Essential Trace Minerals For Proper Health Care

Group of foods that are rich in trace minerals

When we were young, our parents often told us to drink milk so that our bones would grow big and strong. Breakfast cereal boxes and milk cartons often had a label with words like “fortified” or “enriched” with calcium; we learned later that bones grew stronger not because we drank milk, but because it contained calcium and is rich in protein. We also heard of iron and that we should eat meat and poultry products to get enough of the mineral because we needed it for our bodies to grow. Protein sources contain iron, and we later learned that it helped our body produce new blood responsible for transporting oxygen and nutrients to the cells.

Calcium and Iron are some of the minerals we knew growing up. Later on, we learned of other nutrients, what foods have them, and how they benefit our bodies. But did you know that our bodies also need, in tiny amounts, elements like copper, chromium, manganese, and even molybdenum? In this article, we’ll explore the many nutrients our bodies need, the minerals we need, their food sources and how shilajit can help you in filling any mineral nutrient gaps in your nutrition.

Is it mind-boggling that 99% of the body is made up of just 4 elements?

Essential Chemical Elements For Human Health

The human body is made out of elements. Our tissues, the fluids that run through our veins and arteries, hormones, enzymes, and the bones that form our skeleton are made of complex elemental structures. Nitrogen, oxygen, carbon and phosphorus1; these  four minerals account for 99% of the human body. Trace minerals and other elements make up the remaining 1%. Nutrients are also made of complex elemental structures.

The role of minerals in the body is to help us grow and maintain proper health. Calcium, iron, phosphorus, and many others play important metabolic functions in the body.2 There are at least twenty chemical elements we need to maintain proper biochemical, organic processes. Only 14, 15 if we include cobalt or fluorine are essential to human health. How much we need classifies these nutrients into two minerals: macro and micro. We need them to come from food.

What Are Trace Minerals?

Trace minerals or microminerals are elements needed in the body in minute amounts.3 We get these minerals from our diet, and they naturally occur in organic forms or as mineral salts in many vegetables, meats, and starchy food sources. The function of minerals are wide and varied, all of which help ensure proper health.

Food quality has deteriorated through the years, and our calorie-dense diets and poor food options are just two of the factors that play a role in this. Demineralization and poor agricultural practices affect the nutrient quantity and quality too.4 Research suggests that mineral content in agricultural soil is severely depleted; to get proper nutrient levels, we either eat more food or use synthetically prepared nutrients, vitamins, and minerals.

Supplementation is one of the best ways to answer mineral deficiencies. Multivitamins and health mineral supplementations are available without a prescription and are available even at your local grocery. They are everywhere. Synthetically produced minerals are the source of trace mineral supplements. Herbal supplements are good sources of minerals, too, especially those herbo-mineral supplements like shilajit.

Before we go into detail into what these trace mineral functions are, and what foods provide them, a discussion about nutrients groups is instructive to give us a better perspective of what our bodies need. For the purpose of this article, we will refer to minerals as nutrients too.

Shilajit contains a diverse array of nutrients, including trace minerals. When taken daily, it can supply the body with all of its needed minerals for proper health.

foods rich in various trace elements and other nutrients.

Nutrients

Nutrients are made of elements like carbon, nitrogen, hydrogen, oxygen, and we get these elements from the very soil we walk on. All matter, including us, emanates from this earth. The earth is rich in these elements, forming a complex matter that defines us as unique biological structures. The earth provides for sustenance, too, through the nutrients and minerals that power our biological processes so that we can grow and develop into what we are today. Without these nutrients, minerals, and core elements, life as we know it is not possible.

Our bodies need a wide range of nutrients and substances. These nutrients are divided as follows:

  • Macronutrients
  • Micronutrients
  • Macrominerals
  • Microminerals

We need these nutrients and minerals so that our bodies can work at its full capacity for growth and function and prevent diseases. Each nutrient plays a role in the body that is unique and specific to it. The differences lie in how much our bodies need. Properly grown produce and animal products naturally contain them. 

The Case Of Mineral Depletion

Plants absorb trace minerals through the soil and these minerals are typically found in rocks, stones, ores, fossils, and crystals under the earth. Mineral salts, a simple combination of various minerals also form. Sodium and chloride, for example, are mineral salts that we often use to add flavor to our food. Decomposing animal and plant matter helps replenish the soil’s mineral reserves too. Plants utilize the minerals for their development and create various mineral forms other organisms can utilize, including humans. Plants keep the minerals inside their cell walls, which are then transferred to animals when they eat the plants. We absorb minerals when we eat plants and animal products.

Soil mineral content has decreased substantially over the years. Trace minerals found in the soil today is less than it was 50 years ago. In one paper, the researchers claim that twelve apples contained the same amount of iron to one apple grown in the 50s.5 Changing agricultural practices, lack of diversity in produce, and the use of fertilizers and pesticides have all contributed to this decline.

When the soil cannot replenish its minerals stores, plants will not grow properly. According to scientists, soil demineralization contributes to why crops and produce are smaller, and more susceptible to diseases and insects. When insects start destroying crops, they often indicate that crops are failing in health. Poor produce and yield confirm poor plant nutrition from the ground.

It seems that this condition will only get worse. Food demands continue to grow, and growing demand will continue to overuse soil nutrients, depleting mineral stores further.

Remineralizing the Soil

There are efforts to address these problems that do not include reengineering plant DNA and creating genetically modified food strains. Remineralization is a practical solution6, and various scientists discovered that properly remineralized soil produced healthier crops and produce, filled with better quality nutrients at much higher quantities, including plant-based trace minerals.7

Remineralization can be as simple as spreading rock dust on the soil. A simple act can provide plants with a good supply of minerals and nutrients.

Natural Nutrients versus Synthetic Nutrients

Supplementation is helpful, especially now that our diets are getting poorer. The use of supplements has always been a sound approach to prevent nutrient deficiency, but it should not replace food-based minerals. Food derived nutrients are naturally assimilated, in a form the body can use, and in quantities, our body needs. 

Most supplements are made artificially. More often than not, we get more of the nutrients that we need when we use supplements. For example, adults-only need up to 100mg of ascorbic acid per day. Tablets of ascorbic acid are being sold up to 1000mg. Although water-soluble vitamins are unlikely to cause problems, too much can be a concern. 

Naturally occurring nutrients are nutrients we get in our diet while synthetically made nutrients are ones we get from supplements. You can often tell the difference because supplements tend to use the chemical names of the vitamins in the labels.

Nutrient supplements are not made the same way plants produce nutrients. Although chemically identical, our bodies may react differently to them.  Real food does not offer single nutrients, instead, they contain a range of nutrients and organic chemicals that all work together in synergy. Some nutrients mix with food compounds, making it possible for our bodies to use them. This might not be so for synthetic nutrients made in a laboratory attached to a factory.

The use of synthetic nutrients has been deemed safe for a long time. The FDA, however, does not review dietary supplements, even for safety. There is the potential of fraud as supplements may not contain the nutrient levels as advertised, and they may contain additives, heavy metals, and microbes potentially harmful to health. 

There is no truth as well that taking more supplements can cure diseases or treat conditions, neither will it enhance your health beyond what is optimum.

Naturally, we recommend that you get all your needed vitamins and minerals from food. You simply cannot substitute the quality you get from whole foods. There would be no need for supplements if we were eating a healthy plate of various foods daily. However, this does not mean that nutrient supplements are terrible or bad for you. Certain stages in life often demand more nutrients than usual.8 The elderly, for instance, need more or less of a specific nutrient.  Diseases or conditions or even genetics may require specific nutrient requirements. These situations are where supplementation is most helpful. 

There is no need for supplements when you eat a variety of foods daily. But do not rule out supplements just yet. Supplements can help fill up the nutritional gaps in the diet.

Before we move further into discussing what minerals (trace minerals), let us first consider the other nutrients we need to function at our fullest.

MACRONUTRIENTS

The first group of nutrients we need are those that we can visibly see in our plates, often in large portions. Carbohydrates, protein, and fat (lipids) are the macro nutrients the body needs for energy. The energy produced when the body breaks these nutrients down is what we call calories. This is an important distinction because the other nutrients we need do not provide any energy at all, but play a role in how our bodies utilize the energy made.

A variety of foods on your plate ensures you get all the nutrients.

Carbohydrates

We need carbohydrates the most and in the largest amounts. Carbohydrates provide our bodies most of our energy, and the USDA recommends that up 65% of our caloric intake come from carbohydrate sources.9

Carbohydrate-rich foods include a wide variety of starchy foods. Potatoes and grains, milk, fruits and vegetables contain carbohydrates. Potatoes and grains, including rice are some of the best sources. They also contain energy fixing B vitamins that help break down the carbohydrate molecules for energy. There are two categories of carbohydrates, simple and complex. Sugar and sweets are simple sugars. Complex sugars include those found in grains, vegetables, and other carbohydrate sources usually from plant-based foods. Although we cannot digest fiber, it is a complex carbohydrate and it plays a role in maintaining a healthy gut.

Protein

The USDA recommends up to 35% of our calories to come from protein sources.10 Our cells need protein for a myriad of bodily processes, concerning proper growth and optimum function. Muscles, enzymes, hormones, and blood are made up of protein, and these substances play vital roles in the body, without which could severely affect the body and its capacity for work.

Production of new tissue, tissue repair, bone growth and the maintenance of bodily functions by supplying essential amino acids for enzymatic reactions are critical functions of proteins. It plays a significant role in proper immune and brain function too. Hormone production and regulation require amino acids only protein sources can provide. 

Protein provides energy too, although the role is best served by carbohydrate-rich foods. 

Meat, poultry, fish and eggs are excellent sources of protein. Eggs are some of the best sources of high quality, cheap protein. Milk and dairy products are excellent too albeit, pricey. For vegans, excellent choices including nuts and legumes. 

Fat (Lipids)

Fat or lipids should account for up to 20% of the food we consume.11 Fat components in the meat products we consume supply most of the fat we need, although these sources are far from desirable. Cooking oil is also the usual source of fat from the diet. We need fat for proper brain development and the nutrient plays role as a component of many hormones. It acts as natural insulation which helps keep us warm and protect our organs by providing a layer of tissue around them. Fat-soluble vitamins like Vitamin E and A, need fat before our bodies can use them and store the excess. Lastly, fat is a great source of energy offering 9 calories per gram compared to carbohydrates only offering 4 calories per gram.

Plant-based fats and oils are excellent sources. Avocados, chocolates, nuts, olive oil, just to name a few are quality sources and markedly healthier than meat-based fats (saturated fats). Plant-based oils and lipids contain unsaturated fatty acids that are healthier than those meat-based saturated forms. Saturated forms of fat and trans fat (harmful kinds of transformed unsaturated lipids) have been linked to increased cardiovascular problems and obesity. For animal-based sources, cheese is an excellent source of fat.

Water

Your body needs the three nutrients mentioned above to come regularly from your diet, and supply should come from quality sources as much as possible. Many people believe and ( we do too) that there is another macronutrient that carries the same importance, if not more, and required in substantially larger quantities than anything else. That nutrient is water.12

Water is an essential inorganic nutrient. You may not realize it, but we take in water more often than we do food.

Our bodies need water to come in regularly. We need it more than we do the other nutrients. Without water, bodily processes will easily deteriorate, collapsing completely which can lead to death, if extreme dehydration results. Water helps remove waste too preventing chemical toxicities and It keeps the skin cool when we sweat. Water helps regulate basal temperature so we do not overheat which can lead to organ failure. Water serves a vital purpose not only to quench thirst. Without it, a person can die in just a matter of days.

A plate full of colorful fruits, known to be rich in nutrients, just like shilajit

MICRONUTRIENTS

We need micronutrients in smaller amounts but are equally important. Unlike macronutrients, these nutrients do not provide energy but often play a role in how we use food for energy. Nutrient metabolism within the cell, maintenance of energy levels, various cellular functions need micronutrients.13 Minerals form part of micronutrients too, but for the article, we will discuss those separately. 

Micronutrients are split into two:

  • Water-soluble vitamins
  • Fat-soluble vitamins

For a list of all vitamins, please see the table below.

Water and fat-soluble vitamins need water and bile, respectively before the body can use them. Water-soluble vitamins play in a range of functions with the majority in energy-related processes. Fatty tissue and the liver also stores any excess fat-soluble vitamins.

Our bodies cannot store water-soluble vitamins, unlike fat-soluble ones, thus solubility is a distinction between the two and is quite important in identifying deficiency and toxicities.

Excess of water-soluble vitamins is generally not an issue. Our kidneys can eliminate any excess through pee and sweat. Too much of any fat-soluble vitamins, however, may be problematic since our body can store it. The excess accumulates in the liver and tissues causing a condition called hypervitaminosis. In truth, toxicity is rare even for fat-soluble vitamins. Overdosing supplements is the usual case where this condition results.

Water-Soluble Vitamins

VitaminFunctionFood Source
Vitamin B1 (Thiamine)Nutrient to Energy converterWhole grains, meats, fish, eggs, seeds,
Vitamin B2 (Riboflavin)Metabolism and cell functionOrgan meats, milk, eggs, nuts, green leafy vegetables
Vitamin B3 (Niacin)Energy productionMeat, Fish, poultry, green vegetables, coffee, tea
Vitamin B5 (Panthothenic Acid)Break down of fatty acidsOrgan meats, tuna, avocado, various nuts
Vitamin B6 (Pyridoxine)Breakdown of carbohydrates for energy, red blood cell synthesisFish, milk, potatoes, carrots, pork and meat products, organ meats
Vitamin B7 (Biotin)Fat, glucose, and amino acid metabolismNuts like peanuts, walnuts, eggs, milk, cereals, fish products, pork
Vitamin B9 (folate)Cell divisionGreen vegetables, beans, citrus fruits, grains
Vitamin B12(Cobalamin)Red blood cell formation, brain function, nervous systemFish products, meat products, poultry, eggs, milk
Vitamin C (Ascorbic Acid)Skin protein, collagen formation, neuron formation, antioxidantCitrus fruits, some vegetables, capsicum

Fat-Soluble Vitamins

VitaminFunctionFood Source
Vitamin AProper Organ functionEggs, milk and cereals, orange and yellow-colored vegetables and fruits
Vitamin KBlood clotting, bone formationGreen leafy vegetables,

Fish and organ meats, eggs

Vitamin DImmune function, calcium absorption, bone growthSun exposure, Fatty fish products, organ meats, cheese, eggs
Vitamin EImmune function, antioxidantNuts like peanuts, hazelnuts, almonds, vegetable oils


No single food item will provide all the nutrients you need. A right mix of vegetables, fruits and starchy foods, meat, poultry or fish products, guarantees that you get all the nutrients.

Vegans can still get the right mix of nutrients from various food groups, without any meat, poultry, or fish. Supplementing your diet with the nutrients naturally occuring in meat, poultry, and fish products would be the sound approach.

Recommended Daily Allowance for Vitamins

The values below represent values recommended for ages 19 and over. Requirements for older adults and teenagers vary.14

MineralRecommended Amount For MenRecommended Amount for womenDaily Limit
Vitamin A900mcg (3,000 IU)700mcg (2333 IU)3,000mcg
Vitamin B1 (Thiamine)1.2mg1.1mgNA
Vitamin B2 (Riboflavin)1.3mg1.1mgNA
Vitamin B3 (Niacin)16mg14mg35mg
Vitamin B5 (Pantothenic Acid)5mg5mgNA
Vitamin B6 (Pyridoxine)1.3mg (1.7mg for ages over 50)1.3mg (1.5mg for ages over 50)100mg
Vitamin B12 (Cobalamin)2.4mcg2.4mcgNA
Vitamin B7 (Biotin)30mcg30mcgNA
Vitamin B9 (Folic Acid)400mcg400mcg1000mcg
Vitamin C (Ascorbic Acid)90mg75mg2000mg
Vitamin D (Calciferol)15mcg (600 IU)20mcg (800 IU)50mcg (2000 IU)
Vitamin E (Alpha Tocopherol)15mg15mg1000mg
Vitamin K120mcg90mcgNA

antioxidant and trace mineral rich foods.

MACROMINERALS

Minerals needed in larger amounts are what we refer to as macrominerals or major minerals. Calcium, phosphorus, potassium, and sodium, are essential body minerals and play crucial roles in a wide variety of physiological processes for everyday function. Both macro and micro (trace) groups of minerals are vital to human health.15

We associate calcium for building healthy and stronger bones but the mineral has roles in muscle contraction and nerve function too. Potassium and sodium together are commonly known electrolytes needed for proper blood volume, blood pressure regulation and maintaining water inside the body. 

These minerals need to come from the diet because we cannot make them nor store them efficiently. Except for bone minerals, macro minerals are poorly stored in muscle tissues and the liver. Once depleted, the food sources need to provide them or we should get them from supplements. Unlike macronutrients, no single mineral can serve all of the functions of another mineral, effectively substituting it. Needless to say, we need all minerals to come from the diet for proper health.

Animals and plants break down minerals in the form the bodies can utilize. We mentioned mineral salts a while back and those are the forms our bodies can utilize. We may not be able to eat sodium and chloride separately, but we can sprinkle table salt (sodium chloride) in our food. The body cannot utilize metallic ions and inorganic forms of the elements comprising these minerals. Doing so may be harmful to the body. Getting stones and rocks with the minerals and using them directly on food is a bad idea too since these rocks may contain heavy metals known to cause health problems like liver damage and kidney failure.

There are seven important minerals for body function. These are:

  • Calcium
  • Sodium
  • Chloride
  • Potassium
  • Phosphorus
  • Magnesium
  • Sulfur

The table below summarizes the role of macro minerals as well as the common food sources rich in them. Included are the details on what the minerals are good for.16

Take note that some of the minerals in the list are associated with many lifestyle diseases. Too much sodium is associated with a wide range of cardiovascular diseases including high blood pressure. Take note of the foods you are consuming and see if they contain too much of the mineral to cause any health problems.

MineralFunctionMineral Food Sources
CalciumBone formation and teeth, muscle contractions, nerve function, blood pressure regulation, immunity,Milk and milk products, canned fish (sardines)
SodiumFluid balance, nerve function, muscle contractionTable salt, processed foods
ChlorideFluid balance, a component of various extracellular fluids stomach acidity controlTablet salt, processed foods
PotassiumFluid balance, nerve transmission, contraction, may reduce blood pressureMeats, and milk, certain vegetables, and grains
PhosphorusBone and teeth formation, Carbohydrate and fat utilization, acid-base balance maintenanceMeat, fish, poultry, eggs
MagnesiumProtein synthesis, nerve transmission, muscle contraction, heart rate regulation, bone strength, biochemical reactionsNuts and seeds, green leafy vegetables, seafoods
SulfurConnective tissue creation, joint tissuesMeat products, poultry, fish and milk, nuts

Recommended Daily Allowance for Macro Minerals

The values below represent values recommended for ages 19 and over. Requirements for older adults and teenagers vary.17

MineralRecommended Amount For MenRecommended Amount for womenDaily Limit
Calcium1000mg (1200mg for ages over 70)

 

1000mg (1200mg for ages over 70)2500mg
Chloride2.3gm (2.0gm for ages over 50)2.3gm(2.0gm for ages over 50)NA
Magnesium420mg320mg350mg
Phosphorus700mg700mg4000mg (3000mg for ages over 70)
Potassium4.7gm4.7gmNA
Sodium2300mg2300mgNA
SulfurNANANA

 

MICROMINERALS OR TRACE MINERALS

Micro minerals or trace minerals are essential minerals needed in much more smaller amounts.18 Trace minerals functions in the body are wide and varied but all play a vital role in maintaining proper function. They are part of many cellular processes and chemical reactions, and many minerals have a synergistic relationship with two or more elements.

The following are clear examples where nutrients working in tandem:

  • Copper helps oxidize iron and helps with iron transport.19
  • Cytoplasmic superoxide dismutase uses copper and zinc to convert superoxide into oxygen and water.20
  • Iron and sulfur are present in ferredoxin proteins involved in electron transport.21

List of Trace Minerals

There are 10 trace minerals the body needs in minute amounts. Cobalt is present as some sources include, but it naturally occurs in Vitamin B12 as a key component of the vitamin, which is why it is omitted by other authors. In the list below, we included cobalt.

Trace minerals listed below:

  • Copper
  • Fluorine
  • Iron
  • Iodine
  • Manganese
  • Molybdenum
  • Selenium
  • Zinc
  • Chromium
  • Cobalt
MineralFunctionSources
CopperBlood formation together with iron, maintenance of bone, blood vessel health, immune function, cardioprotectiveOysters, nuts, mushrooms, seafood, leafy vegetables, dark chocolate
FlourideFormation of bones and teethDrinking water, teas, fish and toothpaste
IronA component in hemoglobin – which carries oxygen in the bloodMeat, poultry and fish products Green leafy vegetables, grains, nuts and beans
IodineFor thyroid hormones – responsible for various metabolic processes, proper bone health, and brain healthFish and seafood, dairy products, fortified sea-salt
ManganeseAmino acid, carbohydrates, cholesterol metabolism, bone formation, blood clotting, and inflammation managementNuts, beans and grains, leafy vegetables and fruits
MolybdenumMetabolic detoxifier, component in various enzymesLegumes, beans, and grains,
SeleniumA component in many proteins and enzymes, thyroid hormone metabolism and DNA synthesis , protective against cell damage and detoxifierMeat products, and poultry products, beans
ZincImmune system, cellular processes including growth, carbohydrate breakdown, over 100 chemical reactionsMeat products, dairy, seafood, legumes and seeds, eggs,
ChromiumFat and carbohydrate digestion, fatty acid and cholesterol synthesis, brain function, insulin and glucose actionBeef and poultry products, fruits, potatoes and vegetables, dairy products
CobaltNutrient absorption, disease preventive, helps repair myelin and nerve cells, blood formationFish, leafy green vegetables, oats

Trace Minerals Dosage

The values below represent values recommended for ages 19 and over. Requirements for older adults and teenagers vary. Shilajit contains many minerals too including trace minerals. For a copy of Pürblack’s pure shilajit mineral dosage and mineral content, please contact support.

MineralRecommended Amount For MenRecommended Amount for womenDaily Limit
Copper900mcg900mcg10000mcg
Iron8mg18mg (8mg for ages over 50)45mg
Iodine15mcg150mcg1100mcg
Manganese2.3mg1.8mg11mg
Chromium35mcg25mcgNA
Fluoride4mg3mg10mg
Selenium55mcg55mcg400mcg
Zinc11mg8mg40mg
Molybdenum45mcg45mcg2000mcg
Cobalt5mcg5mcgNA

Ma running in track field wearing a red shirt

Common Trace Mineral Functions

Trace minerals play a role in many functions. Interestingly, no single mineral can serve the purpose of others. Cellular processes that appear to be the same but are chemically different use of trace minerals, and have their own unique metabolic pathways.  Regulation of various metabolic processes and breakdown of macronutrients is the most common function of many trace minerals, but we also need them for proper growth and development.

The following are common functions of certain minerals:

  • Copper, iron, manganese, and cobalt blood functions, including blood clotting. 
  • Selenium, manganese, and molybdenum have antioxidant properties. 
  • Zinc, iodine, cobalt, and copper play roles in our immunity, growth, and development. Chromium and manganese help break down nutrients.

Although some minerals share similar functions, one cannot effectively replace or substitute for another. Iodine, for example, is needed in creating thyroid hormones. No other mineral can substitute the function of iodine. Each mineral also serves a multitude of other tasks.

Although we need very small amounts, trace mineral deficiency still affects many people and may have serious consequences when not addressed immediately. The elderly are more susceptible to mineral deficiencies than anyone. Specific conditions affecting the gut and its capacity to absorb nutrients increases the likelihood of complications.

People in third world countries who lack access to nutrient-dense food and proper nutrition education are at risk for mineral deficiency related conditions. Those who are undergoing therapy, surgery, and regularly using medication may also develop deficiencies. Modified “lifestyle” diets may put you at risk as well.

If you feel that you are deficient in some of the trace minerals, we suggest talking to a physician first before buying mineral supplements. Many of the signs of symptoms of a mineral deficit are common everyday problems. Understanding if it is mineral deficiency can be tricky. 

Like anything, trace mineral deficiency can lead to severe conditions. Some specific mineral deficiencies increase the risk of various ailments like diabetes, atherosclerosis, and heart disease. Cobalt, for example, is linked closely to Vitamin B12 deficiency. Lack of one leads to a lack of both.

Although rare, trace mineral toxicity or mineral poisoning is still possible. The likely causes of toxicity include exposure to industrial levels of the mineral and over-supplementation (overdose) as food sources are unlikely to cause poisoning. The mineral forms in food are easily assimilated by the body and any excess removed immediately by the kidneys. The body may not be able to do the same if too much comes into the body at once, overloading the kidneys causing poisoning.

Trace Mineral Deficiencies & Toxicity

Copper

According to one study, 25% of Americans are not meeting their daily copper requirements.22 The following are common signs and symptoms of not getting much from the diet.

  • Weakness—Copper helps in absorbing iron. Less of it may worsen anemia. Copper helps create ATP, the primary source of energy that power cells.
  • Weak bones—Copper encourages the creation of bone cells. Deficiency may increase the likelihood of developing osteoporosis
  • Learning and memory problems—Copper plays a role in brain development. Lack of copper can lead to stunted learning, especially in children.
  • Susceptibility to diseases—Copper plays an essential role in making immune cells.
  • Other symptoms include pale skin, gray hair, and temperature sensitivity.

Certain diseases such as celiac disease may increase the likelihood of copper deficiency.

Our bodies only need about 900mcg of copper daily, and most of it is stored in the liver and the muscles. The kidneys effectively remove any excess unless there is too much.  Severe cases of copper toxicity can lead to kidney damage and liver failure. 

Iron

Iron plays a vital role in the body, being a component of red blood cells. Deficiency can lead to iron deficiency anemia, and when not addressed could lead to serious health problems.23 Iron is part of Hemoglobin which is a component of blood. Blood carries all nutrients, not just oxygen, to all cells in the body. Iron deficiency significantly affects nutrient delivery.

  • Fatigue— Getting tired quickly is the most common sign of iron deficiency anemia.
  • Paleness — red blood cells get their color from hemoglobin. Less of it gives the skin a pale complexion.
  • Heart palpitations — Less oxygen in the blood causes the heart to work harder to supply oxygen from the lungs.
  • Shortness of breath — To compensate for the lack of oxygen, the body reacts by increasing your breathing rate.
  • Other symptoms include soreness in the mouth, damaged skin and nails, feeling anxious, and susceptibility to infections.

Iron toxicity cases seldom arise from consuming too many iron-rich foods. Most cases usually come from overdosing iron supplements. Nausea and pain in the abdominal area are common signs associated with toxicity.

Side effects include low blood pressure, weak pulse, and poor blood clotting. Severe cases often lead to liver failure and liver cirrhosis. Iron toxicity damages the digestive tract as well as leading to permanent scarring, which affects scarring nutrient absorption.

Fluorine/Fluoride

We usually associate fluorine as fluoride in toothpaste, and toothpaste usually contains the mineral since a deficiency in fluorine leads to increased dental decay. It is also associated with osteoporosis prevention. Deficiency is rare since we get all of our fluoride in toothpaste. Brushing your teeth ensures you get enough.24

  • Cavities — Fluoride helps prevent the growth of bacteria in the mouth. The bacteria break down carbohydrates, creating acids damaging to dental enamel. 
  • Increases the risk of developing osteoporosis — Fluorine plays a role in keeping our bones healthy.

Fluoride toxicity is not common today. Still, it may be a concern for many children who are not aware that they are using toothpaste improperly. Chronic ingestion of fluoride from toothpaste can interfere with proper bone formation. Ongoing research about fluoride toxicity suggests neurodevelopment issues in children, but overall, cases of fluoride toxicity are rare. The most common problem connected to fluoride toxicity is fluorosis. 

Iodine

Iodine plays a significant role in thyroid health. The thyroid gland is responsible for many health processes by producing thyroid hormones for growth, repair, and function of various cellular structures in the body.25 Unlike fluorine, Iodine deficiency affects many people even to this day. Landlocked countries with limited access to seafood have a higher likelihood of developing a goiter and iodine deficiency. Fortifying sea salt with iodine substantially helps prevent hyperthyroidism in those places.

  • Goiter — The most unusual sign of iodine deficiency is swelling in the neck. A bulge develops either below the jawline or on one side of the neck; — the bulge results when the thyroid gland works harder to make thyroid hormones. Lack of iodine causes it to overwork so that its mass increases to compensate.
  • Weight gain — Thyroid hormones play an essential role in metabolism, particularly the consumption of using up of energy forms. When deficient, fewer calories burn  and eventually stored as fat, leading to weight gain.
  • Fatigue — Because there are fewer calories to burn for energy, a person gets tired quickly.
  • Difficulty learning — Thyroid hormones are needed for proper brain development. 

Other problems associated with iodine deficiency include erratic heartbeat, memory problems, susceptibility to cold, dry skin, and hair loss. For women, iodine deficiency can cause problems during pregnancy. 

Iodine toxicity is rare. Our bodies can tolerate high levels of up to 1100mcg a day. Food sources do not have much to cause toxicity, and usual cases of poisoning are overdosing supplements. Certain diseases may aggravate toxicity, such as Grave’s disease and goiters. Seafood has high levels of natural iodine and is one of the richest sources of minerals.

Iodine toxicity is linked to hyperthyroidism. Iodine toxicity shares many of the signs and symptoms of hyperthyroidism like elevated heart rate and weight loss.

Manganese

Manganese plays a role in bone formation and carbohydrate metabolism. The mineral is essential, especially by children, since most of its functions involve growth and development.26

  • Skeletal defects and poor bone development—Manganese plays an important role in bone growth along with calcium. Deficiency may lead to bone demineralization and bone malformation in children.
  • Impaired carbohydrate and fat metabolism—Glucose utilization may be affected. Diabetic patients are at risk in developing manganese deficiency. 
  • Low cholesterol levels—Cholesterol is essential to the production of cell membranes, hormones, vitamin solubility, and bile. 
  • Other signs and symptoms include weakness, nausea and vomiting, infertility, hair and nail problems.
  • Too much manganese can cause problems with reproductive development and can slow growth.

Manganese tends to compete with iron absorption, so too much can result in anemia. Common side effects include headache and insomnia. More severe side effects include memory loss and impaired motor skills. 

Molybdenum

Deficiency in Molybdenum is quite rare, just like the rest mentioned above. It plays a role in many enzymatic processes and also acts as a detoxifier. As a cofactor in many enzymes, molybdenum deficiencies could lead to severe problems. Molybdenum is found in both animal and food sources, so the body will get what it needs in diet more often than not.27

Lack of molybdenum affects the following processes:

  • Sulfite Oxidase—This is the mechanism that prevents the build-up of sulfites.
  • Aldehyde oxidase — Aldehyde oxidase helps the liver metabolise drugs and breaks down aldehydes.
  • Xanthine oxidase— Xanthine oxidase creates uric acid when xanthine breaks down. It is also involved in the breakdown of nucleotides needed in DNA and allows the body to remove DNA by-products in the urine.
  • Mitochondrial by-product metabolism—We do not fully understand this function of molybdenum. It may play a role in removing toxin byproducts in cellular function.
  • The body can best utilizes molybdenum present in food. It may be unsafe to take molybdenum directly by mouth. Gout may result when molybdenum level intake is very high. 

Selenium

Selenium play a role in many biological processes, especially those in hormone metabolism and DNA synthesis. It serves a function in proper reproduction too.  Selenium deficiency is linked to hypothyroidism.28

  • Hair loss—Hair loss is a common sign that you may be deficient in selenium, but selenium deficiency does not in itself cause the hair loss. It is usually tied to another condition like hypothyroidism.
  • Fatigue—People who suffer from hypothyroidism get tired quickly.
  • Weight Gain—Decreased nutrient metabolism, especially those regularly needed like what is found in carbohydrates, often lead to weight gain. 
  • Glutathione—Glutathione is a complex natural antioxidant that renders toxins harmless. We need selenium to make proteins that in turn are made into glutathione peroxidase. 
  • Illness—Selenium is a powerful antioxidant and helps maintain good immunity. If deficient, you are more susceptible to diseases and infection.

One unusual case of selenium toxicity came about when a person ate too many Brazil nuts. Garlic breath and having a metallic taste in the mouth are unique signs, accompanied by nausea, diarrhea, and irritability. Overall, selenium toxicity is rare.

Zinc capsule containing zinc orbs

Zinc

Zinc is essential for maintaining a healthy and responsive immune system, and it also plays a role in healing wounds. Zinc plays a role in making proteins, including DNA, and the mineral is a priority for pregnant women so that the fetus can grow correctly. Zinc deficiency causes developmental issues in children and affects copper utilization too.29

  • Decreased wound healing—Wounds will not heal as quickly when you have a zinc deficiency.
  • Impotence—Zinc plays a role in growing proper sex organs. Long term deficiency may lead to impotence. 
  • Slowed growth—Zinc deficiency can stunt growth in children and affect learning and memory.
  • Accelerated aging—Long term zinc deficiency may cause premature aging.
  • Accelerates HIV progression—Zinc deficiency may exasperate the symptoms of HIV.
  • Pregnancy complications—The risk of developing fetal problems increases.

Other symptoms include hair loss, diarrhea, and loss of appetite. Sometimes unexpected weight loss may be a sign of zinc deficiency. Loss of taste for food is also a common sign.

Zinc functions in over 100 chemical reactions. Eating plenty of meat products, including fish and seafood, ensures adequate levels in the diet. Toxicity cases are rare, but they still happen. Overdosing from supplements and accidental ingestion of zinc-rich products are usual cases of poisoning. Zinc overdose can be life-threatening, and if you believe you ingested more than you should, it is best to get yourself to the nearest ER to be safe.

Nausea, diarrhea, and stomach pain are common symptoms of zinc poisoning. When left untreated, zinc toxicity could lead to copper deficiency because the two compete for absorption in the GI tract. Susceptibility to infections is also a concern.

Chromium

Chromium comes in two forms: trivalent and hexavalent. The former is what the human body can use, while the latter is a known toxin that can cause lung cancer. Chromium helps with blood sugar control, and helps with diabetes, but taking enough does not reverse the condition. Supplement companies market chromium picolinate as a weight loss solution.30 

  • Problems with glucose utilization— Chromium deficiency reduces blood sugar control and may worsen type 2 diabetes.
  • Cholesterol— Chromium helps with cholesterol management and increases the risk of atherosclerosis and heart problems.

200mcg to 1000mcg is safe for healthy adults. Toxicity can affect brain chemistry, although it is rare. Because it plays a role in insulin management, too much chromium in the blood may reduce blood sugar substantially.

Cobalt

Numerous metabolic processes use cobalt. Some of its functions are thyroid hormone production, blood cholesterol maintenance, enzymatic reactions, the formation of red blood cells (as part of Vitamin B12). In certain reactions, cobalt can replace manganese deficiency.31

  • Poor red blood cell formation—Cobalt is often associated with anemia since it is involved in red blood cell formation. 
  • Vitamin B12 deficiency—Since it forms part of Vitamin B12 (cobalamins), it shares many symptoms of Vitamin B12 deficiency.
  • Potential damage to nerve function—You need Vitamin B12 for proper nerve function. 

Too much cobalt is toxic to the heart muscle and may lead to cardiomyopathy. Vitamin B12 and cobalt toxicity go hand in hand. Goiters worsen when too much cobalt is present in the blood.

How Many Trace Minerals Should I Take?

There are 10 trace minerals, nine if you exclude cobalt that you should consider and must come from the diet. Like we mentioned before, a diet rich in all food groups will guarantee that you get all in the diet. 

If you are in the market for mineral supplementation, please look for the 10 minerals we mentioned the supplement’s label. We urge that you consult a physician first to know if it is proper before you buy a bottle of mineral supplements. 

Please check the recommended daily allowance for macro and micro minerals above. There are many factors that affect mineral needs, but healthy adults can use the recommended guidelines above. 

mushrooms and pill supplements are great sources for trace minerals including the supplement shilajit

How To Get Trace Minerals In The Diet?

The best way to get trace minerals is to eat high-quality whole foods. Eating a wide range of foods helps you get all trace minerals your body needs.32 We sometimes forget that our food is nutrient poor because we are so busy with work, and our lifestyles do not allow us to be more mindful with what we eat.  Taking supplements adds the assurance that we are getting what we need, but they should not replace food, which often contains these nutrients and minerals in forms we can utilize easily. herbal supplements also contain minerals. Shilajit or mineral pitch are especially known to contain some of the trace minerals we mentioned here.

Other Minerals Found in the Body

There are other minerals present in food that our body may need. None are essential,  and their function is poorly understood. Some elements do not have to be ingested. Exposure in the air may be enough.

We have yet to know much about these elements and if we have recommended intake levels. Some, like silver and gold in the right forms, demonstrate useful health qualities, but we do not know if they have any metabolic functions in the body.

ElementsFunction
BromineBromine Potentially helpful in tissue development; catalyst in collagen development. Bromine helps activate certain enzymes.33
NickelNickel aids in iron absorption and glucose metabolism. Nickel may Potential role in certain metalloenzymes.34
BoronNo known human function but is essential for plant growth. Helps remove excess calcium and works with Vitamin D in animals.
LithiumLithium has no known biological use for human systems.
StrontiumStrontium may play a role in calcium utilization.
SiliconSilicon is used in many biological processes of various organisms. No clear function with humans.
VanadiumVanadium is used in many biological processes of various organisms. No clear function with humans.


There are elements found in the body with no potential metabolic function. These are not essential to human health, but they do not cause any harm either. Like anything, excess leads to various health problems. We do not fully understand the role of many of these minerals in the body but some have applications outside the body.

ElementsPotential Health Benefits and known therapeutic uses (If Any)
SilverSilver finds application in wound management and as an antibacterial agent.
GoldGold may have potential applications against arthritis, anti-HIV, cancer therapy.
Lithium (lithium carbonate)Lithium is used in medicine to help with bipolar disorders. Lithium deficiency is associated with bipolar disorder.
RubidiumRubidium may replace the function of potassium as an electrolyte.
CesiumCesium has no known health benefit.
StrontiumStrontium is added in toothpaste, may helpful against dental caries.

Strontium ranelate is helpful in bone growth by increasing bone density.

Strontium-89 pain relief from bone metastases, and other form of cancers.

BariumBarium has no known human benefit
RadiumRadium has no known benefit. Radium-233 is used in bone cancer treatment, palliative for bone pain.
ScandiumScandium is commonly used in therapy imaging.
TitaniumTitanium oxalate studies (animal) show application in reducing tumor development.
VanadiumVanadium is being investigated for insulin control applications. It is found to be useful in certain bacterial functions.
NickelNickel may play a role in microorganism survival. However, it causes helicobacter pylori virulent.
Yttrium Yttrium is often used in cancer treatment.
ZirconiumZirconium is often used in antiperspirant products. It helps prevent bacteria from developing body order.
NiobiumNiobium has potential antiviral action.
CadmiumCadmium has no known health benefits to human systems.
HafniumHafnium has no known health benefit to human systems.
TantalumTantalum is used in implants and bone repair, scaffolding for bone ingrowth.
TungstenSodium tungstate behaves similar to insulin may help regulate glycemia and diabetes.
RheniumIsotopes of Rhenium are used in cancer treatment and for alleviating pain.
OsmiumOsmium tetroxide is used to destroy necrotic tissue in arthritic joints, mimics dismutation of the superoxide, potential applications in cancer research.
IridiumIridium has applications in cancer therapy.
PlatinumPlatinum has applications in cancer therapy.
MercuryMercury was formerly used to preserve vaccines. It has no known health applications.
LanthanumLanthanum is used in hyperphosphatemia and in helping against electrolyte imbalance.
CeriumCerium has bacteriostatic benefits, used in burn treatment (Ce3+ nitrate-silver sulfadiazine formulation).
SmariumSmarium is used for pain management in cancer treatment.
EuropiumEuropium finds application in MRI imaging.
GalodiniumGadolinium finds application in MRI imaging.
Holmium Holmium is used in radiation therapy.
YtterbiumYtterbium is used for pain management in cancer therapy.
LutetiumLutetium is used in cancer therapy.
ActiniumActinium is used in cancer therapy.
AluminumAluminum salts are used as adjuvants in vaccines, may help stimulate immune response.
GalliumGallium has applications in  radiopharmacology.
IndiumIndium has no known biological role but potential applications in cancer therapy.
ThalliumThallium has no known biological role, and can interfere with K+ usage.
GermaniumGermanium has no known health benefit but has been sold as part or sole component in “health elixirs.”
TinTin has no known health benefit, but trace amounts are often found in the body.
ArsenicArsenic exists in ultra-trace levels in the body. Arsenic is considered a heavy metal.
AntimonyAntimony has no known health benefit but was formerly considered to have therapeutic effects in ancient time.
BismuthBismuth is used as antibacterial agents.
TelluriumTellurium has no known health benefits but may have potential in cancer therapy.
AstatineAstatine has potential uses in cancer therapy.
HeliumHelium is used against a wide range of respiratory ailments.
ArgonArgon finds use in medical applications.
KryptonKrypton is used in MRI imaging.
XenonXenon is considered a general anesthetic.
RadonRadon has no known health benefits.

Solid shilajit rocks on top of rocks.

Shilajit As A Source of Trace Minerals

Shilajit is a biogenic substance made from fermented medicinal plants. It contains a vibrant blend of nutrients, including bioactives, and interestingly, It is an impressive source of minerals we need regularly, like iron, calcium, phosphorus, and magnesium, which is why many people value it as an all in one mineral health care supplement.

Herbo-mineral preparations contained herbs and organic minerals all beneficial to proper health. Shilajit is a one of a kind herbo-mineral rich in nutrients beneficial to all biological beings.

Traditional medicine considers shilajit as one of the most important health substances known, and used in the Far East. Healers gave the substance to the malnourished,, regardless of social status. It is not outside the realm of possibility that shilajit’s quality nutrients and organic minerals were helpful in alleviating the many health issues early users encountered.

Benefits of shilajit supplementation include:

  • Enhanced energy levels
  • Augments longevity
  • Promotes healthy cognitive health
  • Efficient nutrient transport 
  • Increased nutrient utilization 
  • Fill nutrient and mineral gaps in the diet
  • Amplify the effect of herbs
  • Promotes a healthy response to pain and 
  • Maintains electrolyte balance
  • Promotes a healthy  response to bone and muscle healing

What makes shilajit stand out even against the best trace mineral supplement is that its mineral content is wholly organic, all from nature and from medicinal plants, in a form that is all-natural and pure. Organic humic substances chelate with minerals, forming complex structures that make the nutrients easy to utilize. 

The source tells us much about its nutritive quality too. Previously we said that poor nutrients and mineral levels in the soil affect nutrient quality in produce. In this case, shilajit cannot be grown commercially. It can only be collected in high altitude locations, specifically in shilajit bearing rocks, which is free from human intervention. The natural, untampered vegetation provides for shilajit’s core nutrients and minerals which can only be described as superior, from the humic substances found in soil.

We mentioned that mineral supplements, including vitamins are artificially made in laboratories and mass-produced in manufacturing facilities. Shilajit nutrients, on the other hand, are organic forms as they come from the earth and are processed by plants, which makes them readily available and easily assimilated by the human body. 

Humic substances including fulvic and ashless humic acids play a role in moving the minerals in the body, something that quality shilajit contains plenty of. Fulvic acid is an efficient nutrient transporter and helps move nutrients and minerals in the blood to cells that need them.35 Shilajit’s ashless humic acid and its di-benzo alpha pyrones also help with nutrient transport. 

We are not recommending that shilajit be your only source of minerals and vitamins. It can help fill nutritional gaps in the diet for sure, but it should not replace food nutrients. Our busy lifestyles often lead to us not getting the nutrients we need. We fall back to foods that are often calorie-dense and poor in vitamins and minerals. In this case, shilajit can fill in the nutrient deficiencies acting as a natural, organic nutrient supplement. 

Shilajit is best taken in the morning before food. Combining shilajit with coffee, tea, juice, or your favorite protein shake are all good strategies to get the most of our resin.

Shilajit Resin

The growing demand for shilajit has led to the manufacture of powdered and capsulized shilajit. These are usually imitations containing humic products from shilajit sedimentary rock formations, and humus, the nutritive component of soil. We mentioned previously that soil mineral levels are severely depleted. If the shilajit imitations use bioactives from nutrient-depleted humus, then you can guess how ineffective it would be as a nutrient supplement. These imitations and “shilajit fulvic acid complexes” are likely to contain fewer nutrients and minerals. Even if they do, the quality of the fulvic and humic acid complexes does not match that of pure shilajit resin. Humic substances from shilajit is significantly superior due to the quality medicinal plants involved in its creation.

Nature created shilajit as a resin which oozes from the heat of the sun during the summer times. It turns into a brittle solid when the winter winds blow past shilajit bearing rocks. 

Authentic shilajit resin made by Pürblack™ gets its shilajit resin from shilajit bearing rocks. It is pure shilajit, masterfully processed to remove heavy metals and kill microbes common to shilajit raw material. Traditional purification methods destroy some of the nutrients present in the resin, but with Pürblack™ and the technology they use, the company can manufacture a resin rich in all nutrients and minerals while getting rid of all impurities. Pürblack is an excellent source of trace minerals, particularly macro minerals. Elemental quantification for a small sample of pure shilajit resin reveals dietary levels of calcium, iron, potassium, magnesium, sodium, and phosphorus. Shilajit also contains a  small amount of cobalt, chromium, manganese, selenium, and zinc.

Trace Minerals For Weight Loss

Let’s change the topic for a bit and talk about weight loss. The weight loss supplement is an industry juggernaut, worth billions of dollars in the US alone. Companies market herbal supplements, synthetically produced weight loss solutions, and even vitamin and mineral supplements as a weight loss aid. Do the minerals and vitamins actually help you lose weight?

To lose weight, you need to eat less and to exercise regularly. More than that, it demands determination, perseverance, and consistency.

In our humble opinion, it does not, but we understand why people think that it helps, and why companies see it in that angle. Some trace minerals play a role in how the body utilizes carbohydrates and how it breaks down fat for energy; having these minerals in the diet then ensures that your body utilizes energy sources effectively. The following are minerals (including macrominerals) may play a role in energy utilization and fat breakdown. 

  • Magnesium— Magnesium plays a role in lipolysis or the body’s natural way of breaking down fat.36
  • Potassium— Potassium helps remove bloat by removing excess water along with sodium. Prevents fatigue when working out playing the function of electrolytes.37
  • Calcium—Calcium may help burn fat properly, and enough may help deter the formation of fat stores.38
  • Selenium— Selenium form part of many thyroid hormones responsible for the efficient use of energy, including the breakdown of energy stores (fat).39
  • Zinc— Zinc helps in glucose metabolism. Having insufficient insulin leads to reduced energy levels, causing us to eat more for energy.40
  • Chromium— Chromium helps boost metabolism. It is often sold as chromium picolinate in the weight loss market. With proper exercise and diet, it may aid weight loss.41

One non-essential mineral found in food, which shows promise in many scientific animal model studies is vanadium. Vanadium was found to help reduce weight and lower glucose levels.42

We authors do not subscribe to the claim that these minerals alone with help with weight loss. Weight loss involves food management and exercise to be effective. The one logical argument that makes sense as to why companies market trace minerals as a weight loss solution is because mineral and nutrient deficiency still occur in obesity. Not having the minerals that help in metabolism impedes the efficient use of energy stores. Restoring mineral levels affected by obesity, therefore, restores the body’s capacity to utilize energy and fat stores properly.

Taking more of the mineral does not enhance metabolic effects either. Neither does taking more cure any disease or cure conditions. Instead, it puts you at risk of developing mineral toxicity. Our bodies can only utilize what it needs; any excess is either discarded or stored.

It is safe to say however that getting the right nutrients including trace minerals is the right step towards losing weight. Managing weight and doing exercise on a regular basis will only accelerate the weight loss, and condition the body in the physiological changes that are happening because of the decrease in food. Taking shilajit is helpful when losing weight, as it has bioactives that act as powerful nutrient transporters, and it promotes excellent energy use as well. Shilajit helps maintain electrolyte equilibrium too by providing your body with electrolytes.

Even without herbal supplementation, it is best to just eat a plateful of good food filled with all the nutrients needed for proper health. Coupled with exercise, food moderation, and healthy daily practices, you can lose naturally without ever needing supplements.

Food is the best medicine in this time and age no longer applies. It is far more proper to say, health food is the best medicine.

We cannot overstate the need for essential minerals in the body but do not run yet to the pharmacy and buy a bottle of multivitamins or multi-minerals to secure better health. Everything you need can be found eating whole, nutrient-dense organic foods. The benefit of trace minerals can be had simply by eating foods from various food groups.

If you feel that you are not functioning at your best, even when you are eating healthy food regularly, we recommend consulting a physician first before taking supplements. Many of the signs and symptoms of mineral deficiency are signs and symptoms of other conditions too. Do not self-diagnose. Ask a doctor to be sure.

Mineral supplementation should be the last recourse. Take mineral supplements when you are sure you are not getting enough of them from food or when your doctor has already made a nutrient deficiency diagnosis. Instead of multivitamins, herbo-minerals are good alternatives that can offer more benefits. Shilajit is an excellent example and is scientifically backed to contain a wide array of nutrients including minerals the same way they are found in food. It is an ideal nutrient supplement for everyday use. Shilajit pairs well with other herbs like ginseng, ashwagandha, Tribulus and even common herbs and spices like garlic and ginger. Shilajit herbal formulations can be made at home. Adding them to your morning protein shake works wonders to your body too so you can take on the day ahead.

References:

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  40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307254/
  41. https://www.ncbi.nlm.nih.gov/pubmed/9823013

 

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