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Vitamin D supplements are incredibly popular, but whether vitamin D supplements should be taken during pregnancy and at what dose is still debated, and studies have had conflicting results. Now a review by Canadian researchers of 43 studies of vitamin D supplementation during pregnancy found that there is "insufficient evidence to guide recommendations during pregnancy". They said that overall the studies were small or of low quality -  and the "available data did not provide evidence of benefit" from vitamin D supplementation during pregnancy.

They found that vitamin D supplementation slightly increased the mean (average) birth weight by 2 ounces (58.33 g), reduced the risk of small for gestational age births, and reduced the risk of the child wheezing at age 3. There was no effect on preterm birth, and there was a lack of evidence of benefits of prenatal vitamin D supplementation for maternal health conditions (e.g. gestational diabetes) during pregnancy.

Currently recommendations regarding vitamin D supplementation vary widely among medical and professional organizations, and WHO (World Health Organization) currently recommends against routine prenatal vitamin D supplementation. Luckily there are a number of studies going on right now on this issue that may help answer this question - how much vitamin D, if any, should be taken during pregnancy? From Medical Xpress:

Insufficient evidence to guide recommendations on vitamin D in pregnancy

There is currently insufficient evidence to guide recommendations on the use of vitamin D supplements in pregnancy, conclude researchers in The BMJ today. A team led by Dr Daniel Roth at The Hospital for Sick Children in Toronto, say some of the most critical questions about the effectiveness of taking vitamin D supplements during pregnancy "will probably remain unanswered in the foreseeable future."

Vitamin D helps maintain calcium levels in the body to keep bones, teeth and muscles healthy. Numerous studies suggest that taking vitamin D supplements may also help protect against heart disease, cancer, respiratory infections and asthma - as well as conditions related to pregnancy, such as preeclampsia and gestational diabetes. But results are conflicting and recommendations vary widely among medical and professional organisations.

So Dr Roth and his team set out to assess the current and future state of the evidence on vitamin D supplements during pregnancy. They analysed results from 43 randomised controlled trials involving 8,406 women, to estimate the effects of taking vitamin D supplements during pregnancy on 11 maternal and 27 child outcomes.... The results show that taking supplements during pregnancy increased vitamin D levels in both the mother's bloodstream and umbilical cord blood, but the researchers did not consistently find that higher doses of vitamin D led to healthier women and babies.

Overall, vitamin D increased average birth weight by 58 g and reduced the risk of having a small baby, but more detailed analyses weakened the authors' confidence in these findings. There was a lack of evidence of benefits of vitamin D supplements for maternal health conditions related to pregnancy, no effect on other birth outcomes of public health importance, such as premature birth, and scant evidence on safety outcomes.  [Original study.]

An interesting possibility - that taking supplements of  a type of vitamin E known as gamma tocopherol may reduce the inflammation of the airways common in asthma patients – eosinophilic inflammation.

Note that these findings were from a preliminary study of 15 people with mild asthma, done by researchers at the Univ. of North Carolina. Now larger and longer studies need to be done, especially to make sure that side-effects and an increased risk for hemorrhagic stroke won't occur with gamma tocopherol, as it does for the other form of vitamin E (alpha tocopherol) commonly found in supplements. From Medical Xpress:

Can asthma be controlled with a vitamin supplement?

The shortness of breath experienced by the nearly 26 million Americans who suffer from asthma is usually the result of inflammation of the airways. People with asthma typically use albuterol for acute attacks and inhaled steroids to limit chronic inflammation. Both medications come with side effects. But what if it was possible to keep asthma under control by changing one's diet or taking a vitamin supplement? It may happen sooner than you think.

Preliminary research results from the UNC School of Medicine indicate that a type of vitamin E known as gamma tocopherol may reduce eosinophilic inflammation – a kind of airway inflammation common in asthma patients. The results were published in the Journal of Allergy & Clinical Immunology.

"We started looking into vitamin E because epidemiologic data suggested that people with high amounts of vitamin E in their diet were less prone to asthma and allergic disease," said Michelle Hernandez, MD, professor of pediatrics and senior author of the study.  There are several different isoforms of vitamin E. The type commonly found in vitamin supplements – alpha tocopherol – has been studied previously, but the results suggested that alpha tocopherol was not particularly effective. Even worse, the alpha isoform seemed to be associated with an increased risk for hemorrhagic stroke.

So UNC researchers took a different tack and asked whether the kind of vitamin E being used might have an effect on the outcome. They began looking more closely at gamma tocopherol, the type of vitamin E commonly found in a diet rich in nuts and nut oil. .... "While the alpha isoform does have antioxidant activities, gamma tocopherol has both an antioxidant and a very unique anti-inflammatory action as well," she said "That anti-inflammatory effect is what we think made the difference in this study."

Participants in the study were randomized into two groups that received either gamma tocopherol supplement or a placebo for two weeks. At the end of that period, they were asked to cough up sputum..... After a three week "washout period" where they took nothing, subjects were placed in the other group: if they took the supplement for the first two weeks, they took a placebo for the second period.

"The advantage of a cross-over design like this is that we are able to compare the subjects to themselves," said Burbank. "And what we found is that when people were taking the vitamin E supplement, they had less eosinophilic inflammation." In addition to decreased inflammation, those who were taking vitamin E were also found to have lower levels of proteins called mucins, which affect the stickiness of mucus. Mucins are often elevated in asthmatics.

A recent study looked at 2 specific antioxidant levels in a variety of mushroom species. Mushrooms are an excellent source of nutrients, such as riboflavin and other B vitamins, selenium, copper, potassium, dietary fiber, as well as high levels of antioxidants ergothioneine (ERGO) and glutathione (GSH). The study found the highest levels of these antioxidants in yellow oyster and porcini mushrooms.

Ergothioneine (ERGO), which is found throughout the human body, is a critical antioxidant that acts with other antioxidants to protect against oxidative stress in the mitochondria (in our cells). What foods are good sources of ERGO? Mushrooms have the highest levels, but other foods with high ERGO content include red beans, black beans, kidney beans, oat bran, liver, and king crab.

Glutathione (GSH) is produced by the body and found in every cell - thus the major antioxidant within cells. It also helps the liver remove chemicals (detoxification) of a wide range of toxins, drugs, pollutants, and carcinogens, and maintenance of immune functioning. Low GSH levels are associated with increased risks for cancer, cardiovascular diseases, arthritis and diabetes. So you want to maintain optimal tissue levels of GSH (through dietary intake) because it is so critical for maintaining health. What foods are good sources of GSH? Mushrooms, and many fresh (raw) fruits and vegetables, including asparagus, avocados, potatoes, spinach, squash, tomatoes. Also fresh, uncooked meats and dairy products (raw milk) and eggs. From Science Daily:

Mushrooms are full of antioxidants that may have antiaging potential

Mushrooms may contain unusually high amounts of two antioxidants that some scientists suggest could help fight aging and bolster health, according to a team of Penn State researchers. In a study, researchers found that mushrooms have high amounts of the ergothioneine and glutathione, both important antioxidants, said Robert Beelman, professor emeritus of food science and director of the Penn State Center for Plant and Mushroom Products for Health. He added that the researchers also found that the amounts the two compounds varied greatly between mushroom species.

Beelman said that when the body uses food to produce energy, it also causes oxidative stress because some free radicals are produced. Free radicals are oxygen atoms with unpaired electrons that cause damage to cells, proteins and even DNA as these highly reactive atoms travel through the body seeking to pair up with other electrons. Replenishing antioxidants in the body, then, may help protect against this oxidative stress.

According to the researchers, who report their findings in a recent issue of Food Chemistry, the amounts of ergothioneine and glutathione in mushrooms vary by species with the porcini species, a wild variety, containing the highest amount of the two compounds among the 13 species tested. The more common mushroom types, like the white button, had less of the antioxidants, but had higher amounts than most other foods, Beelman said....Mushrooms that are high in glutathione are also high in ergothioneine, for example. Cooking mushrooms does not seem to significantly affect the compounds, Beelman said.

"It's preliminary, but you can see that countries that have more ergothioneine in their diets, countries like France and Italy, also have lower incidents of neurodegenerative diseases, while people in countries like the United States, which has low amounts of ergothioneine in the diet, have a higher probability of diseases like Parkinson's Disease and Alzheimer's," said Beelman. "Now, whether that's just a correlation or causative, we don't know." [Original study.]

A recent study found that significantly increasing  dietary fiber intake after a diagnosis of colorectal cancer was associated with a lower death rate - from both colorectal cancer and overall mortality (from any cause). The 1575 men and women (all healthcare professionals) in the study had received a nonmetastatic colorectal cancer diagnosis (it had not spread beyond the colon), and the follow-up was about 8 years. These results were from food, not supplements.

How much did extra dietary fiber lower the death rate? For each additional 5  grams of fiber added to their daily diet (after diagnosis) was associated with a 18% lower colorectal cancer death rate, and a 14% lower death rate from any cause. In this study, whole grains, especially in cereals, were found to be the most beneficial. Current dietary guidelines recommend a fiber intake of 25 to 38 grams per day, but most Americans eat far lessDietary fiber is found in plant foods, such as beans, whole grains, nuts, seeds,  vegetables, and fruits. Plant fiber feeds the millions of gut microbes, especially beneficial microbes (here, here, and here) - something that was not really discussed in the study.

The researchers pointed out that a high fiber diet (especially from whole grains and cereals) is linked to a lower risk of getting colorectal (colon) cancer in the first place.  Also, that "higher intake of fiber, especially cereal fiber", has been linked to improved insulin sensitivity, reduced inflammation, type 2 diabetes, cardiovascular disease, and total mortality. Other studies have found that  vitamin D supplementation, exercise, and eating fish all increase survival from colorectal cancer. From From Medical Xpress:

Fiber-rich diet boosts survival from colon cancer

A diet rich in fiber may lessen the chances of dying from colon cancer, a new study suggests. Among people treated for non-metastatic colon cancer, every 5 grams of fiber added to their diet reduced their odds of dying by nearly 25 percent, said lead researcher Dr. Andrew Chan. He is an associate professor in the department of medicine at Harvard Medical School.

"What you eat after you've been diagnosed may make a difference," Chan said. "There is a possibility that increasing your intake of fiber may actually lower the rate of dying from colon cancer and maybe even other causes." Chan cautioned, however, that the study does not prove that the additional fiber caused people to live longer, only that the two were associated.

Fiber has been linked to better insulin control and less inflammation, which may account for better survival, he suggested. In addition, a high-fiber diet may protect people from developing colon cancer in the first place. The greatest benefit was attributed to fiber from cereals and whole grains, according to the report. Vegetable fiber was linked to an overall reduction in death, but not specifically in death from colon cancer, and fiber from fruit was not linked to a reduction in death from any cause. 

For the study, Chan and his colleagues collected data on 1,575 men and women who took part in the Nurses' Health Study and Health Professionals Follow-up Study, and who had been treated for colon or rectal cancer that had not spread beyond the colon. Specifically, the study looked at total fiber consumption in the six months to four years after the participants' cancer diagnosis. The researchers also looked at deaths from colon cancer and any other cause. In an eight-year period, 773 participants died, including 174 from colorectal cancer. [Original study.]

Another study has shown health benefits from eating a diet rich in whole grains, as compared to one with lots of refined grains (think bagels, muffins, white bread). Fifty overweight Danish adults were randomly assigned to either a group where all grains eaten were whole grains or a group where all grain products were of refined grains. They did this for 8 weeks, then ate their usual diet for a few weeks (the "washout period"), and then were assigned to the other dietary group for 8 weeks.

They found that eating the diet rich in whole grains resulted in: consuming fewer calories (the whole grains made them feel fuller), losing weight, and a decrease in chronic low-grade inflammation (by measuring blood inflammation markers). The whole grain rye seemed to be especially beneficial. But interestingly, the researchers found that the whole grain diet did not significantly change the gut microbe composition. But they did find that 4 strains of Faecalibacterium prausntzii and one of Prevotella copri increased in abundance after whole grain and decreased after refined grain consumption. F.prausnitzii is a desirable and beneficial keystone species in the gut (here and here).

Other studies show that eating a diet rich in whole grains (rather than refined grains) is associated with a decreased risk of several diseases, including type 2 diabetes and cardiovascular diseases. Bottom line: choose whole grains whenever possible. From Science Daily:

Several reasons why whole grains are healthy

When overweight adults exchange refined grain products -- such as white bread and pasta -- with whole grain varieties, they eat less, they lose weight and the amount of inflammation in their bodies decreases. These are some of the findings of a large Danish study headed by the National Food Institute, Technical University of Denmark. 

The study included 50 adults at risk of developing cardiovascular disease or type 2 diabetes. Blood tests showed that the participants had less inflammation in their bodies when eating whole grains. In particular, it appeared that rye had a beneficial effect on the blood's content of inflammatory markers. Inflammation is the natural response of the body to an infection, but some people have slightly elevated levels of inflammation (so-called low-grade inflammation) even though there is no infection. This is particularly the case in overweight people. In overweight people, an increased level of 'unnecessary' (subclinical) inflammation may lead to increased risk of developing type 2 diabetes.

The study also shows that participants eat less when whole grain products are on the menu -- presumably because whole grain consumption causes satiety. While eating the whole grain diet, participants have generally lost weight. The researchers used DNA sequencing to analyze stool samples from the participants in order to examine whether the different diet types affected the participants' gut bacteria composition. Overall, the analysis did not shown major effects of the dietary grain products on the composition of the gut bacteria. [Original study.]

For years studies have suggested that eating blueberries and other berries is good for our health (here, here, and here). Now another study suggests that eating wild blueberries benefits children's thinking, specifically attention and "executive function" (mental processes which lets people plan, organize, and complete tasks). What was nice in this study was that it was "double-blind"- which meant that biases couldn't influence the results. 

Flavonoids are a diverse group of phytonutrients (plant chemicals) found in almost all fruits and vegetables. They are powerful antioxidants with anti-inflammatory and immune system benefits. And yes, other studies have also found various benefits to mental processes with an increase of flavonoids in the diet - in both children and adults.

What foods contain flavonoids? There are 6 main classes of flavonoids, and each is found in different foods: - Anthocyanidins – found in red, purple,and blue berries, red wine, and red and purple grapes. - Flavonols - found in onions, leeks, broccoli, Brussels sprouts, kale, tea, berries, beans, and apples. - Flavones - found in parsley, celery, and hot peppers. - Isoflavones - found in soybeans, soy products, and legumes. - Flavanones - found in citrus fruit and tomatoes. - Flavanols - found in tea, red wine, grapes, apples, fava beans, and cocoa. From Medical Xpress:

Primary school children could show better attention by consuming flavonoid-rich blueberries, following a study conducted by the University of Reading. In a paper published in Food & Function, a group of 7-10 year olds who consumed a drink containing wild blueberries or a matched placebo and were tested on their speed and accuracy in completing an executive task function on a computer.The double blind trial found that the children who consumed the flavonoid-rich blueberry drink had 9% quicker reaction times on the test without any sacrifice of accuracy. In particular, the effect was more noticeable as the tests got harder.

Previous [Univ. of] Reading research has shown that consuming wild blueberries can improve mood in children and young people, simple memory recall in primary school children, and that other flavonoid rich drinks such as orange juice, can also improve memory and concentration.

Wild blueberries are grown and harvested in North America, and are smaller than regular blueberries, and are higher in flavonoids compared to regular varieties. The double-blind trial used a flavonoid-rich wild blueberry drink, with a matched placebo contained 8.9 g of fructose, 7.99 g of glucose and 4 mg of vitamin C matching the levels of nutrients found in the blueberry drink. [Original study.] 

Interesting study finding - that both high and low levels of magnesium is associated with a higher risk of dementia. Magnesium is an essential mineral needed for more than 300 biochemical reactions in the body. According to a large study done in the Netherlands of people who were followed for about 8 years - there was a U-shaped incidence of dementia based on their levels of magnesium. The lowest incidence was in those with "in the middle" normal levels of magnesium in the blood. All the study participants were mentally healthy when the study started.

The researchers stated that magnesium levels are considered "relatively stable over time", but a limitation of the study is that they only looked at magnesium levels once - at the beginning of the study, so they could have changed over time. Of course further studies are needed. [Other posts on magnesium and health - here, here, and here.]

Magnesium is widely available in foods. Foods that are good sources of magnesium include: spinach and other dark green leafy vegetables, almonds, cashews, peanuts, bananas, soybeans, kidney and black beans (legumes), whole grains, lentils, seeds, yogurt, brown rice, potatoes, and avocados. It is recommended that magnesium is obtained from the diet, and not from supplements (due to health risks from high doses). From Science Daily:

Both high, low levels of magnesium in blood linked to risk of dementia

People with both high and low levels of magnesium in their blood may have a greater risk of developing dementia, according to a study published in the September 20, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The study involved 9,569 people with an average age of 65 who did not have dementia whose blood was tested for magnesium levels. The participants were followed for an average of eight years. During that time, 823 people were diagnosed with dementia. Of those, 662 people had Alzheimer's disease. The participants were divided into five groups based on their magnesium levels. Both those with the highest and the lowest levels of magnesium had an increased risk of dementia, compared to those in the middle group.

Both the low and high groups were about 30 percent more likely to develop dementia than those in the middle group. Of the 1,771 people in the low magnesium group, 160 people developed dementia, which is a rate of 10.2 per 1,000 person-years. For the high magnesium group, 179 of the 1,748 people developed dementia, for a rate of 11.4 per 1,000 person-years. For the middle group, 102 of the 1,387 people developed dementia, for a rate of 7.8. Kieboom noted that almost all of the participants had magnesium levels in the normal range, with only 108 people with levels below normal and two people with levels above normal[Original study.]

The following study was presented at the recent annual meeting of the Infectious Diseases Society of America. A study of women prone to recurrent urinary tract infections (UTIs) found that increasing daily fluid intake by 1.5 liters of water a day (about three 16-ounce glasses) in addition to their usual daily fluid intake - had a reduced incidence of UTIs that year by 48%, as compared to women who drank their usual daily fluid amount (1.2 liters). So the women who drank about 2.8 liters (water and other beverages) a day had 1.6 UTIs that year on average, and the women who drank their usual fluid amount had 3.1 UTIs on average. Which also resulted in fewer courses of antibiotics in the increased water group. A great result.

Bottom line: Drinking a lot more fluids daily (to flush the bacteria in the bladder and urinary tract) may benefit those with recurrent UTIs. [See more posts on UTI research, and the one treatment that many swear by as truly effective (D-mannose)]. From Futurity:

Women who get frequent UTIs may reduce risk by drinking plenty of water

Drinking an additional three pints of water a day may keep the urinary tract infection (UTI) away - at least for women who are prone - suggests a study being presented at IDWeek [Infectious Diseases Society of America Week] 2017. The study found women at risk of UTIs who increased their water intake by about that much water every day were nearly half as likely to get UTIs as women who did not.

Women are more likely to get UTIs than men in part because the urethra is shorter, meaning it is easier for bacteria to travel from the rectum and vagina to the bladder. Drinking more fluids increases the rate of flushing of bacteria from the bladder and also likely reduces the concentration of bacteria that enter the bladder from the vagina. This reduces the opportunities for bacteria to attach to cells that line the urinary tract, which is necessary to cause an infection, Dr. Hooton said.

The study included 140 healthy premenopausal women who had at least three UTIs in the last year and reported low daily fluid intake. Half of the women (70) who served as the control group continued their usual daily fluid intake, while the remainder were told to drink 1.5 liters of water a day (about three 16-ounce glasses) in addition to their usual daily fluid intake. After one year, women in the control group had 3.1 UTIs on average, whereas those in the water group had 1.6 UTIs on average, a 48 percent reduction. As a result, the water group averaged fewer regimens of antibiotics (1.8) than the limited-water group (3.5), a reduction of 47 percent.

Researchers followed the women throughout the year using visits and telephone calls. They documented that over the course of the study, on average women in the water group increased their daily water intake by 1.15 liters (about 2-1/2 pints) for a total daily fluid intake (including water and other beverages) of 2.8 liters, whereas women in the control group did not increase the amount of water they drank and had a total daily fluid intake of 1.2 liters.

OK, this study was done in mice, but it's the kind of study results that everyone hopes (and thinks) is also true for humans. So drink a nice cuppa black tea and think about how you're increasing bacteria in the gut associated with weight loss.

Black tea (as well as green tea) has polyphenols that stimulate the growth of gut bacterium and the formation of short-chain fatty acids. By the way, the mice were given decaffeinated tea extracts, so theoretically both decaf and caffeinated tea should have benefits. The big question though is - will drinking black tea daily actually result in weight loss? From Medical Xpress:

Black tea may help with weight loss, too

UCLA researchers have demonstrated for the first time that black tea may promote weight loss and other health benefits by changing bacteria in the gut. In a study of mice, the scientists showed that black tea alters energy metabolism in the liver by changing gut metabolites. The research is published in the European Journal of Nutrition. The study found that both black and green tea changed the ratio of intestinal bacteria in the animals: The percentage of bacteria associated with obesity decreased, while bacteria associated with lean body mass increased.

Previous studies indicated that chemicals in green tea called polyphenols are absorbed and alter the energy metabolism in the liver. The new findings show that black tea polyphenols, which are too large to be absorbed in the small intestine, stimulate the growth of gut bacterium and the formation of short-chain fatty acids, a type of bacterial metabolites that has been shown to alter the energy metabolism in the liver.

The researchers also collected samples from the mice's large intestines (to measure bacteria content) and liver tissues (to measure fat deposits). In the mice that consumed either type of tea extract, there was less of the type of bacteria associated with obesity and more of the bacteria associated with lean body mass. However, only the mice that consumed black tea extract had an increase in a type of bacteria called Pseudobutyrivibrio, which could help explain the difference between how black tea and green tea change energy metabolism.

The new study also concluded that both green tea and black tea have different effects on liver metabolism. According to Henning, the molecules in green tea are smaller and can more readily be absorbed into the body and reach the liver directly, while black tea molecules are larger and stay in the intestine rather than being absorbed. When black tea molecules stay in the intestinal tract, they enhance the growth of beneficial bacteria and the formation of microbial metabolites involved in the regulation of energy metabolism. [Original study.]

Two studies looked at manganese and found that high levels are associated with problems. Manganese is an essential trace mineral necessary for development, metabolism, the antioxidant system, and for normal brain and nerve function. Getting manganese through foods (e.g. nuts, seeds, whole grains) is beneficial, but ingesting large amounts through supplements or being exposed to high levels in some other way (such as polluted air) is associated with various health problems. 

The first study found that high manganese in the diet (in mice) was associated with an increased risk of staph (Staphylococcus aureus) heart infection. The second study (done in East Liverpool, Ohio) found that exposure to consistently high levels of manganese in the air is associated with lower IQ scores in children. And why did the air the children were breathing have high levels of manganese? Because there was a nearby hazardous waste incinerator and a facility that handles manganese.

From Medical Xpress: Excess dietary manganese promotes staph heart infection

Too much dietary manganese—an essential trace mineral found in leafy green vegetables, fruits and nuts—promotes infection of the heart by the bacterium Staphylococcus aureus ("staph"). The findings, reported this week in the journal Cell Host & Microbe, add to the evidence that diet modifies risk for infection. The discovery also suggests that people who have excess levels of tissue manganese, including those who consume dietary supplements with high concentrations of the metal, may be at increased risk for staph infection of the heart.

Skaar and his colleagues studied the impact of dietary manganese on staph infection in a mouse model. Most of the mice that consumed a high manganese diet—about three times more manganese than normal—died after infection with staph. The investigators discovered that the animals on the high manganese diet were particularly susceptible to staph infection of the heart, which was a surprise, said Skaar, who is also professor of Pathology, Microbiology and Immunology.... The researchers found that excess manganese inactivates a key line of defense against pathogens: the innate immune system's reactive oxygen burst. 

Staph is the leading cause of bacterial endocarditis (infection of the inner lining of the heart chamber and heart valves) and the second most frequent cause of bloodstream infections. Interestingly, some populations of people have both increased risk for staph infections, particularly endocarditis, and higher than normal levels of tissue manganese, Skaar noted. These populations include intravenous drug users, patients with chronic liver disease and patients on long-term intravenous diets.

From Medical Xpress: Higher manganese levels in children correlate with lower IQ scores, study finds

A study led by environmental health researchers at the University of Cincinnati (UC) College of Medicine finds that children in East Liverpool, Ohio with higher levels of Manganese (Mn) had lower IQ scoresThe study analyzed blood and hair samples of 106 children 7 to 9 years of age from East Liverpool and surrounding communities, who enrolled in the study from March 2013 to June 2014.... The study found that increased Mn in hair samples was significantly associated with declines in full-scale IQ, processing speed and working memory.

Manganese is an element generally found in combination with iron and many minerals. It plays a vital role in brain growth and development, but excessive exposure can result in neurotoxicity. Manganese is used widely in the production of steel, alloys, batteries and fertilizers and is added to unleaded gasolineLocated in northeast Ohio along the Ohio River, East Liverpool has a demonstrated history of environmental exposures, with EPA records showing elevated levels of manganese concentrations since 2000.... all  [air] monitors in East Liverpool had "consistently exceeded" health-based guidelines set by the agency.

 Manganese (Mn). Credit: Wikipedia