Bone Health Supplement For Women | Diet Supplement For Ramadan

Therapeutic vitamins A and D (link D2), and their analogs and antioxidants vitamin C (link C2), vitamin E (link E2), and coenzyme Q vitamins play an increasing role in skin care. Their benefits range from skin conditions such as acne and psoriasis to the protection against environmental insults (1).

In accordance with one study a micronutrients present in the diet such as carotenoids, vitamins E and C, and polyphenols contribute to antioxidant defense and may also contribute to endogenous photo protection.

Combination of vitamins E and C protects the skin against UV damage. It is suggested that daily consumption of dietary polyphenols may provide efficient protection against the harmful effects of solar UV radiation in humans. Furthermore, the use of these micronutrients in combination may provide an effective strategy for protecting human skin from damage by UV exposure (2).

In another study was shown that oral vitamin D supplement could reduce skin colonization of S. aureus and
demonstrated the clinical improvement of patients with atopic dermatitis (3).

Niacin (PP vitamin) (link I2) influences water transformation of skin, causes angiectasia, detoxifies skin and is necessary for keeping hair in the proper state.(4)

Vit C

It was shown, also, that normal skin contains high concentrations of vitamin C, which supports important and well-known functions, stimulating collagen synthesis and assisting in antioxidant protection against UV-induced photodamage.

One of the most compelling arguments for a vital role for vitamin C in skin health is the association
between vitamin C deficiency and the loss of a number of important skin functions. In particular, poor wound healing (associated with collagen formation), thickening of the stratum corneum and subcutaneous bleeding (due to fragility and loss of connective tissue morphology) are extreme and rapid in onset in vitamin-C-deficient individuals. It is thought that similar processes occur when body stores are below optimal, although to a lesser extent Good skin health is positively associated with fruit and vegetable intake in a number of well-executed intervention studies. The active component in the fruit and vegetables responsible for the observed benefit is unidentified, and the effect is likely to be multi-factorial, although vitamin C status is closely aligned with fruit and vegetable intake.

Signs of aging in human skin can be ameliorated through the provision of vitamin C. A number of studies support this, although measurement of skin changes is difficult. Some studies include objective measures of collagen deposition and wrinkle depth.

The provision of vitamin C to the skin greatly assists wound healing and minimizes raised scar formation. This has been demonstrated in numerous clinical studies in humans and animals. (5).

Zinc

The skin is the third most zinc (Zn) (link S2)-abundant tissue in the body. The skin consists of the epidermis, dermis, and subcutaneous tissue, and each fraction is composed of various types of cells.

Several human disorders accompanied with skin manifestations are caused by mutations or dysregulation in Zn transporters. Additionally, acquired Zn deficiency is deeply involved in the development of some diseases related to nutritional deficiencies (acquired acrodermatitis enteropathica, necrolytic migratory erythema, pellagra, and biotin deficiency), alopecia, and delayed wound healing.

ZnD is a current problem in both developing and developed countries. We have to pay attention to cutaneous symptoms in order not to miss the ‘dermadrome’ of ZnD. (6)

Vitamins and minerals are the popular components of skin case supplements

In one study mixture of lycopene (3 mg/day), lutein (3 mg/day), beta-carotene (provitamin A carotenoid, 4.8 mg/day), alpha-tocopherol (Vitamin E, 10 mg/day) and selenium (link T2) (75 microg/day) was studied. Skin density and thickness were determined by ultrasound measurements. A significant increase for both parameters was determined in the verum groups. Roughness, scaling, smoothness, and wrinkling of the skin were determined by Surface Evaluation of Living Skin (Visioscan). Roughness and scaling were improved by the supplementation with antioxidant micronutrients. In the placebo group, no changes were found for any of the parameters (7)

In another study, the active ingredients were vitamins C and E, carotenoids, selenium, zinc, amino acids and glycosaminoglycans, blueberry extract and Pycnogenol Skin elasticity was found to be statistically significantly increased by 9% after 6 weeks of treatment compared with placebo. Skin roughness, as evaluated by three-dimensional micro topography imaging, was found to be statistically significantly lowered by 6% compared with the control group after 12 weeks treatment(8).

BONES

The proper dietary Calcium (link O2) intake and calcium supplementation, when indicated, are important factors in the acquisition of peak bone mass during youth and in the prevention of fractures in old age. In addition to its deposition in bone, calcium confers an increase in its resistance and exhibits important activities in different enzymatic pathways in the body (e.g., neural, hormonal, muscle-related and blood clotting pathways). (1)

Concerning Vitamin D (link D2), the main effect of the active vitamin D metabolite 1,25(OH)2D is to stimulate the absorption of calcium from the gut. The consequences of vitamin D deficiency are secondary hyperparathyroidism and bone loss, leading to osteoporosis and fractures, mineralization defects, which may lead to osteomalacia in the long term, and muscle weakness, causing falls and fractures. Vitamin D status is related to bone mineral density and bone turnover. Vitamin D supplementation may decrease bone turnover and increase bone mineral density. Several randomized placebo-controlled trials with vitamin D and calcium showed a significant decrease in fracture incidence. (2)

A tight control of Magnesium (link R2) homeostasis seems to be crucial for bone health. Magnesium deficiency contributes to osteoporosis directly by acting on crystal formation and on bone cells and indirectly by impacting on the secretion and the activity of parathyroid hormone and by promoting low grade inflammation. Less is known about the mechanisms responsible for the mineralization defects observed when magnesium is elevated. Overall, controlling and maintaining magnesium homeostasis represents a helpful intervention to maintain bone integrity (3).

Also one study indicates that decreased bone mass and an increased risk of bone fractures become more common with age. This condition is often associated with osteoporosis and is caused by an imbalance of bone resorption and new bone formation. Lifestyle factors that affect the risk of osteoporosis include alcohol, diet, hormones, physical activity, and smoking. Calcium and vitamin D are particularly important for the age-related loss of bone density and skeletal muscle mass, but other minerals, such as magnesium, also have an important role. Article summarizes how optimal magnesium and vitamin D balance improve health outcomes in the elderly, the role of magnesium and vitamin D on bone formation, and the implications of widespread deficiency of these factors in the United States and worldwide, particularly in the elderly population.(4)

Also in another study was evaluated the Effect of Prenatal Calcium Supplementation on Bone During Pregnancy and 1 Y Postpartum. Study reminds that low calcium intake during pregnancy may cause maternal skeletal calcium mobilization to meet fetal needs. The Recommended Dietary Allowance (RDA) for calcium in nonpregnant, pregnant, or lactating women aged 19-50 y is 1000 mg/d. An insufficient calcium intake could increase maternal bone loss during pregnancy and reduce bone recovery postpartum.
Data the study show that supplemental calcium provided during pregnancy may improve bone recovery postpartum in women (5)

Teeth

In accordance with Monographs in Oral Science a lower intake of vitamin A (link B2) has been associated with decreased oral epithelial development, impaired tooth formation, enamel hypoplasia and periodontitis. Vitamin D (link D2) deficiency during tooth development may result in non-syndromic amelogenesis and dentinogenesis imperfecta, enamel and dentin hypoplasia, and dysplasia. Clinical studies have demonstrated an association between vitamin D’s endocrine effects and periodontitis. On the other hand, no significant association has been found between cariogenic activity and vitamin D deficiency. Vitamin C (link C2) deficiency results in changes in the gingivae and bone, as well as xerostomia; while vitamins B deficiencies are associated with recurrent aphthous stomatitis, enamel hypomineralization, cheilosis, cheilitis, halitosis, gingivitis, glossitis, atrophy of the lingual papillae, stomatitis, rashes around the nose, dysphagia, and pallor.

The effects of vitamins E (link E2) and K (link F2) on oral health are not as clear as those of other vitamins. However, vitamin K has a systemic effect (increasing the risk of haemorrhage), which may affect individuals undergoing oral surgery or suffering an oral injury. (1)

One study emphasizes, that nutrition plays an important role, especially key vitamins D3 (link D2) and K2 which are necessary for proper dentofacial development and food consistency influence on crowding and dental arches narrowing. Changes in our dentition and facial appearance are caused by changing our diet from primitive hunter gatherer to a more modern industrialized agriculture. Nutrition and its impact on epigeneticaly-mediated mechanisms continuously shape our phenotype which impacts overall health and can reverse the path for overall health and facial bone development. Orthodontics and nutrition both play a role in following nature’s path to reestablishing facial balance and dental arches proportions to accommodate all 32 teeth (2).

Evaluation of association between the number of teeth and dietary intake was conducted a cross-sectional analysis of data from 2049 individuals aged ≥ 50 years.
In accordance with study results, carbohydrate intake was higher whereas protein, minerals (potassium, magnesium (link R2), and zinc (link S2)), vitamins (vitamins A (link B2), E (link E2), B1 (link G2) B6 (link I2) , β-carotene, and folic acid (link K2)), and dietary fiber intakes were lower among individuals with fewer teeth (3)

One more study about effects of Vitamin D (link D2) status on oral health informs, that inadequate vitamin D status has shown to be associated with a wide variety of diseases, including oral health disorders. Insufficient sunlight exposure may accelerate some of these diseases, possibly due to impaired vitamin D synthesis. The beneficial effects of vitamin D on oral health are not only limited to the direct effects on the tooth mineralization, but are also exerted through the anti-inflammatory functions and the ability to stimulate the production of anti-microbial peptides (4)

Also available information shows a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases, which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. One of possible mechanisms of that connects PDs with adverse pregnancy outcome is maternal vitamin D status. On the base of trials, a role of inadequate vitamin D status in the genesis of PDs has been reported., and was stated that administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes(5).

In accordance with another study that evaluated the association between dietary vit C (link C2) intake and periodontitis in the representative Korean adult population (a total of 10,930 Korean adults (≥19 years), those with inadequate dietary vit C intake were more likely by 1.16 times to have periodontitis than those with adequate dietary vit C intake. Were concluded that inadequate dietary vit C intake was independently associated with periodontitis among Korean adults. Hence, adequate intake of dietary vitamin C could be substantially important on the promotion of periodontal health among Korean adults (6).

Vitamin D

In accordance with resent review Vitamin D (link D2) deficiency is associated with oxidative stress in skeletal muscle that influences the mitochondrial function and affects the development of skeletal muscle atrophy. Namely, vitamin D deficiency decreases oxygen consumption rate and induces disruption of mitochondrial function. These deleterious consequences on muscle may be associated through the vitamin D receptor (VDR) action. Moreover, vitamin D deficiency may contribute to the development of muscle atrophy.

For example is one study HD patients received calcitriol or paricalcitol (active vitamin D) for control of secondary hyperparathyroidism. Patients in the VitD group had larger thigh muscle cross-sectional areas and were stronger across all strength measures after controlling for age and gender. There were no significant differences in any measurements between patients who received calcitriol or paricalcitol. (2

Vitamin D is known to be important for calcium homeostasis and bone metabolism. It also has important direct effects on skeletal muscle. In accordance with another review in some studies, vitamin D supplementation has been shown to increase muscle strength, particularly in people who are vitamin D deficient. Higher serum levels of vitamin D are associated with reduced injury rates and improved sports performance. In a subset of the population, vitamin D appears to play a role in muscle strength, injury prevention, and sports performance. (3)

Combined vitamin D and calcium

One says about effects of enhanced exercise and combined vitamin D and calcium supplementation on muscular strength and fracture occurrence in postmenopausal women with a high risk of osteoporosis. In conclusion enhanced exercise and combined calcium vitamin D supplementation may help sustain muscle strength in postmenopausal women, while calcium and vitamin D supplementation may improve muscular strength within a short period of time. (4)

Magnesium

In accordance with one comprehensive review (5) some cross-sectional surveys demonstrated a positive association between Magnesium (link R2) status and muscle performance, including grip strength, lower-leg power, knee extension torque, ankle extension strength, maximal isometric trunk flexion, rotation, and jumping performance. Additionally, findings from intervention studies showed that Mg supplementation might lead to improvements in functional indices such as quadriceps torque. Moreover, Mg supplementation could improve gait speed and chair stand time in elderly women.

Cysteine Synthesis, Protein Synthesis and Sulphur Amino Acid Metabolism

Sulphur-containing amino acids include methionine, cysteine, homocysteine, and taurine. Methionine and cysteine are classified as proteinogenic, canonic amino acids incorporated in protein structure. Sulphur amino acids are involved in the synthesis of intracellular antioxidants such as glutathione and N-acetyl cysteine. Moreover, naturally occurring sulphur-containing ligands are effective and safe detoxifying agents, often used in order to prevent toxic metal ions effects and their accumulation in human body (1)

Vitamin B6

Vitamin B6 (link J2) has a central role in the metabolism of amino acids, which includes important interactions with endogenous redox reactions through its effects on the glutathione peroxidase (GPX) system. In fact, B6-dependent enzymes catalyse most reactions of the transsulfuration pathway, driving homocysteine to cysteine and further into GPX proteins. (2)

Molybdenium

In humans, 4 enzymes requiring Molybdenum (link R2) have been identified to date: sulfite oxidase, xanthine oxidase, aldehyde oxidase, and mitochondrial amidoxime-reducing component (mARC). Sulfite oxidase, an enzyme found in mitochondria, catalyzes oxidation of sulfite to sulfate, the final step in oxidation of sulfur amino acids (cysteine and methionine). (3)

Selenium

The importance of Selenium (Se) (link T2) as an essential trace element is linked to its role as selenocysteine
Selenocysteine, the selenium-containing analogue of cysteine, is the twenty-first proteinogenic amino acid. It was discovered almost fifty years ago (4) It plays role in a number of selenoproteins including antioxidant enzymes.

These enzymes protect tissues against the damaging effect of reactive oxygen species (ROS) and other endogenous products of cellular metabolism implicated in DNA damage and potentially leading to mutagenesis, cell death, and carcinogenesis. For example one review informs that reduced body Se and antioxidant enzyme activity during pregnancy results in oxidative stress within tissues contributing to premature birth, miscarriage, preeclampsia, and intrauterine growth retardation (5).

Zinc

In the past five years there has been a great expansion in our knowledge of the role of Zinc (link S2) in the structure and function of proteins. Not only is zinc required for essential catalytic functions in enzymes (more than 300 are known at present), but also it stabilizes and even induces the folding of protein subdomains. The latter functions have been most dramatically illustrated by the discovery of the essential role of zinc in the folding of the DNA-binding domains of eukaryotic transcription factors, including the zinc finger transcription factors ( factors are protein that controls the rate of transcription of genetic information from DNA to messenger RNA), the large family of hormone receptor proteins, and the zinc cluster transcription factors from yeasts. Similar functions are highly probable for the zinc found in the RNA polymerases and the zinc-containing accessory proteins involved in nucleic acid replication. The rapid increase in the number and nature of the proteins in which zinc functions is not unexpected since zinc is the second most abundant trace metal found in eukaryotic organisms, second only to iron. If one subtracts the amount of iron found in hemoglobin, zinc becomes the most abundant trace metal found in the human body.(6)

E.g. results of one experiment suggest that Zinc can regulate the synthesis of specific proteins rat liver through changes in the relative abundance of specific mRNAs (7).

Also, since organic matrix in bone is mainly composed of protein and since zinc is an essential trace mineral that is a component of >200 enzymes and is known to be necessary for normal collagen synthesis and mineralization of bone, a significant correlation between human bone zinc content and bone strength exists. Low zinc intake has been reported to be associated with low bone mass in women. Furthermore, reduced serum or plasma zinc concentrations and increased urinary zinc excretion have also been reported in women with osteoporosis. (8)

Cognitive Function

Iron

In accordance with one study (1). Evidence suggests that brain Iron (link P2) deficiency at any time in life may disrupt metabolic processes and subsequently change cognitive and behavioral functioning. Women of reproductive age are among those most vulnerable to iron deficiency and may be at high risk for cognitive alterations due to iron deficiency.
A blinded, placebo-controlled, stratified intervention study was conducted in women aged 18-35 y of varied iron status who were randomly assigned to receive iron supplements or a placebo. Cognition was assessed by using 8 cognitive performance tasks

At baseline, the iron-sufficient women performed better on cognitive tasks and completed them faster than did the women with iron deficiency anemia.

After treatment, a significant improvement in serum ferritin was associated with a 5-7-fold improvement in cognitive performance, whereas a significant improvement in hemoglobin was related to improved speed in completing the cognitive tasks.

It was confirmed that iron status is a significant factor in cognitive performance in women of reproductive age. Severity of anemia primarily affects processing speed, and severity of iron deficiency affects accuracy of cognitive function over a broad range of tasks. Thus, the effects of iron deficiency on cognition are not limited to the developing brain.

Zinc

In accordance with one review (2) zinc deficiency may affect cognitive development by alterations in attention, activity, neuropsychological behavior and motor development. The exact mechanisms are not clear but it appears that Zinc (link to S2) is essential for neurogenesis, neuronal migration, synaptogenesis and its deficiency could interfere with neurotransmission and subsequent neuropsychological behavior. Studies in animals show that zinc deficiency during the time of rapid brain growth, or during the juvenile and adolescent period affects cognitive development by decreasing activity, increasing emotional behavior, impairing memory and the capacity to learn. Evidence from human studies is limited. Low maternal intakes of zinc during pregnancy and lactation were found to be associated with less focused attention in neonates and decreased motor functions at 6 months of age. Zinc supplementation resulted in better motor development and more playfulness in low birth weight infants and increased vigorous and functional activity in infants and toddlers. In older school going children the data is controversial but there is some evidence of improved neuropsychological functions with zinc supplementation.

For example a randomized double-blind placebo-controlled design (3) was employed to investigate the effects of Zn supplementation on cognitive function in 387 healthy adults aged 55-87 years. Several measures of visual memory, working memory, attention and reaction time were obtained at baseline and then after 3 and 6 months of 0 (placebo), 15 or 30 mg Zn/d.

There were significant interactions indicating a beneficial effect (at 3 months only) of both 15 and 30 mg/d on one measure of spatial working memory and a detrimental effect of 15 mg/d on one measure of attention.

Iodine

Cognitive impairments are the main consequences of iron deficiencies (ID. One of them is endemic cretin. When ID is severe and persists for long durations, then this effect is observed. From the second trimester of pregnancy, the damage initiates and if Iodine (link Q2) is supplied, then it reverses (Lazarus, 2000). However, after the end of the second trimester, the damage continues irreversibly and causes severe cognitive impairments, such as speech and hearing problems (Prado & Dewey, 2014). Typically, patients with cretins are manageable and they can also perform simple tasks. Lower risk levels of ID cause lower degrees of impairment. The quantity of people affected is more than the quantity of people facing the effects of severe deficiency. From the modest, this alteration extends and then noticeable neurological deviations may cause reduced learning levels and grades in school (Khattak, Khattak, Ittermann, & Völzke, 2017). By this way, ID hampers socioeconomic advancements among the population (Mtumwa, Ntwenya, Paul, Huang, & Vuai, 2017).

To improve the value of life, alleviation of ID contributes a vast role. It eliminates cretinism and other minor grades of neuromotor and cognitive activity impairments, and thus improves survival (4).

Mental Performance, Synthesis and Metabolism of Some Neurotransmitters and Nervous System

Many vitamins function as cofactors (non-protein chemical compounds or metallic ion that is required for an enzyme’s activity as a catalyst, a substance that increases the rate of a chemical reaction) in fundamental pathways, such as glycolysis, the Krebs cycle, the respiratory chain and amino acid metabolism. Although all tissues have these vitamin-dependent pathways, they take on increased importance in the brain because of its high metabolic rate and dependence on continuous metabolism. In fact, the discovery of vitamins was closely linked to the sensitivity of the brain to deficiency, specifically that of thiamine. Furthermore, in the brain these pathways are linked to neurotransmitter synthesis (1).

Role of Vitamins in Brain Function: These Vitamins Are Critical for Normal Brain Function and Are Required in the Diet (1)

VitaminFunctionalExamples of ReactionsInfluenced Neuronal System

Thiamine	Thiamine pyrophosphate	Pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, transketolase	Acetylcholine
Pyridoxine	Pyridoxal phosphate	Decarboxylation	GABA, serotonin, dopamine
Niacin	NAD+, NADP+	Oxidative reactions	Coupling to acetylcholine synthesis
Vitamin E	Tocopherol	Free radical quenching	Neurodegeneration
Vitamin C	Ascorbate	Free radical quencing	Neurodegeneration

Vitamin B1 (thiamine) (link G2) is critical to normal brain function. Thiamine deficiency is a classical and well-studied example of the interaction of nutrition with brain function. Research on thiamine deficiency continues to attract considerable interest.

After 5 to 6 days of a diet deficient in thiamine, healthy young men developed a nonspecific syndrome of lassitude, irritability, muscle cramps and electrocardiographic changes, which were reversed by dietary thiamine. Prolonged thiamine deficiency frequently leads to damage to peripheral nerves.

Environmentally, a number of dietary constituents are known to impair the absorption of thiamine, including ethanol. Severe illness or injury also has been reported to increase thiamine requirements.
Vitamin B3 (niacin) (link I2) deficiency in humans leads to pellagra, which is characterized by dementia, dermatitis, diarrhea and eventually death. The deficiency was recognized in the eighteenth century, shortly after the introduction of American corn (maize) into Europe. Niacin and niacinamide refer to nicotinic acid and its amide, respectively. Although these pyrimidine derivatives can be synthesized from tryptophan in mammals, perhaps at least in part by intestinal bacteria, 60 mg of dietary tryptophan are required to synthesize 1 mg of the vitamin. Niacin is considered to be a vitamin because most human diets do not contain enough tryptophan to fulfill the normal human requirement for the vitamin of 10 to 30 mg/day (1).

Pantothenic Acid (Vitamin B5) (link N2) this vitamin is a substrate for the synthesis of the ubiquitous coenzyme A (CoA). Beyond its role in oxidative metabolism, CoA contributes to the structure and function of brain cells via its involvement in the synthesis of cholesterol, amino acids, phospholipids, and fatty acids. Of particular relevance, pantothenic acid, via CoA, is also involved in the synthesis of multiple neurotransmitters and steroid hormones (2)

Vitamin B6 (pyridoxine) (link J2) is necessary for the biosynthesis of several neurotransmitters. It is a pyridine derivative that can exist as an alcohol, amine or aldehyde. The concentration in brain is normally about 100-fold higher than that in the blood.

Pyridoxine deficiency has occurred in human infants fed a formula from which vitamin B6 had been inadvertantly omitted. The prominent finding was intractable seizures which responded promptly to injections of the vitamin. Deficiency of pyridoxine can contribute to the polyneuropathy of B-complex deficiency. However, very large doses of pure pyridoxine can lead to a persistant sensory neuropathy.
Like those of other nutrients, requirements for pyridoxine can be altered by genetic or environmental factors and are increased in a number of disorders of the nervous system. Treatment of “pyridoxine-deficient” infants may require doses of pyridoxine several hundredfold the normal daily requirement. Maintenance with doses at least tenfold the normal requirement typically permits normal development if irreversible brain damage has not yet occurred. It has been suggested that mild forms of pyridoxine dependence may be a relatively common cause of intractable seizures and mental retardation, but neurochemical studies of these patients are limited.

Vitamin B12 (cobalamin) (link L2) deficiency is commonly associated with neurological syndromes. Cobalamins have two well-established biochemical functions.

Cobalamin deficiencies are relatively common clinically]. Pure dietary deficiency responding promptly to treatment with oral cobalamins has been described in a few children of strict vegan mothers. A more common syndrome is caused by failure of absorption due to an inadequate supply of the glycoprotein intrinsic factor, usually on an autoimmune basis. The most characteristic abnormality is pernicious anemia, characterized by enlarged erythrocytes, called megaloblasts, and abnormal leukocytes. Neurological symptoms occur in many of these patients and can precede the hematological changes combined system disease is the most common B12-mediated neurological syndrome. Affected patients develop unpleasant tingling sensations (paresthesias), followed by loss of vibratory sensation, particularly in the legs, and spastic weakness. The characteristic neuropathology is a spongy demyelination in the long tracts of the spinal cord, particularly prominent in the posterior columns as well as corticospinal tracts. Combined system disease responds poorly to treatment with cobalamins. As with other nutrients, requirements for cobalamin can be modified by genetic and environmental influences.

Folic acid (link K2) plays a key role in the transfer of one-carbon (active methylene) groups, including the conversion of serine to glycine and the cobalamin-dependent transfer from homocysteine to methionine. Dietary deficiency of folate with normal cobalamin leads to anemia without significant neurological signs. However, both genetic and environmental disorders of folate metabolism have been associated with disease of the nervous system.

Environmentally, a number of common medications, including phenytoin and certain antitumor agents, increase requirements for dietary folate. Treatment with folate can mask the hematological signs of cobalamin deficiency without affecting the progressive damage to the nervous system.

Experimental induction of Pantothenic acid (link N2) deficiency leads to signs of peripheral nerve damage, for example, demyelination in laboratory animals and paresthesias in humans. Late signs of CNS damage in animals may relate as well to the adrenal failure that is a prominent part of the syndrome.
The main antioxidants in brain are vitamin E (tocopherol) (link E2), vitamin C (ascorbic acid) (link C2) and glutathione. The first two can be easily manipulated by diet, whereas the latter is more difficult to control. Dietary manipulation of antioxidants has practical implications for brain function.

Vitamin E (α-tocopherol) (link E2) deficiency produces a characteristic neurological syndrome. It presumably results from increased oxidative stress arising from a reduction in antioxidant capacity.
The brain is more susceptible to the deficiency than muscle. Within the brain, the cortex, striatum and cerebellum are the most sensitive regions.

A diet deficient in vitamin E increases glutamate and GABA and decreases tryptophan concentrations in the substantia nigra (the substantia nigra (SN) is a basal ganglia structure located in the midbrain that plays an important role in reward and movement). The increase of nigral glutamate suggests possible links to degenerative processes through glutamatergic excitotoxicity. These results suggest that vitamin E may play a significant role in the degeneration of the substantia nigra and that this tissue may be particularly sensitive to oxidative stress. Furthermore, these findings support the widely held view that oxidative stress in the substantia nigra is important in the pathophysiology of Parkinson’s disease.

Vitamin C (ascorbate) deficiency leads to extensive oxidative damage of proteins and protein loss in the microsomes, as evidenced by accumulation of carbonyl groups on proteins as well as tryptophan loss. Results of studies indicate that vitamin C may exert a powerful protection against degenerative changes in the brain associated with oxidative damage.

Zinc (Zn2+) (link S2) influences numerous cellular functions, including immune mechanisms, actions of several hormones and enzyme activities. More than 200 enzymes are known to be Zn2+-dependent. Severe Zn2+ deficiency during the period of rapid brain growth has effects similar to that seen with protein-calorie malnourishment, including altered regulation of emotions; food motivation; lethargy (reduced activity and responsiveness), and deficits in learning, attention and memory. In addition to the many deficits produced by Zn2+deficiency in the brain, the severe effect of Zn2+ deficiency on other tissues leads to additional peripheral mechanisms that alter brain function Although Zn2+ is essential at low concentrations, higher concentrations are toxic.

Copper (link U2) is an integral component of multiple cellular enzymes, including the cytochromes and superoxide dismutase. Copper deficiency produces clinical signs analogous to those of Par-kinson’s disease and results in low dopamine concentration in the corpus striatum. Neuropathology in experimental animals occurs in only part of the copper-deficient population and is dam- and litter-related, suggesting the presence of a genetic component that alters the response to copper deficiency.

Selenium (link T2) is vital in maintaining the antioxidant capacity of the brain. Glutathione peroxidase is a selenium-dependent enzyme that is important for maintaining the antioxidant capacity of brain glutathione. Selenium deficiency increases dopamine turnover in the substantia nigra but not in the striatum. These results suggest that dietary selenium protects the brain, particularly the substantia nigra, against oxidative damage.

Trace compounds are also important in brain function. Chromium (link X2)-deficient patients develop severe diabetic symptoms, including glucose intolerance, weight loss, impaired energy utilization and nerve and brain disorders. Low dietary boron is reported to cause significantly poorer performance on various cognitive and psychomotor tasks (1).

Reduction of Tiredness and Fatigue, Psychological function

There is a strong biological and physiological rationale that indicates that the long-known involvement of vitamins and minerals in cellular energy production translates into functional and physiological outcomes in humans, including perceived physical and mental fatigue as well as psychological and cognitive functions.
Clinical conﬁrmation of the essential nature of micronutrients and of their role in alleviating fatigue and cognitive dysfunction comes from observations in subjects with low or very low intakes or deﬁcient biological status and from reversal of symptoms following supplementation.

Beriberi, the disease resulting from severe Thiamine (vitamin B1) (link G2) deﬁciency aﬀects several organs, including the muscular and peripheral nervous systems. General symptoms include fatigue, ataxia due to muscle weakness in the legs and arms, muscle pain and tenderness, and dyspnoea on exertion. Cerebral beriberi (thiamine (vitamin B1) deﬁciency) may lead to encephalopathies, characterized by abnormal eye movements, and cognitive impairment, involving a confused, apathetic state and a profound memory disorder, with severe amnesia and loss of recent and working memory. When thiamine deﬁciency is correctedearlyenough, symptoms can be fully reversed and signiﬁcant brain damage can be prevented. However, permanent brain damage and irreversible cognitive dysfunction will occur if thiamine deﬁciency persists and this can be critical as encephalopathies linked to thiamine deﬁciency remain largely undiagnosed.

Riboﬂavin (vitamin B2) (link H2) deﬁciency is most often accompanied by other nutrient deﬁciencies and it is thus diﬃcult to clearly identify speciﬁc symptoms. Anemia, a condition related to fatigue, is associated with low riboﬂavin status.

Inadequate niacin (vitaminB3) link (I2) intakes or status lead to nonspeciﬁc clinical symptoms and include weakness, loss of appetite, fatigue and apathy, neurological symptoms, including depression and loss of memory. These symptoms attenuate or disappear following niacin intake, conﬁrming its role in the brain and nervous system.

Vitamin B5 (link N2) deﬁciency has been experimentally induced using a pantothenic acid kinase inhibitor and a pantothenic acid deﬁcient diet. After approximately 6 weeks, subjects complained of headache, fatigue, insomnia, and they reported excessive fatigue after their daily walk; symptoms decreased then disappeared after 4 weeks of supplementation with 4 g pantothenic acid daily.
One of the most typical features of pyridoxine (vitamin B6) (link J2) deﬁciency is microcytic anemia, due to defective hemoglobin biosynthesis and characterised by symptoms of weakness, tiredness or fatigue. During severe pyridoxine deﬁciency, disturbed neurologic functions, such as convulsive epileptic seizures and irritability and depression, are observed. (1)

One study observed that several pregnant women with anemia who were nonresponsive to iron supplementation also had vitamin B6 deficiency, and that anemia in these cases improved with the administration of vitamin B6. Prospective study in healthy pregnant women showed that blood levels of iron, ferritin and vitamin B6, in particular, fell to the lower limit of the nonpregnant reference range by the third trimester. It was concluded that it is important to take into account the deficiency of vitamin B6 besides iron in the evaluation of anemia during pregnancy. (2)

Biotin (vitamin B8) (link M2) deﬁciency is associated with neurological disorders: depression, lethargy, hallucinations, and paraesthesia (tingling/burning sensation) of the extremities.
Deﬁciencies in folate (vitamin B9) (link K2) can result in megaloblastic anemia, which produces symptoms of weakness and fatigue, headache, palpitations, and shortness of breath.

Deﬁciencies in cobalamin (vitamin B12) (link L2) can result in diminished energy and exercise tolerance, together with fatigue and shortness of breath. It induces neurological dysfunction, including myelopathy, neuropathy and neuropsychiatric abnormalities. Such neurological damage has been reported in 20–30% of cases of vitamin B12 deﬁciency, and can even occur before serum vitamin B12 concentrations reach a level that would be considered deﬁcient by standard criteria. It is likely due to progressive neuronal degeneration, due to the inhibition of methionine synthase. In addition, deﬁciencies in vitamin B12 are associated with mental and cognitive impairment, such as irritability, memory loss, depression, and cognitive disturbances up to dementia.

Before the characteristic features of scurvy (the disease caused by severe vitamin C (link C2) deﬁciency) are present, symptoms of moderate deﬁciency include fatigue, irritability, and muscle pain. Scurvy is frequently associated with depression, hypochondria, and mood changes, and may be related to deﬁcient dopamine hydroxylation. Because the brain consumes a lot of oxygen and is very rich in polyunsaturated fatty acids, which are prone to oxidation, there is a strong need for antioxidant molecules, such as vitamin C.
The pallor of anemia was associated with weakness and tiredness long before its cause was known. (1)

In accordance with meta-analysis Iron (Fe) (link P2) deficiency is a prevalent nutritional disease, and fatigue is a common complaint in the general and patient population. These meta-analyses suggest that improving Fe status may decrease fatigue. This meta-analysis concludes that further research is necessary to identify diagnostic criteria for selecting fatigue patients who might benefit from Fe therapy and to assess the prevalence of IDNA with fatigue in the general population (3).

Most of the early symptoms of Magnesium (link R2) deﬁciency include neurological or neuromuscular manifestations. Neuromuscular hyperexcitability, including muscle cramps, is a common feature of magnesium deﬁciency, but latent tetany, generalized seizures, vertigo and muscular weakness may also be present. These symptoms are related to the role of magnesium in nerve transmission and muscle contraction. Other symptoms of magnesium deﬁciency may include fatigue, lethargy, staggering, and loss of appetite (1).

Observational studies show an association between low Zinc (link S2) dietary intake or low zinc status and depression in adults or elderly subjects. For example, the meta-analysis of nine studies indicates inverse associations between dietary zinc and iron intake and risk of depression (4).

Supplementing individuals with vitamin and minerals is thus highly likely to result in health beneﬁts in the areas of mental and physical fatigue, as well as cognitive and psychological functions. However, eﬃcient and safe supplementation should carefully consider practical dimensions, such as the chemical form of vitamins and minerals, which can aﬀect their bioavailability, or the duration of treatment, which should be suﬃcient to ensure the restoration of adequate status in people where intakes are not suﬃcient, and who are the more likely to beneﬁt from supplementation (1)

Blood Clotting

Calcium

Clotting factors are arguably the crux and most essential components of hemostasis. Hemostasis is the body’s physiologic response to vascular endothelial injury, which results in a series of processes that attempt to retain blood within the vascular system through the formation of a clot. Hemostasis can be further divided into primary and secondary hemostasis. Primary hemostasis, which results in the formation of a soft platelet plug, involves vasoconstriction, platelet adhesion, platelet activation, and platelet aggregation. Secondary hemostasis is primarily defined as the formation of fibrinogen into fibrin, which ultimately evolves the soft platelet plug into a hard, insoluble fibrin clot. Within primary and secondary hemostasis, 3 coagulation pathways exist: intrinsic, extrinsic, and common. Clotting factor IV is a Сalcium (link O2) ion that plays an important role in all 3 pathways. (1)

For example, hemostatic clot formation entails thrombin-mediated cleavage of fibrinogen to fibrin. Studies have shown that the thrombin concentration present during clot formation dictates the ultimate fibrin structure. In most prior studies of fibrin structure, clotting was initiated by adding thrombin to a solution of fibrinogen. Assembly of procoagulant complexes and generation of thrombin requires Сalcium, which shortens the onset of clotting and produces thicker fibrin fibers than are seen in the absence of calcium (2)

Vitamin K

Also, the primary deficiency disease associated with vitamin K (version F2) is bleeding due to impaired blood clotting,

Vitamin K is essential for the synthesis of proteins belonging to the Gla-protein family. To the members of this family belong four blood coagulation factors, which all are exclusively formed in the liver. The importance of vitamin K for hemostasis is demonstrated from the fact that vitamin K-deficiency is an acute, life-threatening condition due to excessive bleeding. Other members of the Gla-protein family are play key functions in maintaining bone strength, arterial calcification inhibition, and cell growth regulation.

It is often thought that high intake of vitamin K may increase thrombosis risk. This is evidently not true.

Full carboxylation (and thus: maximal procoagulant activity) of the vitamin K-dependent clotting factors is essential, and vitamin K metabolism has been designed to meet that goal with highest priority. Excess vitamin K intake cannot result in more clotting factor carboxylation. This has also been demonstrated within our institute in thousands of subjects taking high doses of vitamin K during several years. Even when monitored with the most sensitive techniques (endogenous thrombin potential, ETP), an increased thrombosis tendency was not found in any of the participants. An exception is formed by patients receiving oral anticoagulants like warfarin or acenocoumarol that act as vitamin K-antagonists. Obviously excess vitamin K intake will interfere with this medication. On the other hand it is becoming increasingly clear that the long-term use of these drugs is associated with accelerated bone loss, low bone mass, and widespread valvular and arterial calcifications thus demonstrating once more the importance of vitamin K for bone and vascular health.

Fromation of Red Blood Cells, Blood Formation, Iron Transport, Iron Metabolism, Oxygen Transport

Fromations of red blood cells, hemoglobin. Oxygen transport in the body (A 39, A40, A62)

Anemia also known as Iron-poor blood, Low blood, Tired blood. Anemia is a condition in which your blood has a lower-than-normal amount of red blood cells or hemoglobin.

Hemoglobin is an Iron-(link P2) rich protein that helps red blood cells carry oxygen from the lungs to the rest of the body. If you have anemia, your body does not get enough oxygen-rich blood. This can cause you to feel tired or weak. You may also have shortness of breath, dizziness, headaches, or an irregular heartbeat. (1)

Iron deficiency and iron deficiency anemia are global health problems leading to deterioration in patients’ quality of life and more serious prognosis in patients with chronic diseases. The cause of iron deficiency and anemia is usually a combination of increased loss and decreased intestinal absorption and delivery from iron stores due to inflammation. Oral iron is first line treatment the goal of treatment is normalization of hemoglobin concentration and recovery of iron stores. (2)

Iron deficiency disproportionately affects women and children. Premenopausal women usually have low iron status because of iron loss in menstrual blood*. Conditions which further increase iron loss, compromise absorption or increase demand, such as frequent blood donation, gastrointestinal lesions, athletic activity and pregnancy, can exceed the capacity of the gastrointestinal tract to upregulate iron absorption. Women of reproductive age are at particularly high risk of iron deficiency and its consequences.(3)

B6 (link to J2) has a role in hemoglobin formation (4). It is also an essential element of heme synthesis, and deficiency can lead to anemia (5).

Pyridoxal phosphate (PLP, the active form of vitamin B6 ) functions in the synthesis of heme from porphyrin procecutors as a cofactor for δ-aminolevulinic acid synthase. The vitamin also binds to hemoglobin. Binding of Pyridoxal (Pal, another name for of vitamin B6) and PalP enhances the O2-binding capacity of the protein and inhibits the physical deformation of sickle cell hemoglobin (6).

Vitamin B12 (link L2) or B9 (link K2) (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cannot function properly.

A deficiency in either of these vitamins can cause a wide range of problems, including: extreme tiredness, a lack of energy, pins and needles (paraesthesia), a sore and red tongue, mouth ulcers, muscle weakness, disturbed vision, psychological problems, which may include depression and confusion, problems with memory, understanding and judgement.

Some of these problems can also happen if you have a deficiency in vitamin B12 or folate but do not have anaemia. Although it’s uncommon, vitamin B12 or folate deficiency (with or without anaemia) can lead to complications, particularly if you have been deficient in vitamin B12 or folate for some time.
Potential complications can include: problems with the nervous system, temporary infertility, heart conditions, pregnancy complications and birth defects. Adults with severe anaemia are also at risk of developing heart failure.

Some complications improve with appropriate treatment, but others, such as problems with the nervous system, can be permanent. (7)

Cu – for Iron transport in the body (A 41)

Together with iron copper is also one of essential nutrients, excesses or deficiencies of which cause impaired cellular functions and eventually cell death. The metabolic fates of copper and iron are intimately related. Systemic copper deficiency generates cellular iron deficiency, which in humans, as it was mentioned above, results in diminished work capacity, reduced intellectual capacity, diminished growth, alterations in bone mineralization, and diminished immune response. Copper is required for the function of over 30 proteins. Iron is similarly required in numerous essential proteins. The essentiality of iron and copper resides in their capacity to participate in one-electron exchange reactions. (8)

Vitamin B2 (Riboflavin), Vitamin A (Retinol) for Iron metabolism (A 42)

One of researchs has shown that Riboflavin (link H) deficiency can alter iron absorption and cause anemia, which leads to fatigue. Riboflavin is involved in red blood cell production and transportation of oxygen to the cells. Improving the amount of riboflavin in the body can increase circulating hemoglobin levels and increase red cell production. (9)

In another study that used data from 1253 Chinese men and women there was a significant interaction between riboflavin and iron intake; when riboflavin intake was low, a high iron intake was associated with a lower probability of anemia at follow-up. This association disappeared when riboflavin intake was high.(10)

Also In rural China, many pregnant women in their third trimester suffer from anemia (48%) and iron deficiency (ID; 42%), often with coexisting deficiencies of Retinol (link B2) and riboflavin. We investigated the effect of retinol and riboflavin supplementation in addition to iron plus folic acid on anemia and subjective well-being in pregnant women. The study was a 2-mo, double-blind, randomized trial.
The reduced prevalence of anemia and iron deficiency anemia were significantly greater in the groups supplemented with retinol and /or riboflavin than in the iron+folic acid group. Moreover, gastrointestinal symptoms were less prevalent in the iron+folic acid+retinol group than in the iron+folic acid group and improved well-being was more prevalent in the groups receiving additional retinol and/or riboflavin than in the iron+folic acid group. Thus, a combination of iron, folic acid, retinol, and riboflavin was more effective than iron plus folic acid alone. (11)

Also the aim of one more research was to assess and estimate the effect of vitamin A supplementation (VAS) on iron status biomarkers and anemia in humans.

The search yielded 23 eligible studies, 21 clinical trials and 2 cohort studies, with children, teenagers, pregnant or lactating women. The meta-analysis of the clinical trials showed that VAS reduces the risk of anemia by 26% and raises hemoglobin levels, compared to non-treated group, independent of the life stage. VAS did not alter the prevalence of iron deficiency among the clinical trials conducted with children and teenagers, whereas a significant increase in serum ferritin levels was observed in trials conducted with pregnant and lactating women (12).

If you take iron supplements, don’t take too much as this could be harmful. Taking of recommended dose of our supplement is unlikely to cause any harm. But, continue taking a higher dose only if advised to by your Doctor.
https://www.nhs.uk/conditions/vitamins-and-minerals/iron/.

Immune System

The immune system, which is integrated into all physiological systems, protects the body against infections and other external and internal insults by utilizing three distinct layers, depending on the nature of the threat: physical (e.g., skin, epithelial lining of the gastrointestinal and respiratory tracts) and biochemical barriers (e.g., secretions, mucus, and gastric acid), numerous different immune cells (e.g., granulocytes, CD4 or CD8 T and B cells), and antibodies (i.e., immunoglobulins).

Micronutrients have vital roles throughout the immune system that are independent of life stage and it has been determined that those most needed to sustain immunocompetence include vitamins A (link B2) , C (link C2) , D (link D2) , E (link E2), B2 (link H2), B6 (link J2), B12 (link L2), folic acid (link K2), beta carotene, iron (link P2), selenium (link T2), and zinc (link S2)

The immune system undergoes many changes over the life course—developing and maturing during childhood, potentially achieving peak function in early adulthood, and gradually declining in most people in older age (Figure 3). Distinct immune features are present during each life stage, and specific factors differentially affect immune function, with a resulting difference in the type, prevalence and severity of infections with age. A common factor throughout life is the need for an adequate supply of micronutrients, which play key roles in supporting immune function. Multiple micronutrient deficiencies are common throughout the world, with the likelihood increasing with age. Tailored supplementation based on the specific needs of each age group may help to provide an adequate basis for optimal immune function. The available clinical data suggest that micronutrient supplementation can reduce the risk and severity of infection and support a faster recovery. However, much more research is required into the effects of micronutrient supplementation on immune functions and on clinical outcomes. Nevertheless, current knowledge regarding the importance of micronutrients in immunity, the effects of micronutrient deficiencies on the risk and severity of infection, and the worldwide prevalence of an inadequate micronutrient status form a sound basis for the use of a targeted multiple micronutrient supplement to support immunity over a person’s lifetime. (1)

Thus Figure (1) collects information about beneficial effects of different vitamins and minerals, micronutrient status for different ages, analyses risk of infections, and immunity issues.

Maggini S, Pierre A, Calder PC. Immune Function and Micronutrient Requirements Change over the Life Course. Nutrients. 2018;10(10):1531. Published 2018 Oct 17. doi:10.3390/nu10101531

DNA Synthesis and Cell Division and/or Specialization

The vitamin A (link B2) effects on cell proliferation, differentiation and functioning might be due to its influence on genome expression at the level of regulation of the transcription of certain genes, posttranscriptional modification of mRNA levels, or changes in the membrane structural-functional organization. Vitamin A can affect the biosynthesis of various proteins, including those involved in regulation of development and cell functioning or determining cell sensitivity to hormones and hormone-like factors. Vitamin A can also influence the formation of secretory proteins which play the role of hormones. It is proposed to use the differential sensitivity of various cells in cell populations to vitamin A or its forms for studying intercellular relations. In particular, the capacity of retinol and retinoic acid to maintain the development and functioning of various vitamin A-dependent cells of the testis can be used for studying local regulation of spermatogenesis in mammals. (1)

Folic acid (folate) (link K2) has a vital role in cell growth and development through many reactions and processes that occur in the body, e.g. histidine cycle, serine and glycine cycle, methionine cycle, thymidylate cycle, and purine cycle. When the body becomes deficient in folic acid, all cycles that are mentioned above will become ineffective and lead to many problems, in addition to other problems such as megaloblastic anemia, cancer, and neural tube defects. Vitamin B12 (link L2) has a vital role in cell growth and development through many reactions and processes that occur in the body. When the level becomes elevated or lower than the normal, the whole process will collapse because each process is linked to another. Deficiencies can be treated by increasing their consumption in diet or by supplement intake.(2)

Despite the long-term study of zinc metabolism, the first limiting role of Zinc (link S2) in cell proliferation remains undefined. Zinc participates in the regulation of cell proliferation in several ways; it is essential to enzyme systems that influence cell division and proliferation. Removing zinc from the extracellular milieu results in decreased activity of deoxythymidine kinase and reduced levels of adenosine (5′) tetraphosphate (5′)-adenosine. Hence, zinc may directly regulate DNA synthesis through these systems. Zinc also influences hormonal regulation of cell division. (3)

Also, Vitamin D (link D2) has anti-proliferative effects and controls cell cycle progression. (4)

Calcium

Calcium is a mineral found in many foods. The body needs calcium to maintain strong bones and to carry out many important functions. Almost all calcium is stored in bones and teeth, where it supports their structure and hardness.

The body also needs calcium for muscles to move and for nerves to carry messages between the brain and every body part. In addition, calcium is used to help blood vessels move blood throughout the body and to help release hormones and enzymes that affect almost every function in the human body.

Many people don’t get recommended amounts of calcium from the foods they eat, including:

Boys aged 9 to 13 years.
Girls aged 9 to 18 years.
Women older than 50 years.
Men older than 70 years.

Certain groups of people are more likely than others to have trouble getting enough calcium:

Postmenopausal women because they experience greater bone loss and do not absorb calcium as well. Sufficient calcium intake from food, and supplements if needed, can slow the rate of bone loss.
Women of childbearing age whose menstrual periods stop (amenorrhea) because they exercise heavily, eat too little, or both. They need sufficient calcium to cope with the resulting decreased calcium absorption, increased calcium losses in the urine, and slowdown in the formation of new bone;
People with lactose intolerance cannot digest this natural sugar found in milk and experience symptoms like bloating, gas, and diarrhea when they drink more than small amounts at a time. They usually can eat other calcium-rich dairy products that are low in lactose, such as yogurt and many cheeses, and drink lactose-reduced or lactose-free milk;
Vegans (vegetarians who eat no animal products) and ovo-vegetarians (vegetarians who eat eggs but no dairy products), because they avoid the dairy products that are a major source of calcium in other people’s diets.

Many factors can affect the amount of calcium absorbed from the digestive tract, including: age, vitamin D, and other components in food. Also many factors can also affect how much calcium the body eliminates in urine, feces, and sweat.

Insufficient intakes of calcium do not produce obvious symptoms in the short term because the body maintains calcium levels in the blood by taking it from bone. Over the long term, intakes of calcium below recommended levels have health consequences, such as causing low bone mass (osteopenia) and increasing the risks of osteoporosis and bone fractures

Symptoms of serious calcium deficiency include numbness and tingling in the fingers, convulsions, and abnormal heart rhythms that can lead to death if not corrected. These symptoms occur almost always in people with serious health problems or who are undergoing certain medical treatments. (1)

Calcium

Vitamin D

In one study sunlight exposure and vitamin D deficiency in Turkish women. The aim of this study was to investigate the efficiency of vitamin D synthesis in 48 premenopausal women (14-44 years) in relation to three different types of dressing in summer. Women in the first group (Group I) dressed in a style which exposed the usual areas of the skin to sunlight; women in the second group (Group II wore traditional clothing with the skin of the hands and face uncovered, while the third group (Group III) dressed in traditional Islamic style, covering the whole body including hands and face.

Vitamin D levels were low in 44 percent of the Group I and 60% of the Group II, which suggested that sun exposure of skin areas of hands and face may partially provide vitamin D synthesis, but may not be enough to eliminate vitamin D deficiency. All the patients in group III had vitamin D levels below normal. This study emphasizes the necessity of vitamin D fortification of food even in a sunny country where some people may not be exposed to sunlight because of inappropriate clothing or an indoor-life(1).

Tags: women, vitamin D, sun exposure, Turkey

Another similar study investigates effects of different dress styles on vitamin D levels in healthy young Jordanian women. Of the women, 21 wore Western-type dress styles (group 1), 80 wore dress styles covering the whole body but the sparing face and hands (group 2), and 23 wore dress styles covering the whole body including the face and hands (group 3). The study was conducted in summer and winter. The 25(OH) D levels in groups 2 and 3 were significantly lower than in the men. No significant differences were noted between women wearing different dress styles. The prevalence of hypovitaminosis D was 62.3% in the study groups as a whole. Dress styles covering the whole body, totally or nearly totally, have adverse effects on 25(OH)D levels and may produce a state of secondary hyperparathyroidism on the long run. Although Jordan enjoys plenty of sunshine, these data are suggestive of widespread hypovitaminosis D in Jordan. (2)

Tags: women, vitamin D, sun exposure, Jordan, comparison with men

In one more study plasma 25-hydroxy cholecalciferol (25-OH vitamin D) concentrations were measured in 31 adult Saudi Arabian women who presented with acute minor illness. Only three subjects had a concentration within the normal range. Plasma 25-OH vitamin D concentrations were significantly lower in subjects living in apartments than in those living in villas or rural areas. When direct questioning was used to assess exposure to sunlight, plasma 25-OH vitamin D concentrations were significantly lower in those subjects whose average exposure was less than 30 min daily than those whose exposure was more than 30 min daily. Findings confirm the importance of inadequate exposure to sunlight in the aetiology of vitamin D deficiency (3).

Tags: women, vitamin D, sun exposure, Saudi Arabian

Despite long hours of sunlight in Qatar and other regions of the Middle East, vitamin D deficiency has been rising. In parallel, the prevalence of metabolic syndrome* has also been increasing in Qatar.
A cross-sectional study of 702 women and 503 men from the Qatar Biobank, comprising Qataris and non-Qataris between the ages of 18 and 80 years, was used to perform multivariate linear regression analyses to examine the association between metabolic syndrome and prevalence of vitamin D deficiency adjusting for age, sex, ethnicity, season of blood collection, physical activity and education.
Approximately 64% of participants were vitamin D deficient with more men being deficient (68.6%) than women (61.3%). Serum vitamin D was 8% lower in individuals with metabolic syndrome compared to individuals without metabolic syndrome (4).
In conclusion. Vitamin D deficiency is prevalent in this Qatari population. Presence of metabolic syndrome was associated with presence of vitamin D deficiency.

Tags: vitamin D, women. men, metabolic syndrome, Qatar
* Metabolic syndrome, sometimes known by other names, is a clustering of at least three of the five following medical conditions: central obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL) (Wikipedia).

The prevalence of hypovitaminosis D is significantly high among population of UAE, Saudi Arabia and many Middle Eastern countries, especially among women, despite abundant sunshine. 86.1% UAE nationals and 78.9% visitors of other nationalities were found <75nmol/L of 25(OH)D. 28.4% of UAE nationals and 17.5% of visitors of other nationalities have extreme deficiency of 25(OH)D. These results are significant, as all of our patients are residing permanently in the UAE or visitors that has yearlong sunlight. In addition, measuring 25(OH)D concentrations in a single laboratory minimized test level variations.
This current study formed the basis of further studies to determine if vitamin D deficiency and insufficiency can aggravate systemic diseases, including hypertension, diabetes or obesity that are also wide-spread in the Middle Eastern region. (5)

Tags: vitamin D, women. men, United Arab Emirate

In this study severe deficiency (25(OH)D <25 nmol/L) was found at gestational week (GW) 15 in 45% of women from South Asia, 40% from the Middle East and 26% from Sub-Saharan Africa, compared to 2.5% in women from East Asia and 1.3% of women from Western Europe.
The serum levels of 25(OH)D increased significantly from GW 15 to 28 in vitamin D deficient women who received a recommendation for supplementation. This recommendation of vitamin D supplementation increased vitamin D levels in deficient women (6).

Tags: vitamin D, pregnant, women, Middle East, supplementation

Seasonal differences in serum 25(OH)-vitamin D levels in Saudi Arabia are counterintuitive, with circulating levels being higher during the winter than the summer season. Increased vitamin D supplementation is thus recommended to maintain optimal serum 25(OH)-vitamin D levels during the summer season. (7).

Tags: vitamin D, summer season, Saudi Arabia, Gulf region.

Prevalence of vitamin D deficiency and insufficiency in different Middle East countries (8):

middle-east-vitamin-d
Tags: Vitamin D, Meddle East

In the UAE and the Gulf region in general, there are several intricate public health issues in the context of vitamin D deficiency that needs to be addressed. Changes in lifestyle such as diet, lack of exercise, cultural habits, avoiding sun exposure due to excessive heat, and other risk factors predispose those who live in GULF countries, such as Emiratis likely to becoming vitamin D deficient.
Clinical practice guidelines for vitamin D in the United Arab Emirates recommend the following vitamin D supplementations for different groups of people:

1. Breastfed infants supplement with 400 IU/day up to age 6 months, and 400-600 IU/day between 6 and 12 months, depending on daily intake of total vitamin D and sun exposure;
2. For children and adolescents of age 1-18 years supplement with 600-1000 IU/day depending on the body weight;
3. Adults greater than 18 years’, supplementation with 1000-2000 IU/day is recommended, while,
4. The elderly (over 65 years) should be supplemented with 2000 IU/day, throughout the year;
5. Pregnant and breast feed women, 2000 IU/day from the first trimester of pregnancy;
6. Premature infants, supplementation of 400-800 IU/daystart from the first days of life;
7. For obese, individuals and those with metabolic syndrome, supplementation of 2000 IU/day;
8. For individuals with dark skin complexions and for night workers, supplementation of 1000-2000 IU/day (25-50μg/day), throughout the year, depending on body weight. The goal of supplementation is to achieve and longer term maintenance of serum 25(OH)D concentration of 30-50ng/mL (9).

Tags: vitamin D, women. men, children, guideline, United Arab Emirate, Gulf countries, supplementation

Few people have symptoms of choline deficiency. One reason might be that our bodies can make some choline. However, if a person’s choline levels drop too low, he or she can experience muscle and liver damage as well as deposits of fat in the liver (a condition called nonalcoholic fatty liver disease that can damage the liver). (1)

Folic acid

International recommendations have recommended folic acid (folate) supplementation during the periconception period as an effective way of preventing neural tube defects (NTDs).

This observational cross-sectional study aimed to examine the knowledge and practices of pregnant women in North Lebanon regarding periconceptional (period from before conception to early pregnancy) folic acid (FA) supplementation.
A total of 465 women were included in the study. Only 37 (7.9%) were aware of the role of FA in preventing birth defects, while 129 (27.7%) were able to identify one food item rich in FA or folate. Only 125 (26.9%) were taking FA supplementation before pregnancy. While 440 (94.6%) participants were taking FA supplements during pregnancy, 158 (34%) were receiving an inadequate dose.
Adequate preconceptional supplementation of FA was significantly associated with the women’s level of education, planned pregnancy, and gynecologic visit before pregnancy. Moreover, young age and small number of children were significant predictors of adequate supplementation during pregnancy. This study revealed deficient knowledge and inadequate intake of FA supplements before and during pregnancy (1).

Tags: folic acid (folate), pregnant, women, Lebanon, supplementation

This cross-sectional study aimed to measure the level of knowledge about periconceptional folic acid use among pregnant women attending for antenatal care at Ain Shams University Hospital, Cairo, Egypt in 2012. Questionnaires were filled through personal interviews with 660 pregnant women. Of the respondents, 62.4% had heard of folic acid and 39.2% knew about the role of folic acid supplementation in prevention of congenital anomalies. Knowledge about using folic acid before and in the first trimester of pregnancy was highest among university-educated women and those working in professional occupations. Only 18.8% of women reported taking folic acid, and 8.8% had used it before conception. (2)

Five hundreds questionnaires were distributed to the female students of the 3 colleges, namely, Humanities, Sciences, and Health in Jeddah, Kingdom of Saudi Arabia in April 2008. The questions included an enquiry on their knowledge regarding the importance of folic acid preconception, and if they will implement what they learned after listening to lectures, delivered by the 4th year medical students, who were trained and supervised by the faculty members of the King Abdul-Aziz University.
Two hundred and seventeen questionnaires were filled, and returned (43.4%). Mean age +/- SD was 20.96 +/- 2.25 years. Almost 88% were not aware of the importance of folic acid in neural tube defects prevention. After listening to the lecture, 82.9% thought that they will surely use folic acid preconception, and 98.6% will relay the important message about the importance of folic acid to others.

This is a cross-sectional study conducted randomly among women aged 18-45 years old, attending the Antenatal and Gynecology Clinics at the Maternity and Children’s Hospital, Al-Qassim, Kingdom of Saudi Arabia from January to November 2012. A total of 1250 subjects were approached, and 1000 women expressed their verbal consent to participate. The questionnaire consisted of 17 items, and results were analyzed using univariate and multivariate analysis.
A total of 88.4% of women were aware of FA. However, only 4.4% of them took FA before pregnancy. Compared to highly educated women (20.4%), only 5% of illiterate women use FA during the first trimester of their pregnancy. Univariate and multivariate analysis showed that educational level had a significant association with FA awareness and use. Most women recall hearing of FA from their doctors. Only 48 women reported a history of a previous child with congenital anomalies, and 4 of them (8.3%) of them used FA before pregnancy (4).

The survey was conducted among three target population groups: women of reproductive age (20 – 49.9 y), adolescents 12-18 y and children 6 – <12 y. Nine governorates were selected randomly to represent four regions; Metropolitan (greater Cairo), Costal (Alexandria and Suez), Lower Egypt (Kafr Elshaik; Sharkia; and Behaira), and Upper Egypt (Bani-suif; Aswan; and Qena). Urban and rural areas from Lower & Upper regions were considered.

The results are in the Figures below:

In conclusion, nutritional education is essential to achieve a good impact of food fortification programs, promoting simultaneously the composition of iron absorption enhancers (such as ascorbic acid and red meat) and avoiding iron inhibitors (tea and coffee, for example). Strengthening other strategies to complement the fortification program; such as supplementation program for vulnerable groups as well as screening program and dietary diversification. (5)

Iron (anemia)

The objectives of this study were to identify the nutritional habits and the prevalence of anaemia among school students in Jeddah (Saudi Arabia), as well as to recognize the students’ awareness of their anaemic nutritional status.

Anaemia was reported among 20.5% of school students. Anaemia was more prevalent among students of at least 12 years as compared to the younger age group. Also, anaemia was more marked among governmental school attendees and those born to low-educated mothers. Menstruating girls were at around double the risk of being anaemic than non-menstruating girls. Anaemia was associated with negative impact on school performance and was more marked among those who failed their exams as compared to students with excellent results.
Only 34.1% of anaemic school students were aware of being anaemic. Awareness was nearly equal in all age groups and social classes but girls were more aware of their anaemic status than boys. Iron deficiency anaemia appears to be prevalent among school students. At age 12 years and over, low social class and menstruating girls constitute the high-risk groups. Screening is recommended for high-risk groups and school health programs are crucial to improve students’ nutritional habits, knowledge and awareness (1)

Tags: Iron, anemia, students, girls, Saudi Arabia

Anaemia, especially iron deficiency anaemia, has been considered one of the main public health problems in the Arab Gulf countries. This paper explores the magnitude of the problem and factors that contribute to the high prevalence of anaemia in these countries. The prevalence of iron deficiency anaemia among preschool children ranged from 20% to 67%, while that among school children ranged from 12.6% to 50%. The percentage of pregnant women who suffered from this anaemia ranged from 22.7% to 54%. Infant feeding practices, food habits, parasitic infection, parity, early age at marriage, and geographical location are among the most important factors associated with iron deficiency anaemia in this region. Programmes to prevent and control this anaemia, are urgently needed (2).

Tags: Anemia, Gulf countries, children, pregnant

Micronutrient deficiency especially the iron deficiency is the bane of our lives, affecting all strata of society. Unfortunately, the women during pregnancy, adolescence, and children are under this curse particularly in developing countries like Pakistan. It is one of the biggest reasons of complications during pregnancy and malnourished children under five years of age. Maternal death, still-births, and underweight births are most common consequences of iron deficiency and these outbreaks as iron-deficiency anemia in Pakistan. Disastrous nature of iron deficiency requires an urgent call to eradicate it. Hence, the solution should not be frail comparing with the huge economic loss and other incompatibilities. Flour fortification, supplementation, dietary diversification, and especially maternal education are possible solutions for combating this micronutrient deficiency (3).

Tags: iron, Pakistan, pregnancy, adolescence, and children

This study aimed to estimate the prevalence of anemia among female college students attending the University of Sharjah (UoS) in the United Arab Emirates (UAE). A secondary analysis of the records of 258 complete blood cell count results from consented female college students. Emirati students represented 50.8% of the studied population. The overall prevalence of anemia (Hb <12g/dL) was 26.7% and the majority (88.4%) of the 69 anemic students had mild anemia, whereas 7.2% were moderately anemic and 2.3% Emirati students were severely anemic (hemoglobin <7g/dL). The results showed that anemia constitutes a health problem among female college students in the UAE (4).

Tags: anemia, female, collage, UAE

Prevalence of anemia in different Middle East countries (5):

Anaemia has remained a widespread public health problem in countries of the Eastern Mediterranean Region. Prevalence figures vary from a low of 17% to a high of over 70% among preschool children; from 14% to 42% among adolescents and from 11% to over 40% among women of childbearing age. Although the prevalence of anaemia has often been used as a proxy indicator for iron deficiency anaemia, this approach is not valid in settings where the etiology of anaemia is complex or unknown or where other micronutrient deficiencies of folate, vitamin B12 and vitamin A can co-exist. An integrated, multifactorial and multisectoral approach has to be adopted comprising targeted interventions to provide iron supplements to especially vulnerable segments of the population, in particular pregnant women; food-based approaches to increase iron intake through food fortification and dietary diversification; and other measures combined with iron interventions where other causes of anaemia are prevalent. (6)

Tags: anemia, iron, folate, vitamin B12, vitamin A, Eastern Mediterranean Region

In one the risk factors for iron deficiency anemia among Saudi women of childbearing age was determined.
Eighty-seven patients and 203 controls were enrolled in the study. Low frequency of eating meat, vegetables or drinking juices right with vitamin C increased the risk of having iron deficiency anemia by 2-4 fold (7)

Tags: anemia, vitamin C, women

Different vitamins and minerals review

Several micronutrient deficiencies are still being reported from many countries of the Eastern Mediterranean Region (iron, iodine, zinc, calcium, folic acid and vitamins A and D), particularly among vulnerable groups, including children and women of childbearing age.
Vitamin A deficiency is considered a public health problem in several countries, affecting preschoolers, school-age children and women of reproductive age. Vitamin A deficiency is highly prevalent with 0.8 million preschool-age children estimated to have night blindness and 13.2 million preschool-age children with serum retinol levels <0.70 µmol/l (Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO global database on vitamin A deficiency. Geneva, World Health Organization, 2009.)
Iodine deficiency is recognized as a significant public health problem in 18 countries, and one third of the population is estimated to be at risk of developing iodine deficiency disorders, which have dramatic consequences for the fetal brain and for cognitive and functional development in early childhood (de Benoist B (et al). Iodine deficiency in 2007: global progress since 2003. Food and Nutrition Bulletin, 2008, 29:195–202.) (1).

in accordance with study about Food-Based Dietary Guidelines (FBDGs) in Eastern Mediterranean and Middle Eastern Countries seven countries (Afghanistan, Iran, Yemen, Lebanon, Oman, Qatar and Saudi Arabia) have their own official FBDGs, reaching a total of 195,616,000 citizens (29% of the entire Eastern Mediterranean population) according to WHO documents.
Concerning vitamins and minerals these FBDGs have their specific recommendations:
Lebanon and Afghanistan suggest consuming fortified foods, such as vitamin D-fortified foods (e.g., milk and yoghurt), iron-fortified flour, vitamin A-fortified oil and iodine-fortified salt.
The Omani FBDGs list fruit and vegetables by nutrients: vitamin C-, vitamin A-, iron- and folic acid-rich foods.
The Afghanistan, Lebanon, Oman and Qatar FBDGs include advice on sun exposure to maintain high vitamin D levels. Moreover, it is advised that people avoid excess sun exposure due to the risk of skin cancer. br
The Saudi Arabia and Afghanistan FBDGs include recommendations to prevent micronutrient deficiencies (such as iron, vitamins A and D, and iodine) in children.
In these countries, the epidemic of obesity is associated with iron deficiency anaemia and vitamin D deficiency, which, despite the sunny environment, remain two important nutritional issues and, in some countries, specific fortification policies are being considered (2).

Tags: Vitamins, minerals, Dietary Guidelines, Middle Eastern Countries

In accordance with the study of association of nutritional intake with educational achievement in high-school students in Iran, the intakes of energy, vitamins A, C, D, folic acid, calcium, iron, and zinc were significantly lower than the dietary reference intake. A statistically significant correlation was seen between iron intake and academic scores in female students (3).

Tags: Vitamins, minerals, high school students, Iran

The objective of this study was to identify the determinants of anaemia in Lebanese women of childbearing age attending health centres in Lebanon. Four hundred and seventy non-pregnant Lebanese women aged 15-45 years participated in it.
Anaemia and iron deficiency were prevalent in 16.0 and 27.2% of the study sample, respectively. Of the total sample, 7.7% had iron-deficiency anaemia. Plasma folate and vitamin B12 deficiency was reported in 25.1 and 39.4%, respectively, and 12.6% of the women had both folate and vitamin B12 deficiencies. Of the anaemic group, 48.0% of the women had iron deficiency. (4)

Tags: iron, folate, vitamin B12, deficiency, Lebanon

A cross-sectional survey using a questionnaire, anthropometric measurements, and laboratory assessments was conducted from January to May 2011 on 194 randomly selected Saudi medical students at Taibah University, Madinah, Kingdom of Saudi Arabia.
This study showed deficiencies in several essential nutrients among medical students, and the prevalence of overweight status, obesity, and inactivity were relatively high.
There were low percentages of recommended daily intake (RDI) of potassium (31.3%), zinc (40.7%), magnesium (24.5%), and calcium (47%), with much lower potassium and magnesium levels among males, and lower calcium levels among females. The % RDI of iron was low among females only, who had a significantly lower number of animal sources than did the males. All intakes of vitamins were low ( (<70%) in both genders, and the most severe deficiencies were for vitamin D (14.2%), B2 (49.4%), folic acid (53.6%), and niacin (67.5%). Males showed significantly lower % RDI than females for vitamin A (9% versus 40%), vitamin C (18.4% versus 71.6%), vitamin B1 (41.3% versus 50.9%), vitamin B6 (19.5% versus 43.1%), and vitamin E (37.7% versus 63.4%) (5):

Tags: vitamins, minerals, deficiency, students, Saudi Arabia

In this cross-sectional study, 534 female college students in Saudi Arabia (≥19 years of age) completed a self-administered questionnaire that include sociodemographic and lifestyle characteristics, perceived health status, dietary supplement use, general awareness, attitudes and behavior.
In all participants, the prevalence of dietary supplement use was 76.6%. High level of education and more physical activity exhibited a significant positive association with users than to non-users. The frequency showed that beta-carotene (54.2%), chamomile (54.2%), and glucosamine (53.8%) were the most preferred diet supplements under the category “when needed”. Cod liver oil (71.3%), omega 3 (68.3%), multi-vitamins (61.5%), ginseng (60%), and vitamin A (60%), were mostly used “from time to time”. Multi-minerals (34.4%) were the preferred choice when it comes to daily use. The main reasons for supplement use were to “maintain healthy hair” and “injury and illness” (both 26.2%). About 38.4% were not aware and 30.3% disagree on differences taking supplements with or without consulting a medical professional. About 36.7% lack information about side effects while, 35.0% were unaware about any health effect of dietary supplements.
In conclusion. The prevalence of dietary supplement use was high in Saudi female students and was significantly associated with sociodemographic and lifestyle factors (6).

Tags: supplements, vitamins. minerals, popularity, women, students

This study aimed to examine the use of supplements by college students in Qatar and to elucidate users’ views about them. A total of 419 college students completed a self-administered questionnaire. Almost half of the respondents (49.6%) had used supplements (ever users), with 32.7% reporting using them in the previous 6 months (current users). Of the latter, 27.7% had used herbal supplements, 56.2% vitamins and minerals and 56.9% non-vitamin, non-mineral, non-herbal supplements. Many participants considered supplements to be safer and more effective than conventional medicines. Supplements were preferred over conventional medicines for the treatment of digestive conditions and common respiratory ailments and for weight management (7).

Tags: Supplements, vitamins. minerals, popularity, students, Qatar

Estimating the Global Prevalence of Zinc Deficiency. The results indicate that inadequate dietary zinc intake may be fairly common, allow inter-country comparisons regarding the relative likelihood of zinc deficiency as a public health problem.

Data are based on the composite nutrient composition database, IZINCG physiological requirements, the Miller Equation to estimate zinc absorption and an assumed 25% inter-individual variation in zinc intake. Data are for the 2005 time frame (2003–2007).

National food balance sheet data were obtained from the Food and Agriculture Organization of the United Nations. Country-specific estimated prevalence of inadequate zinc intake were calculated based on the estimated absorbable zinc content of the national food supply, International Zinc Nutrition Consultative Group estimated physiological requirements for absorbed zinc, and demographic data obtained from United Nations estimates (8).

Tags: zinc, intake, countries comparison

Selenium is an essential element, and a cofactor required to maintain glutathione peroxidase activity. Its deficiency may induce modification in the cellular antioxidative status and the appearance of different diseases.
A cross-sectional study was carried out to determine the status of selenium, dl-alpha-tocopherol, and all-trans-retinol in 513 Saudi children living in Al-Kharj district using serum and toenail samples.
The prevalence of children with serum selenium below the threshold limit of clinical importance in coronary and cardiovascular diseases (45 microg/l) was only 1.4%, while 53.4% of the tested children had toenail selenium >0.56 microg/g, which is considered a low level.
DL-alpha-tocopherol (Vitamin E) deficiency (<0.5 mg/dl) was found only in 3.1%. However, none of the children in this study had a severe all-trans-retinol (vitamin A) deficiency (<10 microg/dl) and the percentage of children with marginal deficiency <20 microg/dl was 5.5%. (9)

Tags: Selenium. Vitamin A. Vitamin E, children, Saudi Arabia

Vitamin A deficiency (VAD) can have a negative impact on pregnancy but there have been no studies in Al-Ain on the vitamin A status of pregnant women. We studied 198 pregnant Emirati women aged 15-49 years attending antenatal clinics in Al-Ain Medical District (1999-2000) to assess the prevalence of VAD. Sociodemographic and health information about the women was collected by questionnaire and they all underwent blood and serum analysis. Of the 198 women, only 6 (3%) had vitamin A deficiency (plasma vitamin A < 20 microg/dL), indicating only a mild problem according to WHO criteria. There was no significant association between the occurrence of VAD and any of the characteristics studied. While the mean values of all the haematological indices were slightly lower in the vitamin A deficient group, this was not significant (10).

Tag: Vitamin A, rare deficiency, UAE

Functioning Area	Vitamin A	Vitamin C	Vitamin D3	Vitamin E	Vitamin K1	Thiamin (B1)	Riboflavin (B2)	Niacin (B3)	Vit B6	Folic Acid (B9)	Vit B12	Biotin
Body (Outside)
Skin	#						#	#				#
Vision	#						#
Bones			#		#
Teeth			#
Hair												#
Nails
Metabolism of Vitamin A
Body (Inside)
Muscle Function			#
Mucous Membranes	#						#	#				#
Connective Tissues
Absorption/Utilisation of Calcium and Phosphorus			#
Synthesis and Metabolism of Vitamin D
Proteins, Amino Acids
Collagen Formation (for the normal Function of Blood Vessels, Bones Cartilage, Gums, Skin, Teeth)		#
Cysteine Synthesis									#
Protein Synthesis
Sulphur Amino Acid Metabolism
Amino Acid Synthesis										#
Digestion, Metabolism
Function of Digestive Enzymes
Macronutrient Metabolism		#
Energy-Yielding Metabolism		#				#	#	#	#		#	#
Protein and Glycogen Metabolism									#
Lipid Metabolism
Carbohydrate, Fatty Acids, Acid-Base Metabolism
Mind and Mood
Cognitive Function
Mental Performance
Reduction of Tiredness and Fatigue							#	#	#	#	#
Psychological Function		#				#		#	#	#	#	#
Synthesis and Metabolism of Some Neurotransmitters
Nervous System		#				#	#	#	#		#	#
Blood Health
Blood Clotting					#
Fromation of Red Blood Cells and Haemoglobin							#		#		#
Blood Formation										#
Iron Transport in The Body
Iron Metabolism	#						#
Iron Absorption Increasing		#
Hormonal Health and Fertility
Regulation of Hormonal Activity									#
Fertility and Reproduction
Testosterone Levels in The Blood
Spermatogenesis (for male)
Maternal Tissue Growth During Pregnancy										#
Production of Thyroid Hormones and Thyroid Function
Synthesis and Metabolism of Steroid Hormones
Immune System and Cell Functions
Function of The Immune System	#	#	#						#	#	#
Protection of Cells from Oxidative Stress		#		#
Regeneration of The Reduced form of Vitamin E		#
DNA Synthesis
Cell Division and/or Specialisation	#		#							#	#
Cardiovascular System, Internal Organs, Blood Glucose
Function of The Heart						#
Homocysteine Metabolism									#	#	#
Blood Calcium Levels			#
Oxygen Transport in The Body
Maintenance of Normal Blood Glucose Levels
Liver Function
Electrolyte Balance

Functioning Area	Pantothenic Acid	Calcium	Iron	Iodine	Magnesium	Zinc	Selenium	Copper	Manganese	Molybdenum	Chromium	Choline
Body (Outside)
Skin				#		#
Vision						#
Bones		#			#	#			#
Teeth		#			#
Hair						#	#	#
Nails						#	#
Metabolism of Vitamin A						#
Body (Inside)
Muscle Function		#			#
Mucous Membranes
Connective Tissues								#	#
Absorption/Utilisation of Calcium and Phosphorus
Synthesis and Metabolism of Vitamin D	#
Proteins, Amino Acids
Collagen Formation (for the normal Function of Blood Vessels, Bones Cartilage, Gums, Skin, Teeth)
Cysteine Synthesis
Protein Synthesis					#	#
Sulphur Amino Acid Metabolism										#
Amino Acid Synthesis
Digestion, Metabolism
Function of Digestive Enzymes		#
Macronutrient Metabolism						#					#
Energy-Yielding Metabolism	#	#	#	#	#			#	#
Protein and Glycogen Metabolism
Lipid Metabolism												#
Carbohydrate, Fatty Acids, Acid-Base Metabolism						#
Mind and Mood
Cognitive Function			#	#		#
Mental Performance	#
Reduction of Tiredness and Fatigue	#		#		#
Psychological Function
Synthesis and Metabolism of Some Neurotransmitters	#
Nervous System		#		#	#			#
Blood Health
Blood Clotting		#
Fromation of Red Blood Cells and Haemoglobin			#
Blood Formation
Iron Transport in The Body
Iron Metabolism
Iron Absorption Increasing
Hormonal Health and Fertility
Regulation of Hormonal Activity
Fertility and Reproduction						#
Testosterone Levels in The Blood						#
Spermatogenesis (for male)							#
Maternal Tissue Growth During Pregnancy
Production of Thyroid Hormones and Thyroid Function				#			#
Synthesis and Metabolism of Steroid Hormones	#
Immune System and Cell Functions
Function of The Immune System			#			#	#	#
Protection of Cells from Oxidative Stress						#	#	#	#
Regeneration of The Reduced form of Vitamin E
DNA Synthesis						#
Cell Division and/or Specialisation		#	#		#	#
Cardiovascular System, Internal Organs, Blood Glucose
Function of The Heart
Homocysteine Metabolism												#
Blood Calcium Levels
Oxygen Transport in The Body			#
Maintenance of Normal Blood Glucose Levels											#
Liver Function												#
Electrolyte Balance					#

Other components

Glutathione

Inositol

Coenzyme Q10

Bamboo extract

Hyaluronic acid

Probiotics

Literature. Vitamins and minerals deficit. Middle East.

Vitamin D

Folic acid (Folate)

Iron (anemia)

Different vitamins and minerals review

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