@THEDOCTORYAMI

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NUTRIENTS
FOOD
OF CONCERN

Last revised Oct 2020

FOOD FORTIFICATION
What is it? Vitamin D fortification in cow’s
If a food is “fortified” that means that vitamins and/or
milk
minerals have been added to the food
Initially by irradiating milk or giving irradiated yeast to cows
A food labeled “enriched” has vitamins and minerals added
that are lost by processing and has to meet certain mandatory Now vitamin D concentrate is directly added to milk
standards
Cows may also be given supplemental vitamin D because
Food fortification began as a public health intervention in the their unnatural diet and unnatural living conditions put them
1920’s to eliminate common nutritional deficiencies at risk for vitamin D deficiency

Common Vitamins and Minerals Fortified cow vs. plant milk

added to fortified foods in the US
Fortified cow’s milk and plant-based milks are often fortified
with vitamin D to comparable levels
1933 1945
Vitamin D Fluoride
Read labels to determine if a product has added Vitamin D
| |

| |
1940 1998

Other foods potentially fortified

|
Thiamin, Niacin, Folic Acid
1924 Riboflavin, Iron
Iodine

1924 - Iodine - Salt (to prevent goiter) with Vitamin D

1933 - Vitamin D - Milk (to prevent rickets)
1940 - Thiamin, Niacin, Riboflavin, Iron - Wheat Flour
1945 - Fluoride - Water supply (to decrease cavities)
1988 - Folic Acid - Wheat flour, enriched cereal grain products,
other products (to prevent neural tube defects in babies)

Yogurt Tofu Breakfast Orange

Processed grains are often Cereal Juice
“enriched” because some of the
nutritional value is lost in the
processing of the grain.

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

 VITAMIN D
What is it? Amounts of Vitamin D But wait! It's not that
Fat-soluble vitamin that promotes calcium
absorption, involved in bone growth and
in plant foods simple!
remodeling, reduction of inflammation,
immune function and other roles. Fortified Plant Milks Other things affect how much UVB rays
1 cup= 100-144 IU penetrate our skin:
Vitamin D deficiency leads to rickets in
children and osteomalacia in adults. These Mushrooms (exposed to UV light) Clothing
conditions cause soft, weak and brittle bones. 1/2 cup= 366 IU Sunscreen
Shade
Smog
Where do you get it? Who is at risk for Age

UV-B rays from sunlight on bare skin deficiency?

Foods that contain vitamin D:
Fatty fish (cod liver oil, trout, salmon)
Mushrooms that have been exposed Exclusively breastfed babies
to UV light Older adults (decreased production in
Fortified foods of plant and animal the skin and conversion in kidneys)
origin (milk, cereal, orange juice) People with darker skin
Fortified cow and plant milks have People taking certain medications (oral
about the same amount of vitamin D steroids, certain weight loss drugs,
certain seizure meds, cholesterol meds)
People with certain medical conditions
Barriers to sufficient (Crohn’s, celiac)
People who do not consume fish or
Vitamin D production fortified foods
People with high body fat
from sunlight exposure
1. Latitude Vitamin D and sunlight
2. Clothing Other considerations
3. Sunscreen
Humans produce vitamin D from UV-B rays
4. Skin tone (melanin content) from sunlight exposure on bare skin
5. Season Increased sun exposure increases risk for
Exposure to UVB rays can produce 10,000- skin cancer and aging effects of the sun
6. Time of Day
25,000 IU of Vitamin D
7. Length of day Balance time in the sun with protective
8. Cloud cover You can’t get too much vitamin D from measures
9. Smog sunshine
Vitamin D is also available through fortified
10. Shade There are several barriers to vitamin D foods and supplements
11. Windows (UVB does not penetrate glass) production from sunlight

How much is Latitude

recommended?*
0-12 months 400 IU (10 mcg)
1-18 years 600 IU (15 mcg)
19-70 years 600 IU (15 mcg)
>70 years 800 IU (20 mcg)
*Recommended dietary allowances for
adequate intake from Food and Nutrition
Board committee at the National Academies
of Sciences, Engineering and Medicine.
In the US, those living above the 37th parallel
north (north of New Mexico, Arizona and
Oklahoma) may not receive enough UVB rays
in the winter
In the spring, summer and fall seasons, 15-
20 minutes with arms, legs, and face
exposed between 10 am and 3 pm may be
sufficient to produce adequate vitamin D
Those with darker skin tones may need more
time

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

 VITAMIN B12
What is it? Who is at risk for deficiency?
Vitamin B12 is a vitamin produced by BACTERIA found in the All adults over the age of 50 (because of decrease in
soil and in the digestive tracts of herbivorous and ruminant stomach acid with age)
animals
Individuals with pernicious anemia (characterized by a lack
Vitamin B12 is stored in the muscle and liver of animals of intrinsic factor)

Vitamin B12 contains the mineral cobalt
B12 concentration in meat and dairy varies based on the
composition of the diet of the animal and their access to
sufficient cobalt
Individuals with GI disorders such as Celiac and Crohn’s
(secondary to malabsorption)
People who have had weight loss or gastric surgery
(potential decreased capacity to absorb nutrients with altered
anatomy)

Why do we need it? Pregnant and lactating vegan mothers

Vegans and vegetarians

Vitamin B12 is essential for red blood cell formation,
neurologic function and DNA synthesis. It also assists in fat
and protein metabolism. How much is recommended?*
Deficiency of Vitamin B12 can lead to megaloblastic anemia,
fatigue, weakness, appetite and weight loss and neurologic 0-6 months 0.4 mcg
symptoms such as numbness and tingling of the hands and
feet, balance problems, depression, confusion and memory 7-12 months 0.5 mcg
problems. 1-3 years 0.9 mcg
4-8 years 1.2 mcg
9-13 years 1.8 mcg
14+ years 2.4 mcg
Pregnancy/lactating 2.8 mcg

*IOM Food and Nutrition Board

Where do you get Vitamin B12? Supplements for Vitamin B12

1. Animal products such as meat, eggs and dairy
2. Fortified plant foods such as nutritional yeast, cereals
3. Present in breast milk and commercial infant formula
4. Vitamin B12 supplements - readily available and
inexpensive in the USA
Because absorption percentage drops as dose increases,
higher doses than RDA may be needed to achieve sufficient
levels.
There is no known toxic intake level, but high doses may
exacerbate acne or skin rashes.

Barriers to Sufficient intake and

Age Twice daily (mcg) Once daily (mcg) Twice weekly (mcg)

0-5 months Breast milk or fortified formula —- —-

absorption 6-11 months

1-3 years
0.4-1.0
0.8-1.5
5-20
10-40
200
375
4-8 years 1-2 13-50 500
9-13 years 1.5-2.5 20-75 750
Absorption of Vitamin B12 depends on sufficient hydrochloric
14-64 2-3.5 25-100 1000
acid in the stomach as well as the presence of intrinsic factor 65+ —- 500-1000 —-
Pregnancy/ 2.5-4 30-100 —-
lactating
NOTE: Vegans and Plant-Based Eaters must
consume Vitamin B12 from fortified foods or
supplements! *from Veganhealth.org

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

 CALCIUM
What is it? Amounts of Calcium in Plant Foods But wait - how much
Calcium is the most abundant mineral in
Fortified plant milk (1 cup)
Tofu (processed with calcium sulfate, 1/2 cup)
300-450 mg
200-400 mg
Calcium is truly
the human body Blackstrap molasses (2 Tbsp)
Orange juice, fortified (1 cup)
Broccoli Rabe, cooked (1 cup)
200-400 mg
350 mg
200 mg
adequate?
Calcium levels in the blood are tightly Soybeans, cooked (1 cup) 184 mg
regulated (do not fluctuate with intake) Kale, cooked (1 cup) 177 mg High dietary calcium is not necessarily
Sesame seeds (2 Tbsp) 176 mg protective against bone fractures
Bok Choy, cooked (1 cup) 168 mg
Bones serve as calcium reservoir for blood White beans, cooked (1 cup) 161 mg
levels Fortified breakfast cereal (1 serving) 130 mg Some experts believe that we may not
Edamame, shelled (1 cup) 122 mg need as much dietary calcium as IOM
99% of the body’s calcium is stored in Almond butter (2 Tbsp) 111 mg currently recommends
Chia seeds (1 Tbsp) 76mg
bones and teeth
WHO 500 mg per day

Why is it important? Should you supplement? NHS (UK) 700 mg per day (19 to 64 y/o)

There are potential risks to excessive

Essential for bone formation and remodeling,
muscle contraction, nerve signaling, blood
vessel contraction and dilation, hormone
secretion and more
Chronic inadequate calcium intake leads to
osteopenia and osteoporosis over the long-
term
These conditions cause weak and brittle
bones
supplemental calcium Why such large differences in
recommendations?
Possible risks of high calcium
supplementation include: constipation, Dietary and lifestyle factors can impact
interaction with medications, decreased calcium and bone metabolism
absorption of iron and zinc, kidney stones,
cardiovascular disease
Cultural, genetic and geographic
differences likely also play a role
Calcium is best obtained from a variety of
natural and fortified food sources

Bone fractures (such as hip fracture) increase

mortality in the elderly
Sources of Calcium
Dairy products naturally contain
abundant calcium
Calcium is also naturally available from
several plant sources such as greens,
beans and some nuts & seeds
Many foods in the US are also fortified
with calcium
Infants obtain adequate calcium from
breast milk or commercial formula
Low dose supplements (~300 mg) are Bottom Line
unlikely to be harmful, but may be
unnecessary Be mindful to choose and optimize sources
of calcium in the diet and minimize calcium
losses
Absorption Varies
It’s ok to use fortified foods
Calcium absorption from food is about 30% Be aware that bone health is more than just
on average calcium
The percent absorbed decreases as
calcium intake increases
In infants & children absorption may be up
to 60%
In older adults, calcium absorption may
drop to 15-25%

Foods may contain nutrients that block

How much is calcium absorption

recommended?* Several factors increase

Recommended Dietary Allowances for
Calcium in the US calcium excretion
Age Male Female
0-6 months 200 mg 200 mg High sodium intake leads to increased
7-12 months 260 mg 260 mg excretion
1-3 years 700 mg 700 mg
4-8 years 1,000 mg 1,000 mg High caffeine intake can increase excretion
9-18 years 1,300 mg 1,300 mg and decrease absorption
19-50 years 1,000 mg 1,000 mg
51-70 years 1,000 mg 1,200 mg High animal protein diet increases excretion
71+ years 1,200 mg 1,200 mg (but may increase absorption by same
*IOM Food and Nutrition Board amount)

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

 BONE HEALTH
Bone Health - It’s Not Just About What to include for bone health
Calcium!
1. Weight-bearing exercise such as walking, running, climbing,
Calcium is important but is not the only determinant of and resistance exercise
bone health 2. Adequate Calcium intake
3. Adequate Vitamin D intake
Bone undergoes constant remodeling throughout life (bone 4. Adequate protein intake (particularly for those over age 65)
is dynamic!) 5. Adequate intake of other vitamins and minerals:
Magnesium, Manganese, Vitamin K, folate, Vitamin C,
In growing children and teens bone formation exceeds Potassium, Boron
breakdown 6. Plenty of fruits and veggies!

In aging adults, bone breakdown can exceed formation

Risk Factors for

Osteoporosis
Age (osteoporosis typically affects older adults)
Female (lower estrogen post-menopause one reason)
Low body weight (less stress on bones)
Ethnic background (increased in white and asian
populations)
Inactivity/sedentary lifestyle
Disordered/restrictive eating practices
Smoking
Family history
Long-term use of certain medications such as steroids
Certain medical conditions that affect nutrient
absorption

What to avoid for bone health Bone supporting nutrients

Magnesium, Manganese, Vitamin K,
1. High sodium diet
2. Smoking
folate, Vitamin C, Potassium, Boron
3. Excess Alcohol are easy to obtain in a plant-based
4. Excess Caffeine diet!

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

 IRON
What is it? How to improve iron intake and
Mineral that is an essential component of hemoglobin in
absorption from plant foods
blood cells

Also supports muscle metabolism and is necessary for Phytates, polyphenols and calcium can inhibit iron
growth, neurologic development, cellular functioning and the absorption
synthesis of some hormones
Avoid taking calcium supplements at meals
There are two types:
Heme - derived from animal products Add a source of Vitamin C to meals (bell peppers, citrus,
Non-Heme - derived from plants tomato, other fruits and veggies)

Nutrient of concern for all humans regardless of diet Avoid coffee and tea at meals (polyphenols)

Eat more legumes (lentils, peas and beans)

Iron deficiency is the most common Soak or sprout beans and whole grains prior to cooking
nutritional deficiency in the world.
How much is recommended?*
Where do you get it?
Recommended Dietary Allowances for
Iron is naturally present in many animal, plant and fortified
0-12 monthsIron
400(in
IU mg)*
(10 mcg)
foods 1-18 yearsMale
Age 600 IUFemale
(15 mcg)Pregnancy Lactation

Heme form is slightly more bioavailable than non-heme form

19-70 years
0-6 months 0.27 600 IU
0.27(15 mcg)
—- —-

>70 years 800 IU (20 mcg)

7-12 months 11 11 —- —-
1-3 years 7 7 —- —-
It is not difficult for vegans and plant-based eaters to obtain
4-8 years 10 10 —- —-
sufficient iron from plant foods
9-13 years 8 8 —- —-
14-18 years 11 15 27 10
*IOM
19-50Food
years and 8Nutrition Board
8 27 9

Iron content in typical animal 51+ years 8 8 —- —-

and plant foods *IOM Food and Nutrition Board

Food milligrams per serving

Fortified breakfast cereal, 1 serving

White beans, 1 cup
18
8
Who is at risk for Iron
Dark chocolate 45-69%, 3 oz
Lentils, cooked ½ cup
7
3 inadequacy?
Spinach, cooked ½ cup 3
Tofu, firm ½ cup 3
Kidney beans, canned, ½ cup 2
Chickpeas, boiled ½ cup 2
1. Menstruating women
Sardines (bone in) 3 oz 2 2. Pregnant women
Beef, 3 oz 2 3. Premature, preterm and low birthweight babies
Potato, baked, skin on 1 medium 2 4. Exclusively Breast fed babies between 4-6 months of age
Cashews, roasted, 1 oz 2 5. Frequent blood donors
Green peas, boiled, ½ cup 1
6. People with malabsorption from chronic conditions or
Chicken, roasted, 3 oz 1
Rice, white, parboiled, ½ cup 1 surgery
Broccoli, boiled, ½ cup 1 7. Children consuming excess cow’s milk and dairy
Egg, hard boiled, 1 large 1 products
Bread, white or wheat, 1 slice 1

Be careful!: Accidental ingestion of iron

supplements can be toxic! Always keep out of
reach of children

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

 IODINE
What is it? Amounts of Iodine in Typical Foods
Trace element naturally present in the earth’s soil and
seawater Food mcg
Usually occurs as a salt (iodide)
Seaweed, Nori, dried, 10 g 232
Essential component of thyroid hormones, also plays a role in Cod, baked, 3 oz 158
immune response
Iodized salt, ¼ tsp 76
Thyroid hormones are critical for proper metabolism
Shrimp, cooked, 3 oz 13

Iodine Deficiency is Dangerous

Earliest sign of deficiency is a goiter (enlarged thyroid
gland)

A goiter occurs because the thyroid gland is trying hard to
absorb iodine from the circulation
In pregnancy, deficiency can lead to growth problems and
cretinism in babies
Iodine deficiency is the most common cause of
preventable intellectual disability in the world
Where do you get it?
Barriers to sufficient
intake/absorption
Although it is naturally present in the soil, levels vary and may
lead to insufficient intake in some regions
Goitrogens are substances that inhibit iodine uptake by the
thyroid

Soy, cassava, sweet potato, millet and cruciferous

vegetables are goitrogens
1. Naturally plentiful in seaweed (nori, kelp, kombu, wakame)
2. Human breast milk and commercial infant formulas
Selenium, vitamin A and iron deficiency can inhibit iodine
3. Fish and seafood
uptake as well
4. Table salt in the US has been fortified with Iodine since
the 1920’s
5. Other fortified foods such as some enriched breads
6. Cow’s milk and chicken eggs contain iodine because it is
added to their feed so levels vary Who is at risk for deficiency?
Note: specialty salts and salt in processed packaged foods
are not typically iodized
1. People who avoid iodized table salt
2. Pregnant women
3. Vegans (especially if salt-free diet and do not consume
How much is recommended ?* seaweed)
4. Those who live in areas with iodine-deficient soil
5. People who have low iodine intake AND consume lots of
Recommended Dietary Allowances for goitrogens
Iodine (in mcg)*
0-6 months 110
7-12 months 130 Should you supplement?
1-8 years 90
9-13 years 120 If you avoid iodized salt, seaweed and seafood (or have
inconsistent intake), it is reasonable to supplement
14+ years 150
Most multivitamins contain a safe amount of iodine
Pregnancy 220-250**
Lactation 290 Individual iodine supplements can contain amounts that
are too high
*IOM Food and Nutrition Board
Kelp and kelp supplements may contain levels that are
**WHO, UNICEF and ICCIDD recommend 250 mcg per day for
too high-use caution
pregnant women

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

OMEGA-3 FATTY ACIDS
What is it? Omega-3's Fatty Acids
A class of polyunsaturated fatty acids In the US there is currently no Recommended Dietary
0-12 months 400 IU (10 mcg)
Adequate
Allowance for Omega-3’s
Intake (in mg)
We often discuss 3 types: alpha-linolenic acid (ALA),
eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) Age
1-18 yearsMale 600 IU (15 mcg)
Female
19-70
Birth-12 years
months* 500 600 IU (15 mcg)
500
ALA is considered an essential fatty acid which means the
human body cannot make it’s own
70 years 700
1-3>years** 800 IU (20 mcg)
700
4-8 years** 900 900
Humans can manufacture a small amount of EPA and DHA 9-13 years** 1,200 1,000
from ALA, but the conversion is limited 14-18 years** 1,600 1,100
19+ years** 1,600 1,100
ALA—> EPA—> DHA Pregnancy** —- 1,400
Lactation** —- 1,300

Why do we need it? *As total Omega-3’s (present in breast milk and fortified in
infant formula)
**As ALA
Used in cell membranes throughout the body especially in From IOM Food and Food and Nutrition Board
retina, brain and sperm

Provide energy Amount of ALA in typical foods

Used to form molecules involved in the cardiovascular, Food
Amount in mg
pulmonary, immune and endocrine systems 7,260
Flaxseed oil, 1 Tbsp
2,139
May have anti-inflammatory properties Chia seeds, 1 Tbsp
2,570
English walnuts, 1 oz
Deficiency can cause rashes, scaly skin and dermatitis. 1,710
Flaxseeds, ground, 1 Tbsp
450
Soy oil, 1.5 tsp
Where do you get it? Canola oil, 1 tsp
433
500
Soybeans, cooked, 1/2 cup
400
1. ALA is derived from plants and is particularly rich in flax Tofu, firm, 1 cup
seeds, chia seeds, hemp seeds, walnuts and plant oils 400
Tempeh, 1 cup
such as flax, canola and soybean oil
2. DHA and EPA are made by marine microalgae!
3. Phytoplankton eat the algae and then fish eat
phytoplankton and store the Omega-3s in their fat Supplements for Vegans and
Plant-Based Eaters
Sources of DHA and EPA Aim to consume adequate ALA from foods such as chia
seeds, ground flaxseeds and walnuts

Vegan DHA/EPA supplements are made directly from

microalgae

Consider supplementing DHA 150-300 mg per day

Cold water fatty fish Vegan/plant-based Plant-Based algal oil supplements likely have the same
Fortified foods
such as salmon, algal oil supplements
such as some
bioavailability as cooked fish
herring, sardines,
trout brands of eggs,
yogurt, milk, juices,
infant formula

Supplements for Pregnancy

How much is recommended?
The American Academy of Pediatrics recommends that
In the US there is currently no Recommended Dietary pregnant and breast breastfeeding women consume 200-300
Allowance for Omega-3’s mg of DHA per day

@thedoctoryami | www.doctoryami.com | Dr. Yami Cazorla-Lancaster

 @THEDOCTORYAMI
@thedoctoryami

DISCLAIMER
Please consult with YOUR medical provider to determine if supplementation
is appropriate for you or your child.

SOURCES
Calcium Vitamins and Minerals www.nhs.uk
Harvard T.H. Chan School of Public Health. The Nutrition
Source. Vitamin D.
How much calcium do you really need? Harvard Health
Publishing, Harvard Medical School
National Institutes of Health Calcium Fact Sheet for
Professionals
National Institutes of Health: Iron Fact Sheet for
Professionals
National Institutes of Health: Omega-3 Fatty Acids Fact
Sheet for Professionals
National Institutes of Health: Vitamin B12 Fact Sheet for
Professionals
The Vegetarian Resource Group: Calcium in the Vegan Diet

National Institutes of Health. Office of Dietary Supplements. WHO: Nutrition: micronutrient deficiencies
Vitamin D Fact Sheet for Consumers.
World Health Organization: Recommendations for
National Institutes of Health. Office of Dietary Supplements. Preventing Osteoporosis
Vitamin D Fact Sheet for Health Professionals.
https://veganhealth.org/daily-needs/
National Institutes of Health: Iodine Fact Sheet for
Professionals