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NOTE : This material is not intended as an alternative to personal, professional medical advice. The reader should consult a physician in all matters relating to health, and particularly in respect of any symptoms which may require diagnosis or medical attention.

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EUROPEAN MEDICAL JOURNAL

SPECIAL REPORT

VITAMINS AND MINERALS

INTRODUCTION

Although they are sometimes called 'micro-nutrients' because we need them in such very small quantities, vitamins and minerals are essential for healthy living.

Vitamins help keep your body tissues healthy, maintain your skin in good condition, produce enzymes to enable your body to function, help turn food into energy, keep your nerves in good condition, assist in the production of hormones, help keep your teeth and bones strong and aid in the production of blood cells.

Minerals also play a vital part in the functioning of your body. For example, iron is essential for the formation of red blood cells. If your body is deficient in iron then your body will form too few red blood cells - the cells which normally carry oxygen around your body - and your tissues will not receive enough oxygen. Calcium helps form the structure of your bones and teeth. Zinc is essential for the proper functioning of some of your body's enzymes.

VITAMINS MAY HELP PREVENT CANCER

For the last two decades there has been a considerable amount of discussion about the value of vitamins (particularly vitamins A and C) in the prevention - and even treatment - of cancer. In vitamin A it is the beta-carotene content which is believed to have the protective quality. Researchers have found that people who eat a diet which is low in vitamin A tend to be more likely to suffer from cancers of the lung, larynx, bladder, oesophagus, stomach, colon, rectum and prostate. And it has been found that vitamin C may lower the risk of cancer of the oesophagus and stomach.

Vitamins aren't the only micronutrients which help prevent cancer. Minerals can play a part too. Zinc, for example, is believed to help prevent cancer. I am aware of three scientific papers which have shown that there may be a link between a low zinc intake and prostate cancer. Despite all the billions of dollars spent on research no one yet knows how cancer develops. One theory is that free radicals - molecules produced routinely within the body - may damage the DNA within our cells, transforming a previously normal cell into a potentially cancerous cell. Every cell in the human body needs oxygen but oxygen is responsible for the production of free radicals - oxygen carrying molecules which are destructive and aggressive. It is free radicals which encourage our tissues and bodies to age and which cause damage to cells and tissues when our immune systems falter. The formation of free radicals is an inevitable part of life. (And is added to by pollutants from the outside world. For example, a smoker breathes in several billion free radicals every time he sucks on a cigarette.)

Fortunately, it is now believed that there are some food substances called antioxidants which can neutralise free radicals which are formed. There are four known antioxidants at the moment: beta-carotene (which is converted in the human body to vitamin A), vitamins C and E and the mineral selenium. There is a growing amount of evidence to show that antioxidants can help reduce the likelihood of numerous diseases including: cancer, arteriosclerosis, heart disease, skin diseases, types of arthritis, Parkinson's disease, cataracts, Alzheimer's disease and radiation damage. The antioxidants could, it seems, even help to counter the effects of ageing.

Finally, it is worth pointing out that human experiments have shown that your body can repair the DNA which has been damaged by free radicals if it receives a plentiful supply of folic acid - one of the vitamin B complex of vitamins. Your body will receive the folic acid it needs if you eat a diet which is rich in dark green, leafy vegetables, fruits, dried peas, beans and wheat germ.

BE CAREFUL HOW YOU PREPARE YOUR FOOD

It is important to be careful about how you store and prepare your food. Vitamin C and the vitamins in the B group are water soluble, which makes them especially vulnerable. As well as being very sensitive to heat, they leach out of food when it is soaked, blanched or boiled. Put a cabbage into cold water and bring it to the boil and you destroy 75% of its vitamin C content. Cook fresh peas for just five minutes and you wipe out 20-40% of their thiamine (one of the B vitamins) and 30-40% of their vitamin C.

Other B vitamins especially at risk in vegetables are folate, riboflavin, and inositol. Folic acid is sensitive to heat and light and it is soluble in water. If you boil your vegetables in too much water, cook food at too high a temperature or even allow your lettuce to soak in water for too long then much of the folic acid will be lost.

Even before you start cooking you can damage the vitamin content of food simply by keeping it for too long. If salad, spinach or green beans or peas are stored for a day they lose up to 40% of their vitamin C content. After another day in storage they may lose the same amount again. If salad vegetables are allowed to stand in water for a quarter of an hour they may lose up to 30% of their vitamin C content and a considerable amount of the vitamin B1 content.

Vitamins are also lost when food is cut up. And the more you chop food the greater the vitamin loss. If bananas or tomatoes are allowed to stand after being chopped they lose 10% of their vitamin content within minutes. Chopped red cabbage may lose 60% of its vitamin content if allowed to stand for two hours. (Incidentally, dribbling a little vinegar or lemon juice onto freshly prepared food may help to slow down the loss of vitamin C). When fruit is peeled and potatoes and tomatoes skinned most of the vitamins are lost.

Vitamins A, D, E and K are fat soluble and so less at risk. Nevertheless, up to 50% of the vitamin E in food can be destroyed by frying or baking and the A vitamin and carotene are destroyed at high temperatures.

I have included some simple, basic rules explaining how to preserve the vitamin and mineral content of your food in the final part of this publication. Making sure that you get the best out of the food you eat is not difficult: it simply requires a little knowledge and a little care. Modern raw foodstuffs are not intrinsically worthless; they are more likely to be emptied of essential vitamins and minerals by careless preparation in the home and the kitchen than by having been grown in poor soil.

VITAMINS

VITAMIN A (Retinol)

What It Does:

Although vitamin A is probably best known as the vitamin that helps us to see in the dark, this reputation is rather exaggerated. The fact is that an excess of vitamin A won't help you see better - vitamin A does help us to see in dim light and a deficiency can cause night blindness but that's about as far as it goes. Another important function of vitamin A is to help us fight infection. Anyone deficient in vitamin A will be more susceptible to infection. Since vitamin A is an antioxidant a shortage of vitamin A may lead to the development of certain types of cancer. Vitamin A may also help protect against heart disease and is necessary for sexual function. Vitamin A also helps in the formation of bones and teeth and helps to keep skin and hair healthy.

Where You May Find It:

Some animal foods - for example, liver, eggs and butter - are particularly rich in vitamin A and are sometimes said to be a suitable source of the vitamin. There are, however, two big problems with animal sources of vitamin A. First, the animal foods which are rich in vitamin A are also often rich in fat. Dairy products, rich in fat, such as milk, cheese, butter and ice cream are rich in vitamin A but are also likely to block your arteries and lead to the development of heart disease and cancer. Second, some animal products are so rich in vitamin A that they can be dangerous. You can, however, obtain all the vitamin A that you need from plant foods - carrots and other orange and yellow-orange fruits and vegetables and dark green, leafy vegetables are both excellent sources of beta-carotene which can be converted into vitamin A. Retinol is only found in animal foods but the carotenes, of which the most important is beta-carotene, are found in orange coloured and green leafy vegetables. In the body, beta-carotene is converted to vitamin A. Unlike retinol, foods which contain beta-carotene can be consumed in plentiful amounts without fear of toxicity. Good supplies of beta-carotene can be obtained from carrots, broccoli, chicory, endives, spinach, lettuce, apricots, elderberries and mangoes. Other useful sources include: sweet potatoes, pumpkin, peas, spinach, kale, peppers, melons, cabbage, peaches, asparagus, watermelon, tomatoes, parsley, avocado. The average person has a two year supply of vitamin A stored in the liver.

Possible Signs of Deficiency May Include:

Night blindness; lack of tear secretion; changes in eyes with eventual blindness if deficiency is severe and untreated; increased susceptibility to respiratory infection; dry, rough skin; changes in mucous membranes; weight loss; poor bone growth; weak tooth enamel; diarrhoea; slow growth.

Possible Signs Of Overdose/Toxicity May Include:

A high intake of retinol - the animal form of vitamin A - can be harmful, causing liver and bone damage. Anorexia, drowsiness, irritability, hair loss, headaches and skin problems are possible symptoms. Excessive consumption by pregnant women of vitamin A, but not beta-carotene, has also been linked with an increased risk of birth defects. Children are more sensitive to vitamin A and are more likely to develop toxicity with high dosages. Taking an oral contraceptives may increase vitamin A concentration.

VITAMIN B

Note: When vitamins were first discovered they were given letters as they were discovered - A, B, C, D etc. But scientists then discovered that the substance they had called vitamin B actually consisted of several different substances, so they began to rename the vitamins in the B group, calling them B1, B2, B3 and so on. To add to the confusion some of the vitamins in the B group - are also known by names. Vitamin B1, for example, is known as thiamine while vitamin B2 is sometimes called riboflavin.

VITAMIN B1 (Thiamine)

What It Does:

Vitamin B1 is used by the body to release energy from carbohydrates, fats and alcohol. The bigger the carbohydrate consumption the greater the need for thiamine. This can lead to deficiency if high levels of refined carbohydrate are eaten.

Where You May Find It:

Vitamin B1 is present in many different plant foods but most of us get all the vitamin B1 we need from the cereals we eat. As with rice much of the vitamin B1 is removed from the husk during the milling process. Theoretically, therefore, white flour should be deficient in vitamin B1. However, most countries have laws which ensure that white flour has the missing vitamin B1 put back into it. Foods which contain vitamin B1 include: peas, wholewheat flour, wheatgerm, dried sunflower seeds, brown rice, soya beans, kidney beans.

Possible Signs of Deficiency May Include:

If your body is short of vitamin B1 then you are likely to develop fairly typical symptoms which consist of numbness and pins and needles in your hands and feet. A severe deficiency of vitamin B1 can lead to a condition called beri-beri which is particularly common in rice eating countries where the husk (the part of the rice which contains vitamin B1) is removed and the rice is polished. Deficiency of thiamine may also cause palpitations and muscular weakness, loss of appetite, anorexia, indigestion, constipation, fatigue, nausea and vomiting, depression and other mental problems such as memory loss and personality changes. Vitamin B1 deficiency is common among alcoholics and elderly people - particularly those who live alone and may not feed themselves properly. In alcoholics vitamin B1 deficiency can lead to permanent brain damage. In the elderly vitamin B1 deficiency commonly leads to mental confusion and to heart disease.

Possible Signs of Overdose/Toxicity May Include:

The vitamins in the vitamin B group can cause a wide range of problems when taken in excess (despite the fact that vitamin B, like vitamin C, is water soluble and therefore excesses of the vitamin are eventually discarded in the urine). Occasionally large doses of vitamin B1 have caused hypersensitive reactions resembling anaphylactic shock. The drug may cause drowsiness in some people.

VITAMIN B 2 (Riboflavin)

What It Does:

Vitamin B2 helps your body turn carbohydrate foodstuffs into energy. (It shares this duty with vitamin B1 and vitamin B3). It isn't particularly easy to become deficient in vitamin B2 but if you do then your first symptoms are likely to include sore, cracked lips and a sore, discoloured tongue. When vitamin B2 deficiency does occur it is usually accompanied by a deficiency of other vitamins. Vitamin B2 also helps keeps the eyes healthy, and helps keep the skin, tongue and mouth healthy. It helps preserve the nervous system and promotes normal growth and development.

Where You May Find It:

Vitamin B2 is found in fairly large quantities in eggs and in dairy products such as milk and cheese; however, since vitamin B2 is sensitive to light the vitamin B2 content of milk can be destroyed if the milk is left in full sunshine on the doorstep. Vitamin B2 is also found in wholemeal products and wheatgerm, broccoli, spinach and brewer's yeast.

Possible Signs Of Deficiency May Include:

Cracks and sores in the corners of mouth and inflammation of tongue and lips. The eyes become red, sore, sensitive to light and easily tired, there is itching and scaling of skin around the nose, mouth, forehead, ears and scalp. Other symptoms may include: trembling, dizziness, tiredness, poor concentration and insomnia. Possible Signs Of Overdose/Toxicity May Include: Dark urine, nausea, vomiting.

VITAMIN B 3 (Niacin - consisting of nicotinic acid and nicotinamide)

What It Does:

Vitamin B3 helps turn food into energy and helps to maintain the skin, nerves and digestive system.

Where You May Find It:

Vitamin B3 can be found in a wide variety of plant and animal foods. Liver, chicken and fish contain it. Sunflower seeds, nuts and many vegetable and cereal foodstuffs contain it.

Possible Signs Of Deficiency May Include:

Muscle weakness, general fatigue, loss of appetite, headaches, swollen, red tongue, skin lesions, including rashes, dry scaly skin, wrinkles, coarse skin texture, nausea and vomiting, dermatitis, diarrhoea, irritability, dizziness. A severe deficiency can cause a disorder called pellagra - this will affect the brain, skin and gastro-intestinal tract and can result in death.

Possible Signs Of Overdose/Toxicity May Include:

Nausea, vomiting, abdominal cramps, diarrhoea, weakness, light-headedness, headache, fainting, sweating, high blood sugar, heart-rhythm disturbances, jaundice.

VITAMIN B 5 (pantothenic acid)

What It Does:

Promotes normal growth and development; aids in release of energy from fats, carbohydrates and proteins and helps the synthesis of numerous body materials.

Where You May Find It:

A diet with a good nutritional intake of the other B group vitamins will contain enough vitamin B5. (Sources include offal, meat and cereals.)

Vitamin B5 is so widely distributed in foods that deficiency is rare. Possible Signs Of Overdose/Toxicity May Include: Diarrhoea and water retention.

VITAMIN B 6 (pyridoxine)

What It Does:

Vitamin B6 plays a vital role in the way enzymes metabolize proteins and amino acids. However, although some drugs (notably the oral contraceptives) increase the human body's requirement for vitamin B6, diseases due to vitamin B6 deficiency are not usually reported in adult human beings. The body's requirement for vitamin B6 increases with protein consumption - and, in particular, with the consumption of animal protein. Meat-eaters have a greater need for this vitamin than vegetarians and vegans.

Where You May Find It:

No particular foods contain large amounts of vitamin B6 but many foods contain small amounts and your body's requirements for the vitamin are small. Meat, offal, fruit, vegetables and cereals contain vitamin B6. Specific foods containing vitamin B6 include: bananas, potatoes, peas, carrots, cabbage and beans, cereal products and bread.

Possible Signs Of Deficiency May Include:

Weakness, mental confusion or depression, irritability, hyperactivity, skin lesions and anaemia. Possible Signs of Overdose/Toxicity May Include: Too much vitamin B6 can cause depression and nerve damage that can lead to clumsiness, numbness and a loss of balance. A dose in excess of just 10mg a day may cause nerve damage. (Many supplements on sale contain as much as 250 mg of vitamin B6).

VITAMIN B 9 (folic acid)

Note: the word 'folate' is a generic term for the many compounds which are derived from folic acid.

What It Does:

Promotes normal red blood cell formation and is essential for protein metabolism. Recent research suggests that people who have a diet which is low in folic acid may be more likely to die of heart disease.

Where You May Find It:

In green, leafy vegetables, such as spinach, kale, lettuce and also in wholemeal products, peas, rice and soya beans.

Possible Signs Of Deficiency May Include:

Anaemia, infertility, abnormalities of linings of intestines, vagina, uterus and bronchi.

Possible Signs Of Overdose/Toxicity May Include:

Appetite loss, nausea, flatulence.

VITAMIN B 12 (cyanocobalamin)

What It Does:

Like folic acid, vitamin B12 is essential for the formation of red blood cells. If your body is short of vitamin B12 you are likely to develop a condition called pernicious anaemia - the size of your individual red blood cells will be increased but their number will be reduced. Vitamin B12 plays a vital part in the working of your central nervous system. A long-term shortage of the vitamin can lead to permanent damage being done to the brain and spinal cord. Vitamin B12 aids the production of genetic matter inside cells which is needed for the creation of new cells. Vitamin B12 is an unusual vitamin in that before it can be absorbed into the body it needs to be linked to a substance called 'intrinsic factor' which is formed in the stomach. Patients who have had stomach surgery may be unable to produce this 'intrinsic factor'. This problem is less common these days now that ulcer healing drugs have made many stomach operations obsolete.

Where You May Find It:

Found in many animal products - including meat, eggs and dairy produce. Also available in tempeh, soya milk, edible seaweeds, dried spirulina and the wide range of fortified products now available (including cereals, margarines, textured vegetable proteins and fortified yeast extracts and savoury spreads). Vitamin B12 is manufactured by micro-organisms such as yeasts, bacteria, moulds and some algae. The human body can store this vitamin for long periods (up to five or six years) so a daily dietary source is therefore not necessary. In addition, the healthy body recycles this vitamin very effectively, recovering it from bile and other intestinal secretions, which is why the dietary requirement is so low. There is also some evidence that vitamin B12 may be produced by bacterial activity in the small intestine. Vitamin B12 is also found in nutritional yeast, beer, cider, fermented soya foods (such as soy sauce), barley malt syrup and parsley. The most reliable vegan sources of B12 are foods fortified with the vitamin. Soya products (such as soya milks), breakfast cereals, yeast extracts and margarines are particularly likely to contain added vitamin B12. Vegan women who are pregnant and vegan mothers who intend to breast feed their babies should make sure that they eat foods which are fortified with vitamin B12 and they should talk to their doctors too.

Possible Signs Of Deficiency May Include:

Pernicious anaemia with the following symptoms: fatigue, weakness, especially in arms and legs; sore tongue; nausea, appetite loss, weight loss; bleeding gums; numbness and tingling in hands and feet; difficulty in maintaining balance; pale lips, pale tongue, pale gums; yellow eyes and skin; shortness of breath; depression; confusion and dementia; headache; poor memory. First obvious signs of B12 deficiency might be pins and needles or coldness in the hands and feet, fatigue and weakness, poor concentration or even psychosis.

Possible Signs Of Overdose/Toxicity May Include:

If taken with large doses of vitamin C, vitamin B12 may cause nose bleeding, ear bleeding, dry mouth.

VITAMIN H (B-group vitamin, biotin)

What It Does:

Essential for normal growth and development and repair and for a healthy metabolism.

Where You May Find It:

Intestinal bacteria probably produce all the biotin the body needs. The vitamin is available in almost all foods including brown rice, bulgur wheat, cashew nuts, peas, lentils, oats, soya beans, sunflower seeds.

Possible Signs Of Deficiency May Include:

Dry scaly dermatitis, nausea and vomiting, anorexia, fatigue, depression, sleepiness, muscular pains, loss of muscular reflexes, tongue becomes smooth and pale, hair loss, anaemia.

Possible Signs Of Overdose/Toxicity May Include:

Unlikely.

VITAMIN C (ascorbic acid)

What it does:

Vitamin C helps the body to form connective tissue - the packing material which supports and protects the rest of the body. Your skin contains a considerable amount of connective tissue and if you are short of vitamin C the first symptoms you notice are likely to be bruising and bleeding. This condition is called scurvy and the gums are usually the first part of the body to show it. In addition small cuts and grazes take an extraordinarily long time to heal. Scurvy is still fairly common - usually among people who do not eat enough fresh fruit and vegetables. Vitamin C will also help your body to fight off infections and it will help your body to absorb iron. Indeed vitamin C increases the ease with which iron is absorbed by a factor of five. Meat eaters are, ironically, often more likely to develop iron deficiency anaemia than are vegetarians because they tend to eat less fruit and vegetables. Vitamin C also helps the body to use calcium to build bones and blood vessels. Women need slightly more vitamin C than men, smokers need considerably more than non smokers and the sick and convalescent need good supplies of vitamin C in order to get well again. We need regular supplies of vitamin C since, like all the vitamins in the B group, it is water soluble and is, therefore, not stored.

Where You May Find It:

Fresh fruit of most kinds (but particularly citrus fruits) and fresh vegetables contain good quantities of vitamin C. One of the most important sources of vitamin C, however, is the potato (simply because it is such an important constituent in our diets). New potatoes contain more vitamin C than old ones and overcooking potatoes destroys the vitamin. Since vitamin C is water soluble leaving vegetables to soak in water for a long time will cause the vitamin C to disappear. Vitamin C is extremely fragile. It is destroyed by heat and it leaks out of foods into the water in which they are being cooked.

Possible Signs Of Deficiency May Include:

Wounds fail to heal and there is an increased liability to infection. Severe deficiency manifests as scurvy: muscle weakness, swollen gums, loss of teeth, tiredness, depression, bleeding under skin, bleeding gums.

Possible Signs Of Overdose/Toxicity May Include:

Large amounts of vitamin C can produce diarrhoea and gastric irritation and it is possible that too much vitamin C may cause kidney problems - specifically kidney stones - and can affect growing bones. In addition people who have been taking high doses of vitamin C for long periods and then suddenly cut down their intake can develop rebound scurvy.

VITAMIN D (cholecalciferol, calciferol)

What It Does:

Vitamin D helps the body absorb and use calcium and phosphorus effectively for making strong bones and teeth. If your body is deficient in vitamin D then you will develop a condition called osteomalacia - in which your bones become weak and prone to fracture. In children a shortage of vitamin D leads to a condition called rickets.

Where You May Find It:

Your body can make its own vitamin D with the aid of a little sunshine and there are relatively few countries in the world where the supply of sunshine is inadequate for the manufacture of vitamin D. Regular exposure of hands, arms and face to summer sunlight (for as little as ten minutes a day) can provide sufficient vitamin D. The main dietary sources are fortified foods such as margarine and breakfast cereals although vitamin D is present in quite a number of different foods - salt water fish, mushrooms and dairy products for example.

Possible Signs Of Deficiency May Include:

Rickets (a childhood disease): bent, bowed legs, malformations of joints and bones. Osteomalacia (adult rickets): pain in ribs, lower spine, pelvis and legs, brittle, easily broken bones.

Possible Signs Of Overdose/Toxicity May Include:

Vitamin D, even in only relatively high doses, can damage the body by encouraging deposits of calcium. Vitamin D is one of the most toxic of vitamins when taken in excessive quantities.

VITAMIN E (tocopherol)

What it does:

Vitamin E deficiency disorders are virtually unknown. Some manufacturers (and some fans of the vitamin) claim that vitamin E supplements can be used to boost mental, athletic or even sexual skills but I have not been able to find any scientific evidence to support these claims. Vitamin E has, over the years, acquired something of a reputation as a 'sex vitamin' but this reputation was based on experiments done on rats many decades ago. The experiments showed that a vitamin E deficiency in rats can lead to sterility. However, since a deficiency of vitamin E in human beings is virtually unknown (you would probably have symptoms of something else before doctors identified a vitamin E deficiency if you were eating an inadequate diet) and since experiments on animals are of absolutely no value to human beings this evidence is clearly of no significance. More recently it has been claimed that vitamin E may help reduce the incidence of heart disease and may improve the immune system. This is far more likely. Vitamin E is an important antioxidant and therefore protects cells from damage by scavenging free radicals.

Where You May Find It:

Vitamin E is found in vegetable oils such as olive oil, sunflower oil and soya bean oil and in vegetables such as spinach, celery and broccoli. A vegetarian diet is particularly rich in vitamin E.

Possible Signs Of Deficiency May Include:

Lethargy, inability to concentrate, irritability, poor reflexes, visual disturbances, muscle weakness. Possible Signs Of Overdose/Toxicity May Include: Tendency to bleed, altered immunity, impaired sex functions, increased risk of blood clots, altered metabolism of essential hormones.

VITAMIN K (napthaquinone)

What It Does:

Vitamin K plays an essential role in the blood clotting mechanism. It is rare for a healthy adult to be short of this vitamin since vitamin K is widely available in foods.

Where You May Find It:

In many vegetables, particularly green vegetables such as broccoli, cabbage, lettuce and spinach. Vitamin K is also produced by bacterial activity in the large intestine. The use of antibiotics, which reduce gut bacteria, can occasionally cause deficiency.

Possible Signs of Deficiency May Include:

Excessive bleeding and haemorrhaging.

Possible Signs Of Overdose/Toxicity May Include:

Large doses may impair liver function.

MINERALS AND TRACE ELEMENTS

CALCIUM

What It Does:

Helps build and maintain bones and teeth (99% of the calcium in the body is in the bones and teeth); controls transmission of nerve impulses; aids in muscle contraction; assists with blood clotting.

Where You May Find It:

Dairy products (such as milk and cheese) are sometimes thought of as standard or irreplaceable of calcium. However, this isn't true. For example, only about 30% of the calcium in milk is absorbed by the human body - possibly less than for typical green, leafy vegetables. Dark green leafy vegetables (such as kale and broccoli) are good plant sources and some experts believe that calcium is more readily absorbed from kale than it is from milk. One recent study has shown that vegetarians absorb and retain more calcium from foods than do non-vegetarians and other studies cite lower rates of osteoporosis in vegetarians than in non-vegetarians. Vegetarian and vegan diets may actually protect against osteoporosis. The wisest course is to obtain dietary calcium from a wide range of sources.

Possible calcium sources include: broccoli, molasses, chick peas, dried figs, tofu, endive, cabbage, kale, turnip greens, spinach and many different types of beans (including soya beans and vegetarian baked beans).

Probably the simplest way to make sure you get plenty of calcium is to eat plenty of dark green leafy vegetables. It is important to remember that a high calcium intake alone will not necessarily prevent osteoporosis. Countries where there is a high calcium intake (such as Sweden or Finland) tend to have higher fracture rates than countries (such as those in Asia) where calcium intake is not high. Apart from ensuring a reasonable intake of calcium it is necessary to reduce the loss of calcium from your body. There are six things you can do to minimise calcium loss:

• Avoid tobacco (smokers have a hip fracture risk 40% higher than non smokers).
• Don't drink more than two cups of coffee a day.
• Keep your intake of alcohol down.
• Cut animal proteins out of your diet - this can slice your calcium losses in half.
• Take regular, gentle exercise which you enjoy. (But do not exercise if it is painful and always consult your doctor before starting an exercise programme or altering your exercise habits).
• keep your salt intake down.

There are seven basic food groups:

1 Fruit.

2 Vegetables (including potatoes and salad foods such as lettuce).

3 Bread and cereals (including cakes and biscuits).

4 Milk, cheese and dairy products.

5 Meat, fish and eggs.

6 Fats and oils (including butter and margarine).

7 Drinks (including water).

Vitamins can easily be destroyed. Mushrooms, lettuce, broccoli, asparagus and strawberries, for example, all lose their vitamins very quickly. Food which has to be cooked should be cooked for the shortest possible time and at the lowest possible temperature. In order to ensure that the food you eat retains a high vitamin content follow these simple rules:

• Food processing tends to reduce the nutritional quality of food and so where possible you should try to buy fresh food and either eat it raw (if appropriate) or eat it after cooking for the shortest length of time.
• Buy vegetables whole. Don't have the leaves removed from carrots or the stalk removed from a cabbage or cauliflower. If you buy the vegetable whole vitamin C will continue to be produced and moved into the edible parts of the plant.
• Cook foods in the minimum amount of water or steam.
• Avoid high cooking temperatures and long heat exposure.
• Do not allow food to stand for long periods at room temperature. Do not store food in warm places.
• Do not soak vegetables for long periods.
• Do not peel fruit or vegetables unless necessary. (For example, do not peel apples or skin potatoes).
• Try to use food the day you have bought it rather than use frozen foods. Use foods the day you buy them to get the best out of them.
• You can keep fresh products for longer by freezing as soon as you buy them. Deep freezing preserves vitamins and other nutrients. Vegetables should be blanched before freezing. Put them in hot water for a short time. This inactivates enzymes which might otherwise degrade vitamin C.
• Do not allow food - particularly unpackaged fruit and vegetables, vegetable oils and milk - to stand in sunlight.