Manganese is used as a cofactor for many enzymatic activities involved in carbohydrate metabolism, scavenging reactive oxygen species, reproduction, immune system response and bone formation. It is integral to many physiological processes and symptoms of a deficit may include gut dysbiosis. It also influences neuropathologies such as Alzheimer's disease, anxiety, Parkinson's disease, depression and prion diseases. Sperm motility and health is also dependent on manganese.