Michael Buck Shlegeris, 3rd place

Abstract

The human body requires a variety of chemical elements for health. A variety of health organisations around the world have produced tables of ideal consumption levels of the dietary minerals. These have been used as the basis of public health advice.

For this paper, a wide variety of research on supplementation and health effects of various levels of mineral consumption of the quantity minerals was reviewed. Studies with fewer than 1000 participants were ignored. Most studies considered were either extremely large and had gathered lots of citations, or were meta-analyses of published studies.

To determine evidence of the ideal level of consumption, population studies were reviewed to determine the effect of different levels of mineral consumption. Intervention studies were also considered.

The effects of publication bias and biased research was considered, and determined to have little effect on the outcome of this review.

Most people in America have mineral intakes which differ radically from the RDAs. In the case of all of the quantity minerals, research indicates that people should either increase or decrease their consumption in the direction suggested by the RDAs. No evidence of trade-offs, where different levels of consumption had different positive health effects, was found. Most people would be significantly healthier if they followed FDA advice about mineral consumption. Dietary supplements have been shown to be not as good for health as consuming the equivalent minerals in food, but are still better than suffering from marginal or clinical deficiency.

Recommendation List

I believe that all adults should occasionally be tested for deficiency in all the major minerals. Blood tests are relatively cheap, but inaccurate. Dead cell samples, of hair for example, provide a more accurate measurement of the mineral concentration in the body, while costing around $100. These tests should be used to remove the possibility of a deficiency. Deficiencies have extreme negative health effects, and spending $100 to have personalised data which can be used to adjust your intake to ideal levels seems prudent.

Most people have diets which have massively wrong amounts of minerals. Calcium, which probably should have an RDI of something far over 1000mg/day, has an average consumption of only 830mg/day.

In general, it is better to get minerals from food than from supplements. However, if getting the right amount of minerals from your diet is too hard, then supplementation is far better than deficiency. The general recommendation of “eat more fruit and vegetables” is one of the easiest ways that you can improve your health.

Mineral
RDI (men) per day
RDI (women) per day
Judgement of RDI
Advice

Calcium
1000mg
1000mg
Probably too low
Consume lots, but men who do so should take vitamin D. Most people are deficient, even with current RDI.

Magnesium
410mg
320mg
Plausible
Many people are deficient. These people should increase intake

Phosphorous
700mg
700mg
Plausible
Most people should reduce consumption

Potassium
4700mg
4700mg
Plausible
Most people need to increase consumption

Sodium
1500mg
1500mg
Plausible
Most people should reduce consumption

Report Body

Introduction
Nutrition is one of the most hotly and publicly debated areas of science, because it has such relevance to everyone. The correct levels of mineral consumption have been guessed by a variety of government agencies. However, science marches on, and both the recommendation themselves and the types of recommendations are out of date. For most people, health benefits can be easily gained by increasing their mineral intake in sensible ways. My research into the ideal intake levels of quantity minerals suggests that most of the RDAs are fairly close to right. In no cases did I find any trade-offs between different areas of health at different levels of consumption: either more was uniformly good or uniformly bad. However, most Americans do not consume the RDA of any quantity mineral except sodium, which comes in salt, and phosphorus, which comes with protein, both of which are overconsumed.

The general trend of mineral consumption
As the amount of a mineral in the diet increases, its health effects pass through several stages. To start with, a complete denial of a particular dietary mineral to the body is uniformly bad. This is true in respect of both the major minerals and the trace minerals. An increase in the consumption of each mineral then improves general health. There is then a relatively large plateau of consumption, within which the body can effectively regulate supply. After a point, excess quantities of a mineral have toxic effects. The ideal consumption of a mineral then lies in the range between deficiency and toxicity.

I would suspect that the ideal intake of a mineral would be a bit more than we would naturally consume. The body clearly has mechanisms in the kidneys and liver to regulate supply of minerals. In a non-modern setting, the body would have had to distribute minerals as a scarce resource. Nowadays, consuming more of some minerals would probably allow the body to compromise less. However, minerals normally come with food, and eating more food than necessary is clearly unhealthy. This is more of a trade-off for some foods than others: eating more spinach to increase magnesium intake is unlikely to result in any other negative effects. And when avoiding excess carbohydrates, fats, or proteins, dietary supplements with negligible content apart from the desired minerals can be consumed, the only problem being concerns about the supplement's safety and purity.

The obvious heuristic to use with regards to mineral consumption is to avoid both deficiencies and overdoses. From this point of view, any study which finds a lack of effect in supplementing a particular mineral, or which does not find variation in health when considering variations in the mineral intake, is providing evidence for the belief that consumption is somewhere in the “sweet spot”.

Another factor is that people who consume more of a particular mineral consume more of all food, on average. This results in an increased risk of obesity, and all the negative health effects of that.

Evaluating bias in the reporting of health effects of minerals
The drug industry has a reputation for scientific dishonesty. I suspect that the research on mineral supplements is far more accurate and reliable than research on drugs. In America, drug companies must run trials determining the effectiveness and safety of their drugs prior to selling them. However, dietary supplements are considered food items by the FDA. Their safety does not need to be evaluated prior to their sale. Dietary supplements may display “structure/function claims” without prior FDA review, e.g. “Supports the immune system” or “helps support joint and cartilage function.” Even without legislation, effectiveness does not seem to much affect the dietary supplement industry. Consider the disputes about effectiveness and safety of multivitamins. These doubts do not seem to affect the multivitamin industry. As a result, supplement companies have little incentive to create misleading scientific evidence with regards to their dietary supplements.

The reliability of RDIs and AI
In America, the Institute of Medicine (IOM) determines a variety of measures related to nutrition: recommended daily intake (RDI), adequate intake (AI), and so on. (RDI and RDA (recommended dietary allowance) are used interchangeably in a frustrating amount or research. These simply are different names for the same concept.) The IOM decides upon its consumption advice by the extremely crude measure of measuring the intake of healthy people, and then guessing. Current average consumption is clearly not a measure of ideal consumption. For example, the RDI of calcium for an adult male is 1000mg/day[1]. However, Hunt et al argued that the equilibrium level of calcium intake was lower, more like 741 mg/day[2]. (Note that the author of this paper has published several papers arguing for a reduction of RDI for various minerals). The largest study of the health impact of calcium in the diet was a study of 23,000 Swedish men, where Kaluza et al found that men in the highest tertile of calcium consumption had a statistically significant lower rate of all cause mortality than men in the lowest tertile. The highest tertile had a mean calcium intake of 1,953 mg/day, compared to the lowest tertile 990 mg/day. Note that the 990mg/day is nearly the RDI, yet consuming more calcium still had a positive effect. This seems to suggest that the ideal intake is far higher than either the published RDI.

Also, the RDI is simply set attempting to avoid obvious deficiencies. Even if it were completely effective with this goal, an improvement in health could still be observed by increasing intake. So the RDI is by definition inappropriate as a recommendation of ideal intake levels.

However, all the research into mineral consumption which I have reviewed agrees with the RDA in terms of the direction in which most American people's consumption should go. Once the relatively easy gains from shifting consumption to the RDA are achieved, more research could shed light on more precisely optimal quantities of minerals to consume.

Multivitamins
Multivitamins are dietary supplements which include a variety of minerals. These seem like they should have strong positive effects, but large studies show greatly varying results as to their efficaciousness. One large review found no consistent results[3], as did a cohort study[4]. Another review on the effect of multivitamins on breast cancer found the same[5]. Multivitamins don't seem to improve the rate of infection in elderly people[6], even including studies which were later withdrawn from the meta-analysis due to doubts about their validity. Most convincingly, multivitamins do not seem to decrease mortality in hospital patients[7]. Hospital patients would be expected to have deficiencies.

Some studies have shown specific benefits of multivitamins: for example, a reduction of paediatric cancers[8] and other congenital anomalies[9]. However, the folic acid in the multivitamin probably had most of the effect there.

One concern with both multivitamin supplements and other dietary supplements is the lack of regulation. Many people believe that there is far more regulation in dietary supplements than there actually is[10]. People have a tendency to become wild fans of potentially dangerous concoctions which have no evidence for their effectiveness[11]. Multivitamins frequently have different mineral doses on them than their labels claim[12] [13] [14], and there are concerns about their safety and purity[15]. There is no regulation or testing that products are safe[16]. Websites such as ConsumerLab.com independently test supplements for safety and accurate labelling, and often find the supplements are unsafe or incorrectly formulated. Such websites should be consulted before using supplements.

Supplementation versus changes in diet
Increasing the consumption of vegetables improves health in a wide variety of ways[17] [18]. Particularly, green leafy vegetables are great for health. These green leafy vegetables are high in magnesium, of which most people's diets are deficient. However, supplementation does not seem to have nearly as positive an effect as eating the actual vegetables. This could have a variety of causes. Perhaps there are other positive chemicals in food which have not been synthesised yet, or some other chemicals are required to absorb minerals effectively. But regardless, eating more green leafy vegetables is almost certainly a good thing. Changes in diet are better than supplementation. However, supplementation is far better than nothing. Most people do not consume enough vegetables, even though they know they should. These people would be better off consuming supplements, particularly supplements of specific minerals they know they are deficient in. Calcium is one mineral which I would recommend taking as supplement, because dairy, one of the main calcium sources, is high in fat and energy, which can lead to obesity. However, calcium should be supplemented at the same time as taking vitamin D.

Method used to determine ideal intake
As a result, when attempting to determine the ideal intake level of various minerals, I am primarily interested in studies showing the following things.

Clear effects of deficiency. These studies suggest a level of intake which is suboptimal. The surest gains from understanding dietary minerals come from preventing clear deficiencies.

Clear effects of overdoses. These provide an upper bound on the ideal intake level of the minerals.

No effect from an increase in intake. If increasing the intake of a particular substance has no effect at a particular dosage, then this is weak evidence that that dosage is in the ideal zone.

Other studies showing effects of mineral intake on specific health outcomes, for instance if increased calcium intake increases bone density, are weak evidence for the ideal intake being closer to the level associated with the health benefit.

The “bottom drawer effect,” or publication bias, is the tendency of researchers to publish results when they find them, and neglect to publish their findings when they turn out to favour the null hypothesis. In this case, it is possible that researchers studied the health impact of mineral supplementation, or did small population studies determining the effect of various quantities of mineral intake. In both cases, if the study found no effect, this is evidence that the current intake of the particular mineral is close to ideal.

Intervention studies of mineral supplements seem to be greatly obfuscated by the variance in mineral consumption in the population. As such, I believe that studies showing the effect of various levels of consumption, ignoring whether the consumption comes from dietary supplements, are the most useful tool to determine ideal intake levels.

Criteria for study inclusion
I ignored any studies of health effects which considered less than 1000 subjects. Most of the studies cited considered far more than that.

Calcium
Calcium is a quantity material. The RDI is 1000mg/day for men and women until age 50 and 1200mg/day after that.

As previously discussed, a large population study of Swedish men estimated the calcium and magnesium intake of the men, then measured mortality and cancer incidence among these men. Men with the highest tertile of calcium consumed an average of 1,953mg/day, while the lowest tertile consumed 990mg/day. Men in the highest tertile experienced statistically significantly lower all-cause mortality than those in the lowest tertile. This is strong evidence that the ideal intake of calcium is far higher than the RDI. This is particularly strong evidence because people with higher calcium consumption would also be expected to consume more food overall, which would lead to an increase in the incidence of obesity. Cheese and milk, two high fat products, are major sources of calcium. But even with that effect, higher calcium intake is positive.

One major health problem caused by calcium deficiency is osteoporosis. The process by which calcium is used to increase bone density is well understood, and there is little dispute that calcium deficiency can cause osteoporosis. According to Nordin [19], “...established osteoporosis of all kinds is so commonly associated with malabsorption of calcium and/or high obligatory calcium excretion as to suggest that negative calcium balance has at least a contributory, if not a causal role in most forms of osteoporosis.”

There is significant evidence that high calcium intakes, around 2000mg/day and higher, increase the risk of cancer, because calcium consumption suppresses production of vitamin D. This effect was not seen in the Swedish study. However, research indicates that simultaneous supplementation of calcium and vitamin D decreased the risk of cancer[20]. One meta-analysis of calcium supplementation intervention studies indicated that calcium supplements without vitamin D increased risk of heart attacks and strokes[21].

Most Americans do not consume the RDI for calcium[22] [23]. The average intake is about 830mg, calculated from R Bethene Irvin et al's table. Therefore, increasing consumption significantly would be wise for most Americans.

In conclusion, the RDI for calcium seems to be set too low. The best advice seems to be to consume more calcium than the RDI, while supplementing with vitamin D.

Magnesium
Magnesium is one of the quantity minerals required for humans. The FDA has set an RDI of around 410mg/day for adult males, and around 320mg/day for adult females[24]. A large population study of Swedish men estimated the magnesium (and calcium) intake of the men, then measured mortality and cancer incidence among these men. Men from the first and third tertile of magnesium intake consumed an average of 387mg/day and 523 mg/day respectively. This had no statistically significant effect on mortality or cancer incidence. This provides weak evidence that the RDI for magnesium is not too low. Zimmerman et al[25] note that studies investigating the effect of magnesium supplementation on athletic ability have had inconclusive results, but in cases of marginal magnesium deficiency in athletes (defined as an intake of magnesium lower than the EAR, but not clinical magnesium deficiency), magnesium supplementation has been shown to have a positive effect. This is more evidence that the RDI is not too low.

About 60% of the population of the US does not meet the RDI of magnesium[26]. It is unclear whether these people suffer any major long term adverse health effects as a result of this. One study claimed that this deficiency was a causal factor in the recent increase of osteoporosis in developed countries[27]. This is supported by quite a few studies of osteoporosis and magnesium[28] [29] , most convincingly by a review by Rude et al[30].

Other positive effects attributed to magnesium include reduced blood pressure[31], and a reduced risk of stroke[32]. These studies are fairly rigorous. These studies provide additional impetus to increase magnesium consumption for people with other risk factors for such illnesses.

In conclusion, with regard to magnesium, there is probably no health advantage to be gained from consuming far more than the RDI of magnesium. However, most Americans are magnesium deficient. These people can probably benefit from increasing magnesium consumption. Major sources of magnesium include green leafy vegetables and nuts. If it is too difficult to meet the daily requirement of magnesium through dietary changes, a mineral supplement is a sensible alternative.

Phosphorous
The average intake of phosphorous is around 1300 mg/day. The RDA is 700mg/day. This excess phosphorus consumption probably comes from the presence of phosphorus-containing additives in manufactured food, and phosphorous consumption is increasing: it has increased from about 1000mg/day in 1990. This excess phosphorous consumption seems to have a variety of negative effects, as summarised by Karp et al[33]. To start with, phosphorous intake seems to interact with calcium in a variety of ways. A dose of 1500mg/day, which of course is far greater than the RDA or the average consumption, inhibits bone growth[34]. Phosphorous intake above the RDA, particularly in conjunction with calcium deficiency, is detrimental to bone growth[35]. Restriction of phosphorous intake is important to management of renal disease[36]. One large study found that an increase in phosphorous consumption from dairy sources correlated with improved health[37], but it was probably a result of some other effect of the dairy.

It is fairly well established that high phosphorous consumption is bad for health. The RDA is fairly difficult to check, as a result of most people vastly over-consuming potassium. Most people should consume less. Consuming less of processed foods is the simplest way to achieve this.

Potassium
The average intake of potassium is about 2800mg/day. This is far below the RDA of 4700mg/day. When the distance between the RDA and the actual intake is so large, it is hard to judge whether the RDA is flawed. There is a significant body of evidence that potassium deficiency is bad, and that supplementation is positive. This all suggests that the ideal intake is far higher than the current average intake.

A meta-analysis of studies of potassium supplementation found that it helped to lower blood pressure in both hypertensive patients and healthy patients[38] [39]. Higher potassium intake reduced risk of stroke[40], according to a very large meta-analysis. A higher sodium/potassium ratio increases risk of cardiovascular disease and all cause mortality[41]. Food processing increases sodium content and decreases potassium content, so is doubly bad[42].

It is impossible to know if consuming far more than the RDA of potassium is beneficial, because very few people actually do so. The ideal potassium intake seems to be far higher than the current average intake.

Sodium
The average intake of sodium is 3400mg/day. However, the RDA is 1500mg/day. Sodium mostly enters in the human diet through salt. For decades, public health organisations have been trying to convince people to lower their salt consumption. Reducing salt consumption has many positive effects, such as lowering blood pressure, as shown by both intervention studies and population studies [43] [44] [45], and this effect is dose-responsive. A review found that high salt intake increased the risk of stroke and cardiovascular disease[46]. The risk of both diseases decreases with blood pressure.

Increased sodium intake does not appear to have any positive effects. There is little dispute that reducing salt intake is good for health. It seems nearly impossible to have a sodium deficient diet.

Trace minerals
In every case so far, a review of the published research has agreed with the RDA on whether people are consuming too much or too little of each quantity mineral. Research is more limited on the effect of the trace minerals, but it seems prudent to try and increase or decrease intake to RDA levels as appropriate.

There is no evidence that multivitamins with lots of trace minerals in them have noticeable health effects.

The scale of these benefits
The health benefits available from improving the diet are significant. One article claimed that “broader adherence to recommendations for daily intake of fruit, vegetables, fish and fatty acid composition may take away as much as 20-30% of the burden of cardiovascular disease and result in approximately 1 extra life year for a 40-year-old individual.”[47] Most of the research into the effects of different levels of mineral consumption has been on its effect on heart disease, cancer, and osteoporosis. These are major diseases, and reducing the incidence of them is important for health.

A diet which conforms to ideal mineral intake levels results in probably a few extra years of life, not even considering extra quality of life because of the reduced risk of osteoporosis and non-fatal diseases. The monetary cost of an improved diet is pretty much negligible: extra vegetables, nuts, and low fat dairy. It is more effort to arrange a healthier diet, and decreasing your phosphorous and sodium intake requires decreasing your intake of processed food. Improving your diet, even if only by increasing your intake of fruit and vegetables, is one of the most cost effective ways of improving your health.

However, at this point, no mineral supplements have been shown to have a broad positive effect, with the exception of vitamin D and calcium. Also, mineral supplements are more expensive than improvements of diet. If it is impossible to improve the diet, calcium and vitamin D supplements cost less than a dollar per day.

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