Mineral Supplementation

There are two main ways by which substances may be administered to humans the enteral and the parenteral routes. For enteral administration the substance is placed directly into the gastrointestinal tract by permitting a tablet to dissolve when it is placed under the tongue (sub-lingual administration), or by swallowing a tablet, capsule or a solution (oral) or by rectal administration as a suppository. In parenteral administration the substance in solution may be injected subcutaneously, intramuscularly or intravascularly, inhaled as an aerosol, applied topically to the skin as a cream or ointment, or, rarely, in the form of a pessary. 

In mineral supplementation in humans the oral route is the most commonly used, the supplement being given as a tablet, capsule, solution or as a fortified food. Injections are usually reserved for those cases where the patient is unable to eat due to damage to the gastrointestinal tract Or other reason, e.g. in patients on total parenteral nutrition it may be difficult to maintain adequate levels of iron, and supplementation by intramuscular injections of iron, for example, as a sorbitol complex will often be required. In view of the importance of the oral route it is helpful to consider the more salient general aspects of gastrointestinal absorption. 

---

Minerals. Supplementation of macrominerals to mminants is sometimes necessary. Calcium and phosphoms are the minerals most often supplemented in mminant diets. One or both may be deficient, and the level of one affects the utilization of the other. Limestone, 36% calcium, is commonly used as a source of supplemental calcium. Dolomite, 22% calcium oyster sheUs, 35% calcium and gypsum, 29% calcium, are sources of calcium. Bone meal, 29% calcium, 14% phosphoms dicalcium phosphate, 25—28% calcium, 18—21% phosphoms and defluorinated rock phosphate, 32% calcium, 18% phosphoms, are sources of both calcium and phosphoms. Diammonium phosphate, 25% phosphoms phosphoric acid, 32% phosphoms sodium phosphate, 22% phosphoms and sodium tripolyphosphate, 31% phosphoms, are additional sources of phosphoms (5). 

Medical Uses. Citric acid and citrate salts are used to buffer a wide range of pharmaceuticals at their optimum pH for stabiUty and effectiveness (65—74). Effervescent formulations use citric acid and bicarbonate to provide rapid dissolution of active ingredients and improve palatabiUty. Citrates are used to chelate trace metal ions, preventing degradation of ingredients. Citrates are used to prevent the coagulation of both human and animal blood in plasma and blood fractionation. Calcium and ferric ammonium citrates are used in mineral supplements. 

BISPHOSPHONATES. When administering alendronate or risedronate the nurse gives the drug orally in the morning before the first food or drink of the day. Risedronate and etidronate are administered once daily. Etidronate is not administered within 2 hours of food, vitamin and mineral supplements, or antacids. 

A number of substituted triazines are used as herbicides, and their biodegradation has been discussed in Chapter 10, Part 1. Treatment of soil contaminated with atrazine (2-chloro-4-(ethylamino)-6-isopropylamino-l,3,5-triazine) illustrated a number of significant features. Although the soil that was used had the potential for degradation, a laboratory experiment with Pseudomonas sp. strain ADP that had an established potential for atrazine degradation revealed important limitations. There was a substantial decline in the numbers of Pseudomonas sp. strain ADP and only limited mineralization. Supplementation with citrate or succinate increased the survival of the strain, and successful mineralization was dependent on the preservation of a carbon/nitrogen ratio >10 (Silva et al. 2004). The last would apply generally to substrates with a low C/N ratio such as triazines. 

No specific dietary restrictions are recommended for patients with IBD, but avoidance of high-residue foods in patients with strictures may help to prevent obstruction. Nutritional strategies in patients with long-standing IBD may include use of vitamin and mineral supplementation. Administration of vitamin B12, folic acid, fat-soluble vitamins, and iron may be needed to prevent or treat deficiencies. In severe cases, enteral or parenteral nutrition maybe needed to achieve adequate caloric intake. 

There is usually no need to supplement with specific vitamins. Patients should be encouraged to eat a well balanced diet and should also take a multivitamin and mineral supplement. Some clinicians recommend vitamins C and E for their antioxidant properties however, no significant improvements have been shown compared to placebo. Encourage patients to eat a diet rich in vitamin C and E (i.e., bright colored fruits and vegetables, nuts, and whole grains). Metabolism of levodopa may cause elevated homocysteine concentrations that... 

Evans, JR, 2006. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev 19(2) CD000254. 

Copper supplements can also have an anthelmintic effect. Small amounts of copper oxide wire particles (COWP) were effective against both incoming and established Haemonchus contortus worms (Bang et al., 1990) and a mineral supplement containing elemental copper reduced faecal egg counts in lambs (Lindqvist et al., 2001). Also, Burke et al. (2004) showed a great reduction of faecal egg counts and adult worm burden of H. contortus in COWP-treated lambs. However, Dimander et al. (2003) could not show an effect against GIN in grazing cattle. 

Design concepts are now being applied more effectively to mineral supplements. For example, by controlling the redox potential of iron, toxic effects associated with excess Fe(II) during parental supplementation can be avoided. Peroxovanadate complexes can inhibit insulin-receptor-associated phosphotyrosine phosphatase and activate insulin receptor kinase, and both V(IV) and V(V) offer promise as potential insulin mimics. 

The few controlled studies of pharmacotherapy for AN have largely been disappointing. No class of medication has consistently proved effective in the treatment of AN consequently, pharmacotherapy plays a relatively minor role in the routine management of the disorder. Nevertheless, a review of the medications tested for the treatment of AN is informative. Medications used in the treatment of AN include appetite stimulants, antidepressants, antipsychotics, anxiolytics, trace mineral supplementation, prokinetics, and opiate antagonists. 

These facts lead to obvious nutritional advice for the elderly vitamin and mineral supplements, increased intake of fruit and vegetables and provision of appetising food in an attempt to overcome reduced appetite. 

The fluorinated 4-quinoline antibiotic ciprofloxacin (295) is known to interact with iron-containing drugs and mineral supplements. Stability constants have been determined for complex formation of iron(III) with ciprofloxacin, presumably acting as a bidentate 0,(9-donor, in aque-ous " and in micellar media. 

Vitamins with mineral supplements or antacids high in metals (eg, calcium, iron, magnesium, aluminum). 

Mineral supplements In general, do not give mineral supplements they may block the absorption of trientine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson disease. If necessary, iron may be given in short courses, but because iron and trientine each inhibit absorption of the other, allow 2 hours to elapse between administration of trientine and iron. 

Monobasic calcium phosphate is primarily used in fertilizers. It also is used in baking powders as a mineral supplement in food as a buffer for pH control and as a stabilizer for plastics. 

Cobalt(II) acetate is used for bleaching and drying varnishes and laquers. Other applications are as a foam stahihzer for beverages in sympathetic inks as a mineral supplement in animal feed and as a catalyst for oxidation. It also is used in aluminum anodizing solutions. 

Sales of Ca supplements alone were 875 million in the United States in 2002, and comprised 60% of all mineral supplement sales (Anonymous, 2004). In 2004, sales of Ca supplements increased by 9.3% (Uhland et ah, 2004), possibly to some extent in response to the Surgeon General s report on bone health that was issued that year. More recently in 2006, it was projected that dietary supplement sales in the United States would approach 5 billion (Anonymous, 2006). While Ca derived from a balanced diet is preferable, Ca supplements are a popular noncaloric alternative for increasing daily Ca intake. There are a vast number of oral Ca supplements available in the market place in the form of capsules, tablets, chewable tablets, effervescent tablets, liquids, powders, suspensions, wafers, and granules. However, not all Ca salts are equally soluble or bioavailable and the dose of Ca on the label of a supplement may not necessarily be reflective of the relative amount of available Ca once consumed. Furthermore, the same Ca salt may be more or less bioavailable depending on the production process and materials used to manufacture the supplement. 

Attin, T., Meyer, K., Hellwig, E., BuchaUa, W., and Lennon, A. M. (2003). Effect of mineral supplements to citric acid on enamel erosion. Arch. Oral Biol. 48, 753-759. 

Seligman, P. A., Caskey, J. H., Prazier, J. L., Zucker, P. M., Podell, E. R., and Allen, R. H. (1983). Measurements of iron absorption from prenatal multivitamin-mineral supplements. Obstet. Gynecol. 61, 356-362. 

Paget s disease PO 400 mg once a day for 3 mo. Must takewith6-8oz plain water. Do not give within 2 hr of food intake. Avoid giving aspirin, calcium supplements, mineral supplements, or antacids within 2 hr of tiludronate administration. 

To finally underline the wide functional roles that metal-carbohydrate coordination may play in nature, complexes of this type have long been used as mineral supplements because of their greater absorption in the digestive system, e.g. iron-dextran compositions in treating iron deficiency. More recently, metal pectate compositions (see ref. 165 and literature cited therein) have been advocated for use as mineral supplementation. 

Prolcgra Antioxidant vitamins a/id mineral supplement Ccrttonsi cd oil, soybean nit, beeswax Calcium phosphate ... 

One -A-Day Antioxidant Plus Antioxidant vitamins and mineral supplement Soybean oil, beeswax, partially hydrogenalcd vegetable oils Lecithin... 

Pmfcgra Antioxidant vitamins and mineral supplement X X Red 40 Blue X Edible ink ( )... 

Ojic -A-Day AntioAidunl Plus Aluio idjUII vitamin and mineral supplement nutrition facts X X Yel n%v MS Artificial Color X ... 

If you don t eat a balanced diet, take a vitamin and mineral supplement. 

The primary roles and the recommended daily intake of major and trace minerals are listed in Table 38-3. Similar to vitamins, these minerals are typically obtained from dietary sources. Specific minerals may likewise be included in various multivitamins and other dietary supplements, with the intent that these minerals will promote good health and prevent disease. Again, there is generally no need for mineral supplements for most people eating a reasonably balanced diet. On the other hand, mineral supplements can be helpful in specific situations where the body s need for a mineral may exceed dietary supply. Some examples of appropriate supplementation include calcium supplements for people with osteoporosis (see Chapter 31), potassium supplements for people on diuretics (see Chapter 21), and iron supplements for people with certain anemias. Hence, mineral supplements may be helpful in certain individuals, but the dose and type of supplement should be adjusted carefully. 

---