Terms and Abbreviations to Know How to Use This Guide Arthritis Needs How Much is Too Much? Panel of Reviewers From the 2003 Guide: What About Multivitamins? Supplement Guide

Minerals
The salt of the Earth is what minerals are, literally. Minerals are found naturally in the soil and become part of the fruits, vegetables and other plant foods you eat. Your body needs minerals but if you eat plenty of fruits, vegetable greens and grains, you likely get enough. If your diet falls short, supplements can make sure you're covered.

Our mineral chart does not contain listings for boron, iodine, manganese, molybdenum or potassium because people need such small amounts of these minerals, and the amount in foods usually meet the needs. In fact, supplementation of these five minerals is rarely needed and often discouraged.

Calcium
Other names: Calcium carbonate, calcium lactate, calcium citrate, calcium gluconate and calcium citrate malate.
Why: Builds and maintains strong teeth and bones; regulates muscle contractions; transmits nerve impulses and monitors cell permeability. Calcium needs phosphorus and vitamin D present to be effective.
How much: AI = 1,000 mg daily for adults under age 50; 1,200 mg daily for adults older than 50. Some experts recommend as much as 1,500 daily for adults with inflammatory conditions and postmenopausal women not taking hormone-replacement therapy.
Too much: UL = 2,500 mg. Too much causes bloating, constipation, impaired kidney function and stones.
Too little: Contributes to bone loss, tooth loss, muscle cramps and hypertension.
Foods: Milk, yogurt, cheese, ice cream, canned sardines and canned salmon (with bones), broccoli, kale, turnip greens and bok choy, plus calcium-fortified orange juice, cereal and soy products.
Supplements: Inflammatory arthritis accelerates bone loss, so getting the optimum intake daily is critical. Supplement with 500-mg doses one or more times a day with meals but avoid taking after eating foods containing oxalic or phytic acid, such as spinach, parsley, beans and whole cereals. Calcium may interfere with absorption of iron, magnesium and zinc, so take it separate from a multivitamin. Avoid supplements containing coral calcium, bone meal, oyster shell or dolomite; they may be contaminated with lead.
Interactions: Calcium may decrease absorption or effectiveness of some bone drugs, antibiotics and calcium channel blockers. Aluminum-containing antacids, anticonvulsants, corticosteroids, diuretics and laxatives may reduce calcium levels.
Research note: A review of five studies shows the combination of calcium and vitamin D supplements significantly prevented bone loss in people taking corticosteroids. In another study of 65 people with RA, those who took calcium (1,000 mg) and vitamin D (500 IU) supplements not only reversed steroid-induced bone loss but also gained bone mass.

Chromium
Why: Helps body use insulin, protein, fat and carbohydrates.
How much: AI = 35 mcg for men age 14 to 50; 30 mcg for men over age 50; 25 mcg for women age 14 to 50; 20 mcg for women over age 50.
Too much: No known symptoms.
Too little: Impaired glucose utilization.
Foods: Black pepper, brewer's yeast, brown sugar, mushrooms, whole grains and wheat germ.
Supplements: Not necessary or recommended.
Research note: There is no conclusive evidence that chromium supplements can prevent or treat diabetes, but research continues. Using chromium and beta-blockers modestly increases levels of high-density lipoprotein (HDL) levels. Chromium may add to effects of diabetes medications. Antacids, corticosteroids, H2-blockers and proton pump inhibitors may decrease chromium levels.

Copper
Other names: Cupric oxide, copper gluconate, copper sulfate and copper citrate.
Why: Helps build red blood cells, transport iron and make connective tissue; keeps immune system, nerves and blood vessels healthy; and removes free radicals.
How much: RDA = 900 mcg daily for adults.
Too much: UL = 10,000 mcg: nausea, vomiting, diarrhea, abdominal pain, headache or death.
Too little: Rare; anemia and osteoporosis.
Foods: Organ meats, seafood, cashews, semi-sweet chocolate, peanut butter, lentils and mushrooms.
Supplements: Not necessary or recommended; a multivitamin, which typically provides the RDA, is OK.
Interactions: High levels of zinc, iron and possibly vitamin C can block copper absorption.
Research note: Although copper does have anti-inflammatory properties, there currently is no research to support dietary copper or supplementation as a treatment for arthritis.

Fluoride
Why: Necessary for strong bones and teeth (especially tooth enamel).
How much: AI = 4 mg for men; 3 mg for women.
Too much: UL = 10 mg daily: mottled and brown teeth.
Too little: Tooth decay.
Foods: Fluoridated water, tea and canned salmon and sardines (with bones).
Supplements: By prescription only for infants and children without access to fluoridated water.
Interactions: Calcium supplements and calcium- and aluminum-containing antacids.
Research note: Doesn't prevent osteoporosis. Safety concerns related to joint pain and stress fractures from taking extremely high doses.

Iron
Other names: Ferrous fumarate, ferrous gluconate and ferrous sulfate.
Why: Necessary for hemoglobin, the protein in red blood cells that carries oxygen to all cells.
How much: RDA = 8 mg daily for men; 18 mg daily for women, until menopause; 8 mg daily for women, after menopause.
Too much: UL = 45 mg per day: nausea, vomiting, diarrhea or constipation and dark-colored stools. Iron builds up in body tissues and vital organs, leading to cirrhosis, diabetes, heart disease and arthritis (particularly in the knuckles). High levels also lower zinc absorption.
Too little: The most common form of nutritional deficiency, mostly affecting young children, female teenagers and women of childbearing years. Symptoms of mild deficiency include tiredness, shortness of breath, decreased mental performance, poor appetite, unstable body temperature and decreased immunity.
Foods: Heme iron comes from beef, lamb, chicken, turkey, veal liver, ham, bologna or tuna, and is well absorbed by the body. Non-heme iron comes from plant sources and fortified grains, such as raisins, peas, lentils, figs, oatmeal and grits, and is not as well absorbed.
Supplements: Men and postmenopausal women should take multivitamins or other supplements with little or no iron.
Interactions: Calcium. High doses of vitamin C, meat, fish, poultry, citric acid and cream of tartar enhance absorption of iron from plant sources. Coffee, tea, wine, tofu, legumes, grains and rice inhibit absorption of iron from plant sources.

Magnesium
Other names: Magnesium chloride, gluconate, oxide, citrate (supplement forms); magnesium hydroxide (antacid) and magnesium sulfate (Epsom salt).
Why: Needed for more than 300 biochemical reactions in the body. Maintains muscle and nerve function, keeps heart rhythm regular, strengthens teeth and bones.
How much: RDA = 420 mg for men older than 31; 320 mg for women older than 31.
Too much: UL = 350 mg, supplements only; no upper limit via diet. Too much causes diarrhea, confusion, muscle weakness, nausea, irregular heartbeat and low blood pressure.
Too little: Symptoms include loss of appetite, nausea, vomiting, fatigue and weakness.
Foods: Kelp, wheat germ, soy beans, almonds, cashews, sunflower seeds, beans, potatoes, peanut butter and
hard (high mineral) water.
Supplements: Diet usually adequate, but supplementing is OK.
Interactions: May reduce effects or absorption of some diuretics, bone drugs, antibiotics and iron. Chemo-therapy may decrease magnesium level. Fiber may increase absorption.

Phosphorus
Why: Strengthens teeth and bones; also involved in energy production.
How much: RDA = 700 mg.
Too much: UL = 4,000 mg daily before age 70; 3,000 mg daily after age 70. Too much may cause diarrhea and upset stomach. Chronic overdose may cause kidney damage.
Too little: Rare; symptoms could include weak bones and muscles, fatigue, loss of appetite, bone pain and increased susceptibility to infection.
Foods: Milk, yogurt, cheese, eggs, whole wheat bread, soft drinks, turkey, salmon, halibut, peanuts, almonds and lentils.
Supplements: Not necessary or recommended.
Interactions: Aluminum-containing antacids, potassium supplements and potassium-sparing diuretics.
Research note: There is no scientific evidence showing that phosphorus, namely in soft drinks, contributes to bone loss. However, drinking soft drinks in lieu of milk may be a problem.

Selenium
Other names: Sodium selenite (inorganic, supplement form) and selenomethionine (organic form found in food).
Why: Works with vitamins C and E as an antioxidant; essential for proper function of immune system and thyroid gland.
How much: RDA = 55 mcg daily.
Too much: UL = 400 mcg daily. Too much may cause hair and nail loss, fatigue and mild nerve damage.
Too little: Rare; impaired immunity and heart damage.
Foods: Brazil nuts, walnuts, wheat germ, organ meats, shrimp, crab,
tuna, turkey and garlic.
Supplements: Not recommended beyond a multivitamin unless under a doctor's supervision.
Research note: Supplementation of 200 mcg daily may lower the risk of prostate cancer in men, but further studies must be done before scientists make any recommendations. Although people with RA tend to have low selenium levels, there is no evidence that selenium supplements are beneficial.

Sodium
Other names: Sodium chloride (table salt), sodium citrate, monosodium
glutamate (MSG), sodium nitrate, sodium bicarbonate (baking soda), sodium phosphate (baking powder) and sodium saccharin.
Why: Regulates body fluids and blood pressure and helps nerve impulse function and muscle contraction.
How much: AI = 1.5 g for adults 19 to 50; 1.3 g for adults 51 to 70. DV is 2.4 g (2 g sodium = 1 teaspoon table salt). Average daily intake in the U.S. is 5 g.
Too much: No UL determined; excess may cause high blood pressure, stomach cancer, kidney stones and osteoporosis.
Too little: Less than 0.5 g daily leads to headache, nausea, dizziness, fatigue, muscle cramps and fainting.
Foods: Salt. (75 percent of our salt intake comes from sodium added to seasonings or processed foods.)
Supplements: Not necessary or recommended.
Interactions: Diuretics, NSAIDs, opiates and tricyclic antidepressants. People taking corticosteroids should
stay below 3 g daily.
Research note: One study found women who consumed a high-salt diet (9 g daily) lost 33-percent more calcium and 23-percent more of a bone protein than those on a low-salt diet (2 g/day).

Zinc
Other names: Zinc gluconate and zinc acetate.
Why: Involved in wound healing, cell reproduction and tissue growth, sexual maturation, and taste and smell; also associated with more than 100 enzymatic reactions in the body.
How much: RDA = 11 mg daily for men; 8 mg daily for women.
Too much: UL = 40 mg daily: immune suppression (same as deficiency), diarrhea, abdominal cramps and vomiting and copper deficiency.
Too little: Mild deficiency impairs immunity, leading to poor wound healing and infection.
Foods: Oysters, mussels, lobster, beef, pork, lamb, chicken, turkey, milk, cheese, yogurt, maple syrup, peanuts, peanut butter, beans and lentils.
Supplements: Multivitamins with no more than 100% DV recommended.
Interactions: Antibiotics may bind with zinc, decreasing both drug and nutrient absorption. Take multivitamins and antibiotics separately. Calcium can decrease absorption of zinc supplements.
Research note: Zinc may protect against age-related macular degeneration.