 75231 Guidelines,” for the most recent version of the Dietary Guidelines.
800-242-8721 (toll-free)
www.heart.org/en/healthy-living
Publications
Under the AHA website’s “Healthy for Good” listing, you’ll find a
The following publications provide additional information about
wealth of articles and quizzes on healthy eating at home and in
topics in this report. To order, call 877-649-9457 (toll-free), or go
restaurants, along with simple heart-healthy recipes.
online to www.health.harvard.edu.
ConsumerLab.com
333 Mamaroneck Ave. The Benefits of Probiotics
White Plains, NY 10605 W. Allan Walker, M.D., Medical Editor
914-722-9149 (Harvard Medical School, 2020)
https://www.consumerlab.com This digital publication reviews the scientific evidence for probiot-
If you’re looking for comprehensive reviews of herbs and supple- ics. It catalogs the different strains and species and what they’re
ments, this subscription service offers sound advice with rankings helpful for, and explains ways to get more probiotics in your diet.
and grades — sort of a Consumer Reports for supplements. It pro- The Harvard Medical School 6-Week Plan for Healthy Eating
vides in-depth information about products, recalls, and warnings. Teresa Fung, Sc.D., R.D., L.D.N., and Kathy McManus, M.S., R.D.,
Food and Drug Administration (FDA) L.D.N., Nutrition Editors
10903 New Hampshire Ave. (Harvard Medical School, 2019)
Silver Spring, MD 20993 Knowing what you ought to eat and actually doing it are two dif-
888-463-6332 ferent things. This Special Health Report from Harvard Medical
www.fda.gov/food School walks you through a set of weekly changes that will help
The food section of the FDA’s website is your go-to site for infor- you transform your diet in healthy ways, one step at a time.
mation on dietary supplements. The website and toll-free hotline Healthy Eating: Strategies, tips, and recipes to help you
offer information, including warnings and recalls, about dietary make better food choices
supplements and other products. You can also report problems Teresa Fung, Sc.D., R.D., L.D.N., Faculty Editor, and Sharon Palmer,
with foods and supplements via the website. R.D.N., Nutrition Editor
National Academies of Sciences, Engineering, and Medicine (Harvard Medical School, 2019)
500 Fifth St. NW This report explains how to choose the right foods for maximum
Washington, DC 20001 health. It includes information on healthy snacking, meal plan-
202-334-2000 ning, trimming salt, restaurant survival strategies, and finding
www.nationalacademies.org hidden sources of sugar. Includes 23 recipes.

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