The United States eats well, a little too well, according to experts. Amply supplied with a large supply of high-calorie food, our diets might seem to be chock full of every conceivable nutrient. Well, to the question "Getting all the right vitamins, minerals and other nutrients?" the most appropriate answer seems to be "Not exactly." Eating a lot doesn't equal eating a lot of the most important vitamins and minerals. So, which vitamins and minerals are likely to show up in short supply in the typical American diet? Calcium certainly sits at the top of list. According to the most recent Continuing Survey of Food Intake by Individuals, which is conducted by the United States Department of Agriculture (USDA), women and girls age 12 and up are not consuming adequate calcium from their diet. Research reveals that about 1200 mg. day suffices for those over age 50 and 1000 mg a day should be adequate if you're between the ages of 19 and 50. Since strong bones are formed during "the first three decades of life," says Laura Bachrach, MD, of Since strong bones are formed during "the first three decades of life," says Laura Bachrach, MD, of Stanford University, ". . .osteoporosis is a pediatric disease." For long-range protection against that bone-weakening disease, kids should eat calcium-rich, low-fat dairy products and plenty of leafy greens (broccoli, cabbage, kale) as well as salmon (with bones), seafood and soy. But the calcium campaign does not end in early adulthood. Bone mass begins to deteriorate at about age 30. Menopausal hormonal changes can exacerbate bone brittleness. Medical conditions, including cancer, liver disease and intestinal disorders; prescription drugs; tobacco and alcohol indulgence; or a decline in activity, especially the weight-bearing kind, also jeopardize bone strength. According to the National Osteoporosis Foundation, about one in every two American women will break a bone after age 50 due to osteoporosis. That translates into about half a million fractured vertebrae and more than 300,000 shattered hips. Frequently, those breaks are life-threatening.

Crucial Calcium
The critical role of calcium in many body functions is perhaps the most extensively clinically documented among nutrients. Researchers in the Department of Medicine, Oregon Health Sciences University in Portland, reviewed epidemiological and clinical studies conducted over the past two years on the relationship between dietary calcium and blood pressure (J Am Coll Nutr October 1999: 398S-405S). "Nearly 20 years of investigation in this area has culminated in remarkable and compelling agreement in the data," the researchers report, "confirming the need for and benefit of regular consumption of the recommended daily levels of dietary calcium." Investigators at the State University of New York, Buffalo School of Dental Medicine, presented results of their studies of calcium and vitamin C and gum disease at the June 26, 1998 meeting of the International Association for Dental Research. Two separate inquiries revealed that people who consumed too little calcium as young adults, and those with low levels of vitamin C in their diets, appear to have nearly twice the risk of developing periodontal disease later in life than folks with higher dietary levels of either nutrient.

Calcium:
Much Documented
Researchers offer extensive evidence of calcium's benefits on many fronts:
n Osteoporosis poses a threat to older men as well as women, according to Randi L. Wolf, PhD, research associate at the University of Pittsburgh Graduate School of Public Health. Dr. Wolf presented her award-winning study to an October 3, 1999 meeting of the American Society for Bone and Mineral Research. Dr. Wolf suggests that men increase their consumption of calcium, particularly after age 80, to avoid age-related declines in the amount of calcium absorbed. According to Dr. Wolf, "It appears that the hormonal form of vitamin D, which is the main regulator of intestinal calcium absorption, may have an important role. We are conducting more research to better understand the reasons for why calcium absorption declines with age in men." n Scientists at Tufts University in Boston did some earlier work on the calcium-vitamin D connection and reported it in the September 4, 1997 New England Journal of Medicine. Using the National Academy of Sciences (NAS) increased recommended daily intake of 1200 milligrams of calcium and 400 to 600 international units of vitamin D for people over 50, the Tufts researchers found that with supplementation of the nutrients, men and women 65 and older lost significantly less body bone and, in some cases, gained bone mineral density. n Two studies published in American Heart Association journals show that atherosclerosis and osteoporosis may be linked by a common problem in the way the body uses calcium. The September 1997 Stroke revealed that, in a group of 30 postmenopausal women 67 to 85 years old, bone mineral density declined as atherosclerotic plaque increased. Researchers reporting in Circulation (September 15, 1997) advanced the theory that the osteoporosis-atherosclerosis connection may be related to a problem in handling calcium. n For people who had colon polyps removed, taking calcium supplements decreased the number of new polyps by 24% and cut the risk of recurrence by 19%, according to researchers at the University of North Carolina, Chapel Hill, School of Medicine. The study, published in the January 14, 1999 New England Journal of Medicine, was a first in crediting calcium with anti-cancer properties.

The D Factor
Without adequate vitamin D, your absorption of calcium slips and bone loss can accelerate, increasing the risk for fractures. Fifty percent of women with osteoporosis hospitalized for hip fractures at Brigham and Women's Hospital in Boston had a previously undetected vitamin D deficiency (Journal of the American Medical Association, April 28, 1999). University of Pittsburgh Cancer Institute researchers told participants at the April 14, 1997 meeting of the American Association for Cancer Research that vitamin D "significantly inhibits highly metastatic, or widespread, prostate cancer in animals," suggesting its potential for treating men with similar conditions. Few foods that Americans eat, except dairy, contain much vitamin D, but we can usually synthesize sufficient amounts from as few as five minutes' exposure to the sun. But as skin ages, its ability to act as a vitamin D factory decreases. According to Michael F. Holick, the director of the Vitamin D, Skin and Bone Research Laboratory at Boston University Medical Center, upwards of 40% of the adult population over age 50 that he sees in his clinic are deficient in vitamin D. Recently, the National Academy of Sciences (the official body that decrees the required amounts of necessary nutrients) increased the daily recommendations of vitamin D to 600 IU for people over 71, 400 IU for those aged 51 to 70 and 200 IU for people under 50. The best dietary sources, apart from dependable supplements, are dairy and fatty fish like salmon. Four ounces of salmon provide about 300 IU.

The Facts About Fats
The American lust for low-fat, high-carbohydrate diets filled with sugary foods has exploded into nothing short of "obsession," according to experts at the General Research Center at Stanford University Medical Center (Am J Clin Nutr 70, 1999: 512S-5S). That mania oftens robs us of the crucial balance of omega-3 and omega-6 fatty acids typical of the Mediterranean diet that protect us from heart disease by controlling cholesterol and making blood less likely to form clots. These fatty acids cannot be made by the body but are critical for health: n Omega-3 fatty acid (linolenic acid) comes from fresh, deepwater fish (salmon, mackerel, sardines) and vegetable oils such as canola, flaxseed and walnut. n Omega-6 fatty acid (linoleic acid) found primarily in raw nuts, seeds and legumes and in saturated vegetable oils such as borage, grape seed, primrose, sesame and soybean. The American Heart Association recommends limiting total fat consumption to 30% of daily calories. Saturated fats like those in dairy and meat products as well as vegetable oil should comprise 10% of total calories; total unsaturated fat (fish oils, soybean, safflower nuts and nut oils) should be restricted to 20 to 22% of daily calories.

Be Sure About B12
Vitamin B12 presents a particular problem for the elderly because older digestive systems often don't secrete enough stomach acid to liberate this nutrient from food. (The elderly have no problem absorbing B12 from supplements, because it's not bound to food.) Vitamins generally moderate the aging process but, ironically, that process and the diseases that frequently accompany it affect vitamin metabolism (Schweiz Rundsch Med Prax 83, 1994: 262-6). And because of those changes, we need more of certain vitamins. This is the case for vitamins D, B6, riboflavin and B12. Crucial for health, B12 is necessary to prevent anemia, and, according to recent studies, needed (along with folate and B6) to help stave off heart disease. B12, with thiamine and niacin, boosts cognition (Adv Nutr Res 7, 1985: 71-100). Screening for vitamin B12 deficiency and thyroid disease is cheap and easy and can prevent conditions such as dementia, depression or irreversible tissue damage (Lakartidningen 94, 1997: 4329-32). In the January 5-12, 1999 issue of Circulation: Journal of the American Heart Association, the AHA urged doctors to screen levels of homocysteine (the amino acid byproduct of protein digestion that damages arteries, causes heart disease and, possibly, strokes) in patients at high risk for heart disease. They also recommended all Americans to up their daily levels of vitamins B6 and B12, as well as folic acid. Since fruits, vegetables or grains lack B12, vegetarians need B12 supplements. And they're a good idea for the rest of us, too.

Folic Acid Benefits
Folic acid made headlines in the early 1990s when the U.S. Public Health Service declared that "to reduce the frequency of neural tube defects [spina bifida, or open spine, and anencephaly, a lethal defect of the brain and skull] and their resulting disability, all women of childbearing age in the United States who are capable of becoming pregnant should consume .4 milligrams (400 micrograms) of folic acid per day." This recommendation followed voluminous research that showed taking folic acid was associated with a significantly reduced risk of birth defects. (The advisory is based on the fact that nearly half of all pregnancies are unplanned. If you think you are pregnant, consult your health practitioner for supplementary advice.)

A Team Player
Folic acid's efficacy intensifies when it works with other nutrients. Among many studies on the preventive powers of folic acid on birth defects, one published in The New England Journal of Medicine (327, Dec. 24, 1992: 1,832-1,835), disclosed an even greater decrease in neural tube defects when supplements of folic acid contained copper, manganese, zinc and vitamin C. As a warrior against homocysteine, folic acid joins the battalion of B12 and B6 in detoxifying this harmful protein. At the University of Washington's Northwest Prevention Effectiveness Center, researchers recently analyzed 38 published studies of the relationship between folic acid, homocysteine and cardiovascular disease and, according to associate professor Shirley A. Beresford, MD, folic acid and vitamin B12 and B6 deficiencies can lead to a buildup of homocysteine.

Compelling Evidence
Canadian researchers reported in the Journal of the American Medical Association (275, 1996: 1893-1896) that men and women with low folic acid have a 69% increase in the risk of fatal coronary heart disease. This 15-year study of more than 5,000 people stressed the need for dietary supplementation of folic acid. Folic acid also has been credited with the potential to protect against cancers of the lungs, colon and cervix. It appears to help reverse cervical dysplasia, the precursor cells to cervical cancer, especially for women taking oral contraceptives, which may cause a localized deficiency of folic acid in the cells of the cervix. According to Shari Lieberman, PhD, and Nancy Bruning, authors of The Real Vitamin & Mineral Book (Avery), folic acid derivatives work with neurotransmitters, the chemicals that permit signals to be sent from nerve fiber to nerve fiber. A lack of folic acid can cause some nervous-system disorders, such as depression, schizophrenia and dementia; it also may be related to some forms of mental retardation. Other supporting roles of folic acid, according to researchers: the formation of normal red blood cells, important for preventing the type of anemia characterized by oversized red blood cells; strengthening and improving white blood cell action against disease; limiting production of uric acid, the cause of gout.

The Best Sources
Many foods are rich in folic acid: beef, lamb, pork and chicken liver, spinach, kale and beet greens, asparagus, broccoli, whole wheat and brewer's yeast. But experts believe that only 25 to 50% of the folic acid in food is bioavailable. Processing also reduces an estimated 50 to 90% of its content. Folic acid supplementation overcomes these obstacles with little risk, as it has no known toxicity. Women taking folic acid who are current or former users of oral contraceptives may require additional zinc. And be sure to augment your folic acid supplement with its synergistic counterpart, vitamin B12.

Focus on Fiber
The American Heart Association came out squarely behind fiber in a June 16, 1997 issue of its journal Circulation: Double your daily intake to lower cholesterol and the risk of heart disease. The American diet is consistently low in fiber, notes Linda Van Horn, PhD, RD, author of the article. Twenty-five to 30 grams a day from foods (or supplements) are not only heart healthy but seem to aid weight control.

Iron Problem
Getting enough iron? An estimated 25% of adolescent girls in the United States are iron deficient, according to an October 12, 1996 issue of the British medical journal The Lancet, which reported that girls who took iron supplements performed significantly better on verbal tests than those who took a placebo. "Teenage girls should be regularly tested for iron deficiency because rapid growth and the onset of menstruation during puberty increase the body's need for iron," says Ann Bruner, MD, of the Johns Hopkins Children's Center and a lead author of the study.USDA data reveal that women up to age 50 also tend to get much less than recommended levels of iron, a lack of which leads to anemia, a deficiency of red blood cells, hemoglobin or volume of blood. For kids, deficiency is more common from six months to four years and during the rapid growth spurts of adolescence when the body is growing so quickly that the body's iron stores may sink to dangerous levels. Vegetarian women run the greatest risk for deficiency, as meat is iron-rich; foods like beans, grains and vegetables also contain some iron. Supplements, of course, supply easily absorbable iron. And to absorb iron from vegetarian sources, take vitamin C with your meals. That boosts the amount of this mineral you will take in. Bear in mind, however, that certain folks-older men and post-menopausal women-generally have adequate dietary supplies of iron. Of greater concern, in fact, is excessive iron, and for these folks iron-free multivitamin and mineral supplements are available.

Ante Up the Antioxidants
Antioxidant nutrients help protect the body from oxygen-scavenging molecules called free radicals. The products of pollution, the body's own metabolic processes and other sources, free radicals are linked to heart disease, cancer and other chronic health problems. The most important antioxidants, which include vitamin C, E, beta carotene, and selenium, are often lacking in the American diet. Plus, optimal amounts of vitamin E cannot be consumed from food. You need supplements. The bottom line: even though we live in a land of plenty, you can still miss vital nutrients. So make sure to consume these vital substances.

Sprouts: Nutritional
Source of Missing Nutrients
In the search for the nutrients missing from America's diet, one big help is the sprout. The sprout is truly one of nature's heavyweights: fresh, tiny and moist, its power punch of vitamins, minerals, protein, chlorophyll and disease-busting phytochemicals land it in a weight class far beyond that of its full-grown competitors. Size does NOT matter to this nutritional giant. A championship belt currently wraps around the miniscule broccoli sprout, catapulted into the ring by Paul Talalay, MD, professor of pharmacology and molecular sciences at Johns Hopkins University. Dr. Talalay discovered that the seedlings contain substantially more of the cancer-fighting substance sulforaphane than mature plants (Proc. Natnl. Acad. Sci. USA, 94, 10367-10372). Sprouts, the quintessential health food of the Sixties, provide a wonderfully varied and versatile way to get your daily greens. Raw or cooked, strong or mild, vegetable and grass sprouts and their algae cousins add low-calorie texture to recipes and a rich, diverse complement of nutrients and fiber.

Ancient Asia to the Modern Lab
Asians stir-fried sprouts as one of the earliest fast foods as long as 5,000 years ago. The ancient Chinese relied on sprouts for year-round vegetables in colder regions of their vast country. Today, researchers studying sprouts and adult plants have identified their important chemoprotective and other health-bolstering substances. In Paul Talalay's research project at Johns Hopkins, scientists found that three-day-old broccoli sprouts contain up to 50 times more sulforaphane than mature plants, which prompts the body to produce an enzyme that prevents cancer tumors from forming. Uniform levels of the compound saturate the shoots, unlike the chemically uneven adult plants. The Brassica family of broccoli and cabbage is richly endowed with phytochemicals that also help reduce estrogen levels associated with breast cancer. Other phytochemical compounds in the Brassica family are associated with the prevention of stomach and lung cancers. Most of the initial landmark work on phytochemicals' cancer-fighting powers has taken place since 1989 under the aegis of the National Cancer Institute's "Designer Food Program," which isolated, for example, the isoflavones in beans that seem to neutralize cancer-gene enzymes.