Trace elements

Dr. Suppasin Soontrapa

Department of Orthopedics
Khon Kaen University, Khon Kaen, Thailand
 Vitamin and Calvin RDA *Thai RDA
mineral Plus 1’s

Calcium 600 mg 800-1200 mg 800 mg

Vitamin D 200 iu. 200-400 iu 200 iu
Magnesium 40 mg 280-400 mg 350 mg
Zinc 7.5 mg 12-15 mg 15 mg
Copper 1 mg 2 mg 2 mg
Manganese 1.8 mg 2-5 mg 3.5 mg
Boron 0.25 mg none none
*Ref: ค่ าสารอาหารที่แนะนำให้ บริโภคประจำวันสำหรับคนไทยอายุต้งั แต่ 6 ปี ขึน้ ไป (Thai Recommended Daily
Intakes– Thai RDI) จัดทำโดย คณะอนุกรรมการพิจารณาการแสดงคุณค่ าทางโภชนาการบนฉลากของอาหาร 2538
Magnesium
 Magnesium
Elemental Composition of the Human Body

 Magnesium is found Element % of total atoms

H 63
in small amount in O 25.5
C 9.5
the human body N 1.4
Ca 0.31
P 0.22
Cl 0.08
K 0.06
S 0.05
Na 0.03
(http://ods.od.nih.gov/factsheets/magnesium.asp#h2) Mg 0.01
 Magnesium
• Approximately 50% of total body
magnesium is found in bone.
• The other half is found predominantly
inside cells of body tissues and organs.
• Only 1% of magnesium is found in
blood

(http://ods.od.nih.gov/factsheets/magnesium.asp#h2)
 The function of Magnesium

 Magnesium has positive charge

 Magnesium has many necessary function in cells
• Co-factor in many basic cellular function especially in process of energy
production
 Magnesium is needed for more than 300 biochemical reactions in the
body
 The function of Magnesium
• regulate blood sugar levels
• promotes normal blood pressure
• to be involved in energy metabolism and
protein synthesis
• Maintain normal muscle and nerve function
• keeps heart rhythm steady
• supports a healthy immune system
• keeps bones strong.
 Magnesium
• Magnesium is absorbed in the small
intestines.
• Magnesium is excreted through the
kidneys
 Sources of Magnesium
• Green vegetables
– spinach are good sources of magnesium
because the center of the chlorophyll
molecule (which gives green vegetables
their color) contains magnesium.
• Some legumes (beans and peas), nuts
and seeds
• whole grains, unrefined grains are also
good sources of magnesium
 DRIs (Dietary Reference Intakes)
1. Recommended Dietary Allowances
(RDA)
2. Adequate Intakes (AI)
3. Tolerable Upper Intake Levels (UL).
 DRIs (Dietary Reference Intakes)

• Recommended Dietary
Allowances (RDA)
– The RDA recommends the average
daily intake that is sufficient to meet
the nutrient requirements of nearly all
(97-98%) healthy individuals in each
age and gender group
 DRIs (Dietary Reference Intakes)
– Adequate Intakes (AI)
– An AI is set when there is insufficient
scientific data available to establish a
RDA for specific age/gender groups.
– AIs meet or exceed the amount needed to
maintain a nutritional state of adequacy in
nearly all members of a specific age and
gender group
DRIs (Dietary Reference Intakes)

– Tolerable Upper Intake Levels (UL)

– UL is the maximum daily intake
unlikely to result in adverse health
effects.
Recommended Dietary Allowances (RDAs)
for magnesium for children and adults

Age Male Female Pregnancy Lactation

(years) (mg/day) (mg/day) (mg/day) (mg/day)

1-3 80 80 N/A N/A

4-8 130 130 N/A N/A

9-13 240 240 N/A N/A

14-18 410 360 400 360

19-30 400 310 350 310

31+ 420 320 360 320

 Causes of Magnesium Deficiency
• Magnesium is absorbed in the intestines and
then transported through the blood to cells and
tissues.
• Approximately one-third to one-half of dietary
magnesium is absorbed into the body
• Gastrointestinal disorders impair absorption
– Crohn's disease can limit the body's ability to absorb
magnesium.
• Chronic or excessive vomiting and diarrhea may
also result in magnesium depletion
signs and symptoms of magnesium deficiency

• loss of appetite, nausea, vomiting, fatigue, and

weakness.
• As magnesium deficiency worsens,
– numbness, tingling, muscle contractions and cramps,
seizures, personality changes, abnormal heart
rhythms, and coronary spasms can occur
• Severe magnesium deficiency can result in low
levels of calcium in the blood (hypocalcemia).
• Magnesium deficiency is also associated with
low levels of potassium in the blood
(hypokalemia)
Who may need extra magnesium?

• specific health problem

– poorly-controlled diabetes
– persons with alcoholism
• condition limits magnesium absorption
– Individuals with chronic malabsorptive prob
lems such as
• Crohn's disease, gluten sensitive enteropathy, r
egional enteritis, and intestinal surgery may lose
magnesium through diarrhea and fat malabsorpti
on
 Who may need extra magnesium?
• Older adults are at increased risk for m
agnesium deficiency.
• The 1999-2000 and 1988-94 National He
alth and Nutrition Examination Surveys
suggest that older adults have lower di
etary intakes of magnesium than young
er adults
1. Ford ES and Mokdad AH. Dietary magnesium intake in a national sample of U.S. adults. J Nutr.
2003;133:2879-82.
2. Bialostosky K, et al., Dietary intake of macronutrients, micronutrients and other dietary constituents: Unite
d States 1988-94. Vital Heath Stat. 11(245) ed: National Center for Health Statistics, 2002:168.
 Magnesium and osteoporosis
• Bone health is supported by many factors
– most notably calcium and vitamin D
– some evidence suggests that magnesium def
iciency may be an additional risk factor for po
stmenopausal osteoporosis
• Several human studies have suggested that ma
gnesium supplementation may improve bone mi
neral density
Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phosphorus,
Magnesium, Vitamin D and Fluoride. National Academy Press. Washington, DC, 1999
Magnesium and osteoporosis
• magnesium deficiency alters calcium m
etabolism and the hormones that regul
ate calcium1
• In a study of older adults, a greater mag
nesium intake maintained bone mineral
density to a greater degree than a lower
magnesium intake2
1. Elisaf M, Milionis H, Siamopoulos K. Hypomagnesemic hypokalemia and hypocalcemia: Clinical and
laboratory characteristics. Mineral Electrolyte Metab 1997;23:105-12.
2. Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and v
egetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr
1999;69(4):727-36.
 Conclusion
• Magnesium is very important in older a
dults to maintain many functions
• Magnesium deficiency usually found in
poor controlled DM, alcoholism, chroni
c malabsorptive problems, ect.
• magnesium supplementation may impr
ove bone mineral density and prevent
osteoporosis
 Conclusion
• Calvin-plus contain Magnesium 40 mg
(~ 10% of RDA)
Copper
 What is copper?
• copper is a trace mineral that plays an imp
ortant role in our metabolism, it allows ma
ny critical enzymes to function properly.
• the total amount of copper in the body is o
nly 75-100 mg
• Copper stored primarily in the liver, with le
sser amounts found in the brain, heart, kid
ney, and muscles
 The function of copper?
• Copper is an essential component of many enzy
mes.
• Copper plays a role in a wide range of physiologi
cal processes including
– iron utilization,
– elimination of free radicals,
– development of bone and connective tissue,
– production of the skin and hair pigment called mel
anin.
 Iron Utilization
• Approximately 90% of the copper in the bl
ood is incorporated into a compound calle
d ceruloplasmin, which is a transport prot
ein responsible for carrying copper to tissu
es that need the mineral.
• ceruloplasmin also acts as an enzyme, cat
alyzing the oxidation of iron.
 Iron Utilization
• The oxidation of iron by ceruloplasmin is ne
cessary for iron to be bound to its transport
protein (called transferrin) so that it can be
carried to tissues where it is needed.
• Iron deficiency anemias may be a symptom
of copper deficiency.
 Elimination of Free Radicals
• Superoxide dismutase (SOD) is a copper-depen
dent enzyme that catalyzes the removal of super
oxide radicals from the body.
• Superoxide radicals are generated
– during normal metabolism
– white blood cells attack invading bacteria and viruses
(a process called phagocytosis).
• If not eliminated quickly, superoxide radicals cau
se damage to cell membranes
 Elimination of Free Radicals
• When copper is not present in sufficient qu
antities, the activity of superoxide dismuta
se is diminished
• The damage to cell membranes caused by
superoxide radicals is increased
 Development of Bone & Connective Tissue

• Copper is also a component of lysyl oxi

dase, an enzyme that participates in the
synthesis of collagen and elastin
 Melanin Production
• Tyrosinase, a copper-containing enzym
e, converts tyrosine to melanin, which i
s the pigment that gives hair and skin it
s color.
The symptoms of copper deficiency

• iron deficiency anemia

• ruptured blood vessels
• osteoporosis
• elevated LDL cholesterol and reduced
HDL cholesterol levels
• increased susceptibility to infections d
ue to poor immune function
• loss of pigment in the hair and skin
• weakness, fatigue, breathing difficulties
 The risk factors of copper deficiency ?

• most Americans consume less than recomme

nded amounts of copper in their diet
• Certain medical conditions result in decreased
absorption of copper and may increase the ris
k of developing a copper deficiency
– chronic diarrhea
– celiac sprue
– Crohn's disease
 The risk factors of copper deficiency ?

• copper requires sufficient stomach acid

for absorption, so if you consume anta
cids regularly you may increase your ri
sk of developing a copper deficiency.
 RDAs of Copper
• Boys & girls 9-13 years: 700 g
• Boys & girls 14-18 years: 890 g
• Men & women 19-70 years: 900 g
• Men & women >70 years: 900 g
• Pregnant & women 14-50 years: 1000 g
• Lactating women 14-50 years: 1300 g
 Conclusion
• Copper have many functions in man
• Most US people consume less amounts
of copper than recommended
• Copper in calvin plus = 1 mg can
supplement adequate amount of
copper per day
Zinc
 Zinc: What is it?
• Zinc is an essential mineral that is found in almost every cell.
• It stimulates the activity of approximately 100 enzymes, which
are substances that promote biochemical reactions in the body,
including alkaline phosphatase1-2
• Zinc supports a healthy immune system3-4
1. Sandstead HH. 1994;124:322-327.
2. Institute of Medicine. National Academy Press. Washington, DC, 2001.
3. Solomons NW. Nutr Rev 1998;56:27-28.
4. Prasad AS. Zinc: An overview. Nutrition 1995;11:93-99
 Zinc: What is it?
• Zinc is needed for wound healing1
• maintain your sense of taste and smell2
• Zinc is needed for DNA synthesis3
• Zinc also supports normal growth and development
during pregnancy, childhood, and adolescence4,5
1. Heyneman CA. Ann Pharmacother 1996;30:186-187.
2. Prasad AS, et al. Proc Assoc Am Physicians 1997;109:68-77.
3. Institute of Medicine. National Academy Press. Washington, DC, 2001.
4. Simmer K and Thompson RP. Acta Paediatr Scand Suppl 1985;319:158-163.
5. Fabris N and Mocchegiani E. Aging (Milano) 1995;7:77-93.
 What foods provide zinc?
• Zinc is found in a wide variety of foods1
• Oysters contain more zinc per serving than any other food,
• Red meat and poultry provide the majority of zinc in the Americ
an diet.
• Other good food sources include beans, nuts, certain seafood, wh
ole grains, fortified breakfast cereals, and dairy products1-2

1. Institute of Medicine. National Academy Press. Washington, DC, 2001.

2. U.S. Department of Agriculture, Agricultural Research Service. 2001. Nutrient Data
Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp Search the database online.
 The 2001 RDAs for zinc for infants 7 through 12
months, children and adults in mg per day
Infants and Childr
Age en Males Females  Pregnancy  Lactation

7 mo. to 3 years 3 mg        

4 to 8 years 5 mg        

9 to 13 years 8 mg        

14 to 18 years   11 mg 9 mg 13 mg 14 mg

19+   11 mg 8 mg 11 mg 12 mg

Institute of Medicine. National Academy Press. Washington, DC, 2001

 Inadequate intake of zinc
• Low zinc status has been observed in 30% to 50% of
alcoholics.
– Alcohol decreases the absorption of zinc and increases lo
ss of zinc in urine.
– Many alcoholics do not eat an acceptable variety or amo
unt of food, so their dietary intake of zinc may be inadeq
uate1-3
1. Institute of Medicine. National Academy Press. Washington, DC, 2001
2. Menzano E and Carlen PL. Alcohol Clin Exp Res 1994;18:895-901
3. Navarro S, et al., Pancreas 1994;9:270-274.
 Inadequate intake of zinc
• Individuals who have had gastrointestinal surgery
• Digestive disorders that result in malabsorption
– including sprue
– Crohn’s disease
– short bowel syndrome1-3
• These patients may benefit from zinc supplementation
1. Institute of Medicine. National Academy Press. Washington, DC, 2001
2. Hambidge KM, In: Mills CF, ed. Zinc in Human Biology, New York: Springer-Verlag 1989 Pp 281-296.
3. Naber TH, et al., Scand J Gastroenterol 1998;33:514-523.
 Signs of zinc deficiency
• growth retardation
• hair loss
• diarrhea
• delayed sexual maturation
• impotence
• eye and skin lesions
• loss of appetite

Institute of Medicine. National Academy Press. Washington, DC, 2001.

 Signs of zinc deficiency
• weight loss
• delayed healing of wounds
• taste abnormalities
• mental lethargy1-5
1. Hambidge KM, In: Zinc in Human Biology, 1989 Pp 281-296.
2. King JC and Keen CL. In: Modern Nutrition in Health and Disease, 1999, Pp223-239.
3. Krasovec M and Frenk E. Dermatology 1996;193:361-363.
4. Ploysangam A, et al., J Trop Pediatr 1997;43:192-198.
5. Nishi Y. J Am Coll Nutr 1996;15:340-344.
 Who may need extra zinc?
• There is no single laboratory test that adequately measures zi
nc nutritional status1-2
• risk factors of zinc deficiency1
– inadequate caloric intake
– alcoholism
– digestive diseases
1. Institute of Medicine. National Academy Press. Washington, DC, 2001.
2. Van Wouwe JP. Clinical and laboratory assessment of zinc deficiency in Dutch children. A re
view. Biol Trace Elem Res 1995;49:211-225.
 Who may need extra zinc?
• Vegetarians may need as much as 50% more zinc tha
n non-vegetarians because of the lower absorption of
zinc from plant foods
• it is very important for vegetarians to include good so
urces of zinc in their diet1-2
1. Institute of Medicine. National Academy Press. Washington, DC, 2001.
2. Gibson RS. Content and bioavailability of trace elements in vegetarian diets. Am J Clin
Nutr 1994;59:1223S-1232S.
 Conclusion
• Zinc is an essential mineral for many function
including bone growth
• Many people consume inadequate zinc especially
vegetarians
• Zinc in calvin plus = 7.5 mg can supply about
50% of daily requirement of zinc
Boron
 โบรอนในธรรมชาติ
• ในธรรมชาติสามารถพบโบรอนในรู ปของเกลือโบเรต (bo
rate) สามารถพบในอัตราส่ วนทีส่ ู งในน้ำทะเลและในดิน
• ในน้ำทะเลพบความเข้ มข้ นของโบรอนโดยเฉลีย่ ประมาณ
4.6 mg/L
 ระดับของโบรอนในเนือ้ เยือ่ ของมนุษย์
• เราสามารถพบโบรอนได้ ในเนือ้ เยือ่ ทัว่ ร่ างกายของ
มนุษย์
• ปริมาณของโบรอนทั้งหมดในร่ างกายมีต้งั แต่ 3 ถึง 20
mg พบสู งสุ ดในกระดูก เล็บมือและเล็บเท้ าและเส้ นผม (
4.3 – 17.9 ppm)
 อาการของการขาดโบรอน
• การเจริญเติบโตลดลง
• มีการพัฒนาของกระดูกทีผ่ ดิ ปกติ
• เพิม่ การขับแคลเซียมในปัสสาวะ
• เพิม่ อาการของการขาดวิตามินดี (เช่ นการสร้ าง
กระดูกทีผ่ ดิ ปกติและการเจริญเติบโตทีผ่ ดิ ปกติ)
 การดูดซึมโบรอน
• โบรอนสามารถถูกดูดซึมได้ ง่ายทาง GI tract และทาง
mucous membrane เช่ นปาก ตา ช่ องคลอดและทวารหนัก
• Hunt รายงานว่ ามนุษย์ และสั ตว์ สามารถดูดซึม inorganic b
oronได้ เกือบร้ อยเปอร์ เซ็นต์
 การขับโบรอน
• โบรอนส่ วนใหญ่ จะถูกขับออกทางปัสสาวะ
• ประมาณร้ อยละสองขับออกทางอุจจาระ
• ขับทางน้ำดี เหงือ่ และลมหายใจ ในปริมาณเพียงเล็ก
น้ อย
 ปริมาณโบรอนต่ อวัน
• การประเมินปริมาณโบรอนทีร่ ับประทานค่ อนข้ างลำบาก
เนื่องจากไม่ มขี ้ อมูลของปริมาณโบรอนในอาหารและใน p
ersonal care products และปริมาณของโบรอนในน้ำดืม่
• ในประเทศฟิ นแลนด์ รับประทานโบรอนเฉลีย่ ต่ อวัน
ประมาณ 1.7 mg ขณะทีใ่ นประเทศสหรัฐอยู่ระหว่ าง 1.7
ถึง 7 mg/day
 ปริมาณโบรอนต่ อวัน
• Samman และคณะได้ วเิ คราะห์ อาหารทีร่ ับประทาน
ในช่ วง 7 วัน พบว่ า
– บุรุษและสตรีของประเทศออสเตรเรียรับประทาน
โบรอนโดยเฉลีย่ 2.28 + 1.3 mg/day และ 2.16 + 1.1
mg/day ตามลำดับ
 แหล่งอาหารของโบรอน
• แหล่ งอาหารหลักของโบรอนคือ
– ผลไม้ และผัก ส่ วนใหญ่ ได้ แก่ เมล็ด ก้านและเปลือกจะมีโบรอนใน
ปริมาณสู งยกเว้ นมะนาว berries และสั บปะรด
– ผักใบเขียวจะมีปริมาณโบรอนสู งทีส่ ุ ด
– หัวทีอ่ ยู่ใต้ ดนิ (tubers) และ legumes จะมีปริมาณของโบรอนทีส่ ู ง
กว่ าอาหารประเภทธัญพืช (ข้ าวโพด ข้ าวและข้ าวสาลี)
 ความต้ องการโบรอนในมนุษย์
• คาดกันว่ ามนุษย์ มคี วามต้ องการโบรอนในปริมาณ
500 g/d
• จากข้ อเสนอแนะของ The Food and Nutrition
Board of the Institute of Medicine พบว่ าโบรอน
สู งสุ ดทีม่ นุษย์ ทมี่ อี ายุมากกว่ า 18 ปี สามารถรับได้ คอื
20 mg/day
 Evidence Grading
Grading
• A: Strong scientific evidence for this use
• B: Good scientific evidence for this use
• C: Unclear scientific evidence for this use
• D: Fair scientific evidence against this use
• F: Strong scientific evidence against this use
 Evidence Grading
Uses based on scientific evidence Grade
Hormone regulation
Boron may increase hormone (estrogen) levels in women, reducing vaginal
C
discomfort after menopause. More research is needed in humans before a stro
ng conclusion can be reached.
Improving cognitive function
Preliminary human study reports better performance on tasks of eye-hand
coordination, attention, perception, short-term memory, and long-term memo C
ry with boron supplementation. However, additional research is needed befor
e a firm conclusion can be drawn.
 Evidence Grading
Uses based on scientific evidence Grade
Osteoarthritis
Based on human population research, in a boron rich
environment, people appear to have fewer joint disorders. It has a
lso been proposed that boron deficiency may contribute to the dev C
elopment of osteoarthritis. However, there is no clear human evid
ence that supplementation with boron is beneficial as prevention a
gainst or as a treatment for osteoarthritis.
 Evidence Grading

Uses based on scientific evidence Grade

Osteoporosis
Animal and preliminary human studies report that boron may
play a role in mineral metabolism, with effects on calcium, phosph
orus, and vitamin D. However, research of bone mineral density in C
women taking boron supplements does not clearly demonstrate be
nefits in osteoporosis. Additional study is needed before a firm con
clusion can be drawn.
 Evidence Grading
Uses based on scientific evidence Grade
Vaginitis
Inorganic boron (boric acid, borax) has been used as an antiseptic
based on proposed antibacterial and antifungal properties. It is pr
oposed that boric acid may have effects against candidal and non-c
C
andidal vulvovaginitis. A limited amount of poor-quality research
reports that boric acid capsules used in the vagina may be effective
for vaginitis. Further evidence is needed before a recommendation
can be made.
 Evidence Grading
Uses based on scientific evidence Grade

Bodybuilding aid (increasing testosterone)

There is preliminary negative evidence for the use of boron for
improving performance in bodybuilding by increasing testoste
rone. Although boron is suggested to raise testosterone levels, i D
n early human research, total lean body mass has not been affe
cted by boron supplementation in bodybuilders. Additional res
earch is necessary before a firm conclusion can be drawn.
 Evidence Grading

Uses based on scientific evidence Grade

Menopausal symptoms
It has been proposed that boron affects estrogen levels
in post-menopausal women. However, preliminary D
studies have found no changes in menopausal symptom
s.
 Evidence Grading
Uses based on scientific evidence Grade
Prevention of blood clotting (coagulation effects)
It has been proposed that boron may affect the activity of
D
certain blood clotting factors. Study results conflict. There is no
t enough evidence in this area to form a clear conclusion.
Psoriasis (boric acid ointment)
Preliminary human study of an ointment including boric acid D
does not report significant benefits in psoriasis.
 Conclusion
• Boron มีบทบาทสำคัญมากมายต่ อร่ างกาย
• จนถึงปัจจุบันยังไม่ มขี ้ อมูลทีช่ ัดเจนเกีย่ วกับภาวะโบรอน
ในร่ างกาย
• การเสริมโบรอนเชื่อว่ าสามารถให้ ประโยชน์ ต่อร่ างกายใน
หลายๆด้ านรวมทั้งโรคกระดูกพรุน
• Calvin plus เป็ นยาแคลเซียมเพียงตัวเดียวทีม่ โี บรอนเป็ น
ส่ วนประสมอยู่ในปริมาณ 0.25 mg
Thank you