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Vitamin and Mineral Toxicities in Adults

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Judy A. Driskell, Extension Foods and Nutrition Specialist

Our bodies need vitamins and essential minerals. And, like other things, if taken in large amounts, vitamins and minerals can adversely affect health. Large amounts of anything can be toxic.

Nutritional Status

People can have deficient, adequate, or toxic intakes of any essential nutrient. A deficiency occurs when the intake of the essential nutrient is too low to meet a person's need for that specific nutrient. Adequacy occurs when a person gets enough, but not too much, of a nutrient. Nutrient toxicity occurs when you get an overdose of a given nutrient.

Causes of Nutrient Toxicities

Most nutrient toxicities don't occur from dietary intakes of foods. Vitamin toxicities usually come from taking high potency vitamin supplements. Most mineral toxicities are a result of inhalation.

Much of the data on adverse health effects from taking large amounts of a vitamin or mineral pertain to acute rather than chronic use. Because nutrients work together, consuming excessive amounts of one nutrient can cause a deficiency of another.

There is no evidence that low levels of vitamin-mineral supplements adversely affect health. This topic is discussed in a recent NebFact, "Vitamin-Mineral Supplements and Their Usage by Adults."

Table 1. Vitamin and Mineral Toxicities in Adults

Nutrient 1989 RDA^a Men/Women U.S. RDA^b Lowest Reported
Toxic Dose (adults)^c Symptoms of Toxicity (mild and severe)

Vitamin A
(preformed) 1000/800 mcg RE 5000 IU or 1000 mcg RE 6000 RE Headache, vomiting, diplopia, alopecia, dryness of mucous membranes, dermatitis, anemia, insomnia, bone abnormalities, bone and joint pain, hepatomegaly, liver damage, hypercalcemia, hyperlipemia, menstrual irregularities, spontaneous abortions, and birth defects.

Vitamin D 5/5 mcg 400 IU or 10 mcg 45 mcg Nausea, vomiting, excessive thirst and urination, muscular weakness, joint pain, hypercalcemia, disorientation, and irreversible calcification of heart, lungs, kidneys, and other soft tissues.

Vitamin E 10/8 mg -TE 30 IU or 20 mg -TE Unknown Exacerbation of the coagulation defect produced by vitamin K deficiency caused by either malabsorption or anticoagulant therapy.

Vitamin K 80/65 mcg None Unknown Menadione (vitamin K₃) but not phylloquinone (vitamin K₁) causes hemolytic anemia, liver damage, and, in newborns, kernicterus.

Vitamin C (ascorbic acid) 60/60 mg 60 mg 4 g Nausea, diarrhea, kidney stones, mobilization of bone minerals, systematic conditioning to high intakes, and abortion.

Vitamin B₁
(thiamine) 1.5/1.1 mg 1.5 mg 300 mg Gastric upset and prolonged large parenteral injections can lead to sensitized anaphylactoid reactions.

Vitamin B₂
(riboflavin) 1.7/1.3 mg 1.7 mg 1000 mg None reported in humans; precipitates in kidneys and hearts of laboratory rats.

Niacin
(nicotinic acid and nicotinamide) 19/15 mg NE 20 mg or 20 mg NE 1 g Nicotinic acid - vascular dilation, gastrointestinal irritation, increased muscle glycogen utilization, decreased serum lipids, decreased mobilization of fatty acids from adipose tissues, and hepatomegaly.
Nicotinamide - nausea, heartburn, fatigue, dry hair, sore throat, and inability to focus eyes.

Vitamin B₆ 2.0/1.6 mg 2.0 mg 200 mg Dizziness, nausea, ataxia, perpheral neuropathy, and systemic conditioning to high intakes.

Folic Acid
(folate and folacin) 200/180 mcg 400 mcg 5 mg Can obscure the diagnosis of pernicious anemia by preventing anemia and permitting nerve damage and may reduce zinc absorption; precipitates in kidneys of laboratory rats.

Vitamin B₁₂ 2.0/2.0 mcg 6.0 mcg Unknown None reported; rat studies indicate that folate metabolism may be affected.

Biotin 30-100 mcg^d 0.3 mcg Unknown None reported; controversial as to whether reproductive performance of female rats is affected.

Pantothenic Acid 4-7 mg^d 10 mg 10 g Occasional diarrhea and edema.

Choline Vitamin-Like Substance^e — 20 g Nausea, dizziness, diarrhea, depression, excessive cholinergic stimulation, and EKG abnormalities; salivating, trembling, cyanosis, convulsions, and respiratory paralysis reported in laboratory rats.

Carnitine Vitamin-Like Substance^e — Unknown Occasional diarrhea.

Inositol
(myo-inositol) Vitamin-Like Substance^e — Unknown None reported except problems may arise when inositol breakdown is impaired (diabetes mellitus, chronic renal failure, galactosemia, and multiple sclerosis).

Taurine Vitamin-Like Substance^e — Unknown None reported.

Bioflavonoids Vitamin-Like Substance^e — Unknown Some bioflavonoids have been associated with increased occurrence of several cancers.

Calcium 800/800 mg 1 g Over 2.5 g Nausea, constipation, hypertension, hypercalcemia, kidney stones, myopathy, and may inhibit absorption of iron and zinc; individuals with conditions that cause hypercalcemia or nephrolithiasis should not take calcium supplements.

Phosphorus 800/800 mg 1 g Over 2.5 g Calcium antagonism which can result in tetany and convulsions.

Magnesium 350/280 mg 400 mg 6 g Nausea, diarrhea, hypotension, bradycardia, vasodilation, EKG changes, coma, and cardiac arrest.

Iron 10/15 mg 18 mg 100 mg Bloody diarrhea, vomiting, hemosiderosis, hemochromatosis, cirrhosis, diabetes, cardiac failure, increased incidence of hepatoma, and may compromise zinc and copper absorption.

Zinc 15/12 mg 15 mg 19 mg Gastrointestinal irritation, vomiting, impairment of copper status, microcytic anemia, impairment of immune responses, and decline in serum high-density lipoproteins.

Copper 1.5-3.0 mg^d 2.0 mg 100 mg Usually due to accidental/intendual consumption of copper sulfate - get nausea, gastric pain, diarrhea, vascular collapse, and interacts with zinc, cadmium, and molybdenum in the body.

Fluoride 1.5-4.0 mg^d None 4 to 10 mg 4 mg - mottling (chalkiness) of teeth; 10+ mg - adversely affects bone health, kidney function, and possibly muscle and nerve function.

Iodide 150/150 mcg 150 mcg 2 mg Blocks formation of thyroid hormones usually temporarily but can be permanent and may cause goiter.

Selenium 70/55 mcg None 1 mg Fingernail changes, hair loss, nausea, abdominal pain, diarrhea, fatigue, irritability, and peripheral neuropathy.

Manganese 2.0-5.0 mg^d None Unknown Observed in individuals exposed to manganese dust, fumes, or contaminated well water - causes a severe psychiatric disorder, reproductive and immune system dysfunction, and kidney and liver disorders.

Chromium 50-200 mcg^d None Unknown Observed in individuals exposed to chromate dust or absorption through the skin - causes increased incidence of lung cancer, dermatitis, and allergies.

Molybdenum 75-250 mcg^d None 10 mg Antagonistic to copper and increased incidence of gout.

^a1989 Recommended Dietary Allowance for men and women (nonpregnant, nonlactating), 25-50 years of age. Number to the left is for men and number to the right is for women. Reference gives RDAs for other age groups.
^bUnited States Recommended Daily Allowance for adults and children 4 or more years of age. The U.S. RDA is used as a standard for nutritional labeling. The Food and Drug Administration has proposed changes in this labeling.
^cLowest reported toxic dose in publications considered to be reliable.
^dEstimated Safe and Adequate Daily Dietary Intakes; data are sufficient for estimating a range of requirements but not an RDA.
^eOther substances found in foods that have some vitamin-like functions; these nutrients are essential for some higher animals but not proved to be required by normal humans.

Symptoms of Toxicities

Table 1 gives the symptoms of vitamin and mineral toxicities. Toxicities occur at lower intake levels in infants, children, and pregnant and lactating women. If a woman takes excessive amounts of many vitamins and minerals while pregnant her child can be affected.

Table 1 also gives the lowest doses at which toxicities have been reported in reliable scientific publications. The literature contains many case studies where nutrient overdoses are presumed to affect health adversely. The nutrient amounts and time that people with toxicity problems took the nutrients are frequently not given so it is difficult to determine minimum toxicity levels. Size, age, sex, genetic background, as well as general health and previous nutritional status of individuals also affects responses to over consumption of vitamins and minerals.

Complications

Some nutrients have specific pharmacologic effects at high dosages. Pharmacologic doses sometimes, but not always, reduce symptoms of certain diseases and metabolic conditions, and complicate the diagnosis of certain diseases. They also influence treatment of some diseases and metabolic conditions. Medications may interact with vitamins and minerals and influence medicine effectiveness.

Adaptation

Individuals can adapt to taking large amounts of a vitamin or a mineral. And, if they stop taking high levels of nutrient supplements and start consuming normal levels, they can develop nutritional deficiency diseases (for example, scurvy). If one desires to stop taking large doses of a vitamin or mineral, the intake should be gradually decreased.

Legal Regulations

Some supplements have been contaminated and some have failed to meet advertised claims. Because supplements are legally considered to be foods not drugs, the Food and Drug Administration has few regulations concerning them. Regulations are being proposed on the marketing of high dosage supplements.

Selected References

Diet and Health — Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press, 1989.
Handbook of Vitamins, 2nd ed. New York: Marcel Dekker, Inc., 1991.
Modern Nutrition in Health and Disease, 7th ed. Philadelphia: Lea & Febiger, 1988.
Present Knowledge in Nutrition, 6th ed. Washington, DC: Nutrition Foundation, 1990.
Quantitative Evaluation of Vitamin Safety. Pharmacy Times. May, 1985.
Recommended Dietary Allowances, 10th ed. Washington, DC: National Academy Press, 1989.
Trace Elements in Human and Animal Nutrition, 5th ed., volumes 1-2. San Diego: Academic Press, 1986.
Vitamin-Mineral Supplements and Their Usage by Adults. NebFact 92-90. August, 1992.

File NF97 under FOODS AND NUTRITION
C-1g, Nutrition-Nutritive Value of Foods
Issued October 1992

Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture. Kenneth R. Bolen, Director of Cooperative Extension, University of Nebraska, Institute of Agriculture and Natural Resources.

University of Nebraska Cooperative Extension educational programs abide with the non-discrimination policies of the University of Nebraska-Lincoln and the United States Department of Agriculture.

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*Nutrient*	1989 RDA^a Men/Women	*U.S. RDA^b*	Lowest Reported Toxic Dose (adults)^c	*Symptoms of Toxicity (mild and severe)*
Vitamin A (preformed)	1000/800 mcg RE	5000 IU or 1000 mcg RE	6000 RE	Headache, vomiting, diplopia, alopecia, dryness of mucous membranes, dermatitis, anemia, insomnia, bone abnormalities, bone and joint pain, hepatomegaly, liver damage, hypercalcemia, hyperlipemia, menstrual irregularities, spontaneous abortions, and birth defects.
Vitamin D	5/5 mcg	400 IU or 10 mcg	45 mcg	Nausea, vomiting, excessive thirst and urination, muscular weakness, joint pain, hypercalcemia, disorientation, and irreversible calcification of heart, lungs, kidneys, and other soft tissues.
Vitamin E	10/8 mg -TE	30 IU or 20 mg -TE	Unknown	Exacerbation of the coagulation defect produced by vitamin K deficiency caused by either malabsorption or anticoagulant therapy.
Vitamin K	80/65 mcg	None	Unknown	Menadione (vitamin K₃) but not phylloquinone (vitamin K₁) causes hemolytic anemia, liver damage, and, in newborns, kernicterus.
Vitamin C (ascorbic acid)	60/60 mg	60 mg	4 g	Nausea, diarrhea, kidney stones, mobilization of bone minerals, systematic conditioning to high intakes, and abortion.
Vitamin B₁ (thiamine)	1.5/1.1 mg	1.5 mg	300 mg	Gastric upset and prolonged large parenteral injections can lead to sensitized anaphylactoid reactions.
Vitamin B₂ (riboflavin)	1.7/1.3 mg	1.7 mg	1000 mg	None reported in humans; precipitates in kidneys and hearts of laboratory rats.
Niacin (nicotinic acid and nicotinamide)	19/15 mg NE	20 mg or 20 mg NE	1 g	*Nicotinic acid* - vascular dilation, gastrointestinal irritation, increased muscle glycogen utilization, decreased serum lipids, decreased mobilization of fatty acids from adipose tissues, and hepatomegaly. *Nicotinamide* - nausea, heartburn, fatigue, dry hair, sore throat, and inability to focus eyes.
Vitamin B₆	2.0/1.6 mg	2.0 mg	200 mg	Dizziness, nausea, ataxia, perpheral neuropathy, and systemic conditioning to high intakes.
Folic Acid (folate and folacin)	200/180 mcg	400 mcg	5 mg	Can obscure the diagnosis of pernicious anemia by preventing anemia and permitting nerve damage and may reduce zinc absorption; precipitates in kidneys of laboratory rats.
Vitamin B₁₂	2.0/2.0 mcg	6.0 mcg	Unknown	None reported; rat studies indicate that folate metabolism may be affected.
Biotin	30-100 mcg^d	0.3 mcg	Unknown	None reported; controversial as to whether reproductive performance of female rats is affected.
Pantothenic Acid	4-7 mg^d	10 mg	10 g	Occasional diarrhea and edema.
Choline	Vitamin-Like Substance^e	—	20 g	Nausea, dizziness, diarrhea, depression, excessive cholinergic stimulation, and EKG abnormalities; salivating, trembling, cyanosis, convulsions, and respiratory paralysis reported in laboratory rats.
Carnitine	Vitamin-Like Substance^e	—	Unknown	Occasional diarrhea.
Inositol (myo-inositol)	Vitamin-Like Substance^e	—	Unknown	None reported except problems may arise when inositol breakdown is impaired (diabetes mellitus, chronic renal failure, galactosemia, and multiple sclerosis).
Taurine	Vitamin-Like Substance^e	—	Unknown	None reported.
Bioflavonoids	Vitamin-Like Substance^e	—	Unknown	Some bioflavonoids have been associated with increased occurrence of several cancers.
Calcium	800/800 mg	1 g	Over 2.5 g	Nausea, constipation, hypertension, hypercalcemia, kidney stones, myopathy, and may inhibit absorption of iron and zinc; individuals with conditions that cause hypercalcemia or nephrolithiasis should not take calcium supplements.
Phosphorus	800/800 mg	1 g	Over 2.5 g	Calcium antagonism which can result in tetany and convulsions.
Magnesium	350/280 mg	400 mg	6 g	Nausea, diarrhea, hypotension, bradycardia, vasodilation, EKG changes, coma, and cardiac arrest.
Iron	10/15 mg	18 mg	100 mg	Bloody diarrhea, vomiting, hemosiderosis, hemochromatosis, cirrhosis, diabetes, cardiac failure, increased incidence of hepatoma, and may compromise zinc and copper absorption.
Zinc	15/12 mg	15 mg	19 mg	Gastrointestinal irritation, vomiting, impairment of copper status, microcytic anemia, impairment of immune responses, and decline in serum high-density lipoproteins.
Copper	1.5-3.0 mg^d	2.0 mg	100 mg	Usually due to accidental/intendual consumption of copper sulfate - get nausea, gastric pain, diarrhea, vascular collapse, and interacts with zinc, cadmium, and molybdenum in the body.
Fluoride	1.5-4.0 mg^d	None	4 to 10 mg	4 mg - mottling (chalkiness) of teeth; 10+ mg - adversely affects bone health, kidney function, and possibly muscle and nerve function.
Iodide	150/150 mcg	150 mcg	2 mg	Blocks formation of thyroid hormones usually temporarily but can be permanent and may cause goiter.
Selenium	70/55 mcg	None	1 mg	Fingernail changes, hair loss, nausea, abdominal pain, diarrhea, fatigue, irritability, and peripheral neuropathy.
Manganese	2.0-5.0 mg^d	None	Unknown	Observed in individuals exposed to manganese dust, fumes, or contaminated well water - causes a severe psychiatric disorder, reproductive and immune system dysfunction, and kidney and liver disorders.
Chromium	50-200 mcg^d	None	Unknown	Observed in individuals exposed to chromate dust or absorption through the skin - causes increased incidence of lung cancer, dermatitis, and allergies.
Molybdenum	75-250 mcg^d	None	10 mg	Antagonistic to copper and increased incidence of gout.
^a1989 Recommended Dietary Allowance for men and women (nonpregnant, nonlactating), 25-50 years of age. Number to the left is for men and number to the right is for women. Reference gives RDAs for other age groups. ^bUnited States Recommended Daily Allowance for adults and children 4 or more years of age. The U.S. RDA is used as a standard for nutritional labeling. The Food and Drug Administration has proposed changes in this labeling. ^cLowest reported toxic dose in publications considered to be reliable. ^dEstimated Safe and Adequate Daily Dietary Intakes; data are sufficient for estimating a range of requirements but not an RDA. ^eOther substances found in foods that have some vitamin-like functions; these nutrients are essential for some higher animals but not proved to be required by normal humans.