Manganese

Fact Sheet for Health Professionals

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Table of Contents

 Introduction
 Recommended Intakes
 Sources of Manganese
 Manganese Intakes and Status
 Manganese Deficiency
 Groups at Risk of Manganese Inadequacy
 Manganese and Health
 Health Risks from Excessive Manganese
 Interactions with Medications
 Manganese and Healthful Diets
 References
 Disclaimer
This is a fact sheet intended for health professionals. For a reader-
friendly overview of Manganese, see our consumer fact sheet on
Manganese.

Introduction

Manganese is an essential trace element that is naturally present in

many foods and available as a dietary supplement. Manganese is a
cofactor for many enzymes, including manganese superoxide
dismutase, arginase, and pyruvate carboxylase [1,2]. Through the
action of these enzymes, manganese is involved in amino acid,
cholesterol, glucose, and carbohydrate metabolism; reactive oxygen
species scavenging; bone formation; reproduction; and immune
response [3-7]. Manganese also plays a role in blood clotting and
hemostasis in conjunction with vitamin K [5].

Manganese is absorbed in the small intestine through an active

transport system and, possibly, through diffusion when intakes are
high [2]. After absorption, some manganese remains free, but most is
bound to transferrin, albumin, and plasma alpha-2-macroglobulin.
Manganese is taken up by the liver and other tissues, but the
mechanism of this process is not well understood [1,2].

The human body contains about 10 to 20 mg manganese, of which 25%

to 40% is in bone [1,2]. The liver, pancreas, kidney, and brain also
contain manganese. The body maintains stable tissue manganese
concentrations through regulatory control of manganese absorption
and excretion [5]. More than 90% of absorbed manganese is excreted
via bile into the feces, and a small amount is reabsorbed [1,2,4,5]. Very
little is excreted in urine.

Manganese status is difficult to assess and not routinely measured in

clinical practice. Normal whole blood concentrations of manganese
range from 4 to 15 mcg/L [1], but they are highly variable, and their
utility as a status indicator is unclear [4]. Some studies that measured
serum or plasma manganese concentrations in apparently healthy
adults have shown mean serum concentrations of 1.04 mcg/L and
mean plasma concentrations of 1.28 mcg/L [4,8]. Large variations in
manganese intakes appear to affect these concentrations somewhat
[9]. However, these concentrations often do not correlate well with
typical manganese intakes, so whether they are useful indicators of
manganese status is not clear [4].

Although urinary manganese concentrations decrease with severe

deficiency, it is not clear whether they are useful indicators of
manganese status when intakes are within the normal range [4].

Recommended Intakes

Intake recommendations for manganese and other nutrients are

provided in the Dietary Reference Intakes (DRIs) developed by an
expert committee of the Food and Nutrition Board (FNB) at the
National Academies of Sciences, Engineering, and Medicine [4]. DRI is
the general term for a set of reference values used for planning and
assessing nutrient intakes of healthy people. These values, which vary
by age and sex, include:

 Recommended Dietary Allowance (RDA): Average daily level of

intake sufficient to meet the nutrient requirements of nearly all
(97–98%) healthy individuals; often used to plan nutritionally
adequate diets for individuals.
 Adequate Intake (AI): Intake at this level is assumed to ensure
nutritional adequacy; established when evidence is insufficient
to develop an RDA.
 Estimated Average Requirement (EAR): Average daily level of
intake estimated to meet the requirements of 50% of healthy
individuals; usually used to assess the nutrient intakes of groups
of people and to plan nutritionally adequate diets for them; can
also be used to assess the nutrient intakes of individuals.
 Tolerable Upper Intake Level (UL): Maximum daily intake unlikely
to cause adverse health effects.

In its 2001 evaluation, the FNB found the existing data insufficient to
derive an EAR for manganese. The FNB therefore established AIs for
all ages based on usual manganese intakes in healthy populations [4].
Table 1 lists the current AIs for manganese.

Table 1: Adequate Intakes (AIs) for Manganese [4]

Age Male Female Pregnancy Lactation

Birth to 6 months* 0.003 mg 0.003 mg

7–12 months 0.6 mg 0.6 mg

1–3 years 1.2 mg 1.2 mg

4–8 years 1.5 mg 1.5 mg

9–13 years 1.9 mg 1.6 mg

14–18 years 2.2 mg 1.6 mg 2.0 mg 2.6 mg

19–50 years 2.3 mg 1.8 mg 2.0 mg 2.6 mg

51+ years 2.3 mg 1.8 mg

*For infants from birth to age 6 months, the AI is based on mean

manganese intakes of infants fed primarily human milk.

Sources of Manganese

Food
Manganese is present in a wide variety of foods, including whole
grains, clams, oysters, mussels, nuts, soybeans and other legumes,
rice, leafy vegetables, coffee, tea, and many spices, such as black
pepper [1,2,5,10,11]. Drinking water also contains small amounts of
manganese at concentrations of 1 to 100 mcg/L [5]. The top sources of
manganese in the diets of U.S. adults are grain products, tea, and
vegetables [4].

Manganese concentrations are 3 to 10 mcg/L in breast milk and 30 to

100 mcg/L in cow’s milk–based infant formulas [5,12]. Soy-based infant
formulas have higher manganese concentrations, 200 to 300 mcg/L,
than milk-based formulas [12]. Limited research suggests that the
absorption rate of manganese from human milk (8.2%) is much higher
than that from soy formula (0.7%) and cow’s milk formula (3.1%) [13].

Humans absorb only about 1% to 5% of dietary manganese [2,5,7].

Infants and children tend to absorb greater amounts of manganese
than adults [7]. In addition, manganese absorption efficiency increases
with low manganese intakes and decreases with higher intakes [1,2],
but little is known about the mechanisms that control absorption [1].

Dietary iron intakes and iron status (measured by serum ferritin

concentration) appear to be inversely associated with manganese
absorption [14,15]. The mechanism for this effect is unknown, but the
shared transporter of iron and manganese in the intestine might play a
role [2]. In addition, men appear to absorb dietary manganese less
efficiently than women, possibly because men usually have higher iron
status [7,16]. Infants absorb higher proportions of manganese than
adults; limited research shows that formula-fed infants retain about
20% of the manganese they consume [5].

Selected food sources of manganese are listed in Table 2.

Table 2: Manganese Content of Selected Foods [10,11]

Milligrams
(mg) per Percent
Food serving DV*

Mussels, blue, cooked, 3 ounces 5.8 252

Hazelnuts, dry roasted, 1 ounce 1.6 70

Pecans, dry roasted, 1 ounce 1.1 48

Brown rice, medium grain, cooked, ½ cup 1.1 48

Oysters, Pacific, cooked, 3 ounces 1.0 43

Clams, cooked, 3 ounces 0.9 0.9 39

Chickpeas, cooked, ½ cup 0.9 39

Spinach, boiled, ½ cup 0.8 35

Pineapple, raw, chunks, ½ cup 0.8 35

Soybeans, boiled, ½ cup 0.7 30

Bread, whole wheat, 1 slice 0.7 30

Oatmeal, cooked, ½ cup 0.7 30

Table 2: Manganese Content of Selected Foods [10,11]

Milligrams
(mg) per Percent
Food serving DV*

Peanuts, oil-roasted, 1 ounce 0.5 22

Tea, black, brewed, 1 cup 0.5 22

Lentils, cooked, ½ cup 0.5 22

Potato, flesh and skin, baked, 1 medium 0.3 13

White rice, long grain, cooked, ½ cup 0.3 13

Kidney beans, canned, drained, rinsed, ½ cup 0.3 13

Squash, acorn, cooked, cubed, ½ cup 0.3 13

Blueberries, raw, ½ cup 0.3 13

Sesame seeds, dried, 1 tablespoon 0.2 9

Kale, raw, 1 cup 0.2 9

Black pepper, 1 gram (about ½ tsp) 0.2 9

Asparagus, boiled, ½ cup 0.1 4

Table 2: Manganese Content of Selected Foods [10,11]

Milligrams
(mg) per Percent
Food serving DV*

Apple, raw, with skin, 1 medium 0.1 4

Lettuce, romaine, raw, shredded, 1 cup 0.1 4

Coffee, brewed, 1 cup 0.1 4

Shrimp, cooked, 3 ounces 0.0 0

Tuna, white, canned in water, drained, 3 0.0 0

ounces

Chicken, breast, roasted, 3 ounces 0.0 0

Ground beef, cooked, 3 ounces 0.0 0

Egg, whole, hard-boiled, 1 large 0.0 0

Milk, 1%, 1 cup 0.0 0

Yogurt, low-fat, plain, 1 cup 0.0 0

*DV = Daily Value. The U.S. Food and Drug Administration (FDA)
developed DVs to help consumers compare the nutrient contents of
foods and dietary supplements within the context of a total diet. The
DV for manganese is 2.3 mg for adults and children age 4 years and
older [17]. FDA does not require food labels to list manganese content
unless manganese has been added to the food. Foods providing 20% or
more of the DV are considered to be high sources of a nutrient, but
foods providing lower percentages of the DV also contribute to a
healthful diet.

The U.S. Department of Agriculture’s FoodData Central website [11]

lists the nutrient content of many foods and provides a comprehensive
list of foods containing manganese ordered by nutrient content .

Dietary supplements
In dietary supplements, manganese is present in many different forms,
including amino acid chelates (e.g., manganese bisglycinate chelate,
manganese glycinate chelate, and manganese aspartate) [18]. Other
forms include manganese gluconate, manganese picolinate,
manganese sulfate, manganese citrate, and manganese chloride. No
data are available on the relative bioavailability of different forms of
supplemental manganese. The Supplement Facts label on a dietary
supplement product declares the amount of elemental manganese in
the product, not the weight of the entire manganese-containing
compound.

Not all multivitamin/mineral supplements contain manganese, but

those that do typically provide 1.0 to 4.5 mg manganese [18].
Supplements containing only manganese, or manganese with a few
other nutrients, are also available, and most contain 5 to 20 mg
manganese. Many dietary supplements that contain manganese are
listed in the Dietary Supplement Label Database from the National
Institutes of Health [18]. This database contains label information from
tens of thousands of dietary supplement products on the market.

Manganese Intakes and Status

Data on manganese intakes are very limited, but they suggest that
most people obtain adequate amounts of manganese. The National
Health and Nutrition Examination Survey, which provides dietary
intake data for most nutrients, does not include manganese [19].

The Total Diet Study (TDS) is an FDA program that monitors the
nutrient content of typical foods consumed by the U.S population [20].
The most recent report that used TDS data to estimate dietary
manganese intakes, published in 1991, used TDS data from 1982 to
1989 [21]. According to this publication, dietary manganese intakes
were 1.1 mg/day for infants aged 6 to 11 months, 1.48 mg/day for
children aged 2 years, 1.78 to 2.76 mg/day for boys and girls aged 14 to
16 years, 2.14 to 2.23 mg/day for women, and 2.64 to 2.81 mg/day for
men [21]. These values met or exceeded the manganese AI for all age
groups. More recent data from a population study of 719 adults aged
18 to 87 years in northern Italy show a median dietary manganese
intake of 2.34 mg/day [22].

Data on manganese intakes from dietary supplements are not

currently available.

Manganese Deficiency

Manganese deficiency is very rare in humans, and signs and symptoms

of deficiency have not been firmly established [1,2]. The very limited
evidence in humans suggests that manganese deficiency might cause
bone demineralization and poor growth in children; skin rashes, hair
depigmentation, decreased serum cholesterol, and increased alkaline
phosphatase activity in men; and altered mood and increased
premenstrual pain in women [2,4]. Manganese deficiency might also
alter lipid and carbohydrate metabolism and cause abnormal glucose
tolerance [3].

Groups at Risk of Manganese Inadequacy

No known groups of people are likely to have inadequate manganese

intakes.

Manganese and Health

Because of the role of manganese as a cofactor for several enzymes,
low intakes might increase the risk of illness. This section focuses on
two health areas in which manganese might be involved: bone health
and diabetes.

Bone health
Manganese is a cofactor for several enzymes involved in bone
formation [6]. In animals, manganese deficiency can impair bone
formation and reduce bone mineral density [23], and manganese
supplementation can increase both bone mineral density and bone
formation [24].

Scientists have examined whether associations exist between

circulating manganese levels, bone mineral density, and osteoporosis
in humans, but the evidence is very limited and inconsistent. In one
study, 10 women with osteoporosis (mean age, 69.3 years) had lower
serum manganese levels (20 mcg/L) than 20 women (mean age, 64.5
years) who did not have osteoporosis (40 mcg/L) [25]. In another study
in 40 postmenopausal women, serum manganese levels were
positively associated with bone mineral density and negatively
associated with bone fracture rates [26]. Conversely, a study in 77
postmenopausal women with osteoporosis (median age 61 years) and
61 postmenopausal women without osteoporosis (median age 60
years) found no differences in red blood cell manganese levels (14.76
mcg/L for women with osteoporosis vs. 15.54 mcg/L for women without
osteoporosis) or plasma manganese levels (5.34 mcg/L for women with
osteoporosis vs. 5.09 mcg/L for women without osteoporosis) [27]. In
addition, no associations between plasma manganese levels and bone
mineral density were observed in a study of 90 men aged 50 to 80
years [28].

No clinical trials have evaluated the effects of manganese

supplementation alone on bone health. In one small clinical trial,
supplementation with calcium (1,000 mg) plus trace minerals (5 mg
manganese, 15 mg zinc, and 2.5 mg copper) for 2 years improved
spinal bone density compared with placebo in 59 healthy
postmenopausal women (mean age 66 years) [29]. However, it is not
possible to determine to what extent, if any, the manganese alone
affected bone density.

More research is needed to determine whether manganese

supplementation affects bone health in humans.

Diabetes
As a cofactor for several enzymes, manganese is involved in glucose,
carbohydrate, and lipid metabolism, and manganese deficiency might
affect carbohydrate metabolism and cause abnormalities in glucose
tolerance [3]. Therefore, scientists have examined whether
manganese status affects the risk of diabetes.

Several studies have found associations between both increased

[30,31] and decreased [32-34] blood levels of manganese and the
prevalence of type 2 diabetes [35]. For example, in a case-control
study in China of 122 adults with newly diagnosed type 2 diabetes and
429 adults without diabetes (age range for all participants was 40–92
years), those in the highest tertile of plasma manganese (>2.42 mcg/L)
were 7.88 times more likely to have diabetes than those in the lowest
tertile (<1.67 mcg/L) [30]. Conversely, in a case-control study in
Sardinia of 192 adults with type 1 diabetes (mean age 48.8 years), 68
adults with type 2 diabetes (mean age 68.4 years), and 59 adults
without diabetes (mean age 57.2 years), median blood concentrations
of manganese were lower in those with either type 1 (8.62 mcg/L) or
type 2 diabetes (10.7 mcg/L) than in those who did not have diabetes
(14.2 mcg/L) [33].

A large case-control study in China suggested a U-shaped association

between plasma manganese levels and type 2 diabetes [35]. This
study included 1,614 adults with type 2 diabetes (mean age 52.5 years)
and 1,614 adults without diabetes (mean age 54.7 years). Compared
with the middle tertile of plasma manganese concentration (4.21–6.84
mcg/L), those in the lowest tertile (≤4.21 mcg/L) were 1.89 times more
likely, and those in the highest tertile (≥6.84 mcg/L) were 1.56 times
more likely, to have type 2 diabetes. Other studies have found no
associations between blood manganese levels and diabetes
prevalence [36,37].

Research in animals suggests that manganese supplementation might

improve glucose tolerance, reduce oxidative stress, and improve
endothelial dysfunction in diabetes [3], but clinical trials in humans
are lacking. More research is needed to determine whether
manganese plays any role in the development of diabetes.

Health Risks from Excessive Manganese

No evidence shows manganese toxicity from high dietary manganese

intakes [38]. However, manganese toxicity has occurred in people
working in such occupations as welding and mining who were exposed
to high amounts of manganese from chronic inhalation of manganese
dust [1,39]. People who consume water containing high levels of
manganese (in some cases as high as 28 mg/L) have also developed
manganese toxicity [4,40].

Manganese toxicity mainly affects the central nervous system and can
cause tremors, muscle spasms, tinnitus, hearing loss, and the feeling
of being unsteady on one’s feet [1,2]. Additional symptoms include
mania, insomnia, depression, delusions, anorexia, headaches,
irritability, lower extremity weakness, changes in mood and short-term
memory, altered reaction times, and reduced hand-eye coordination
[1,39]. These signs and symptoms can progress to neuromotor
impairments similar to those associated with Parkinson’s disease,
including changes in gait and balance, tremor, and rigidity [1,4].

Iron deficiency increases manganese absorption and can therefore

exacerbate symptoms of manganese toxicity [2]. People with chronic
liver disease have impaired manganese elimination in bile and are
more susceptible to manganese neurotoxicity and other adverse
effects of excess manganese intakes [4].
The FNB established manganese ULs for healthy individuals based on
levels associated with whole-blood manganese concentrations above
the normal range of 4 to 15 mcg/L and risk of neurotoxicity [4]. The
ULs do not apply to individuals who are taking supplemental
manganese under medical supervision.

Table 3: Tolerable Upper Intake Levels (ULs) for Manganese [4]

Age Male Female Pregnancy Lactation

Birth to 6 None established* None established*

months

7–12 months None established* None established*

1–3 years 2 mg 2 mg

4–8 years 3 mg 3 mg

9–13 years 6 mg 6 mg

14–18 years 9 mg 9 mg 9 mg 9 mg

19+ years 11 mg 11 mg 11 mg 11 mg

*Breast milk, formula, and food should be the only sources of

manganese for infants.

Interactions with Medications

Manganese is not known to have any clinically relevant interactions

with medications.
Manganese and Healthful Diets

The federal government’s 2020–2025 Dietary Guidelines for

Americans notes that “Because foods provide an array of nutrients
and other components that have benefits for health, nutritional needs
should be met primarily through foods. … In some cases, fortified foods
and dietary supplements are useful when it is not possible otherwise
to meet needs for one or more nutrients (e.g., during specific life
stages such as pregnancy).”

For more information about building a healthy dietary pattern, refer to

the Dietary Guidelines for Americans and the U.S. Department of
Agriculture’s MyPlate.

The Dietary Guidelines for Americans describes a healthy dietary

pattern as one that:

 Includes a variety of vegetables; fruits; grains (at least half whole

grains); fat-free and low-fat milk, yogurt, and cheese; and oils.

Whole grains are rich sources of manganese. Some vegetables

and fruits also contain manganese.

 Includes a variety of protein foods such as lean meats; poultry;

eggs; seafood; beans, peas, and lentils; nuts and seeds; and soy
products.

Nuts, legumes, and mollusks contain manganese.

 Limits foods and beverages higher in added sugars, saturated fat,

and sodium.

 Limits alcoholic beverages.

  Stays within your daily calorie needs.

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