Chapter 9: Water Chapter 9: Water and the Major and the Major MineralsMinerals

Water: Essential Water: Essential NutrientNutrient Death occursDeath occurs

– Without foodWithout food– Without vitamins, mineralsWithout vitamins, minerals– Without waterWithout water

WaterWater Comprises 50-70% of the bodyComprises 50-70% of the body Muscle contains 73% water (fat Muscle contains 73% water (fat

contains ~20%)contains ~20%) Intracellular fluidIntracellular fluid

– Fluid within the cell (2/3 of total)Fluid within the cell (2/3 of total) Extracellular fluidExtracellular fluid

– Outside the cells (1/3 of total)Outside the cells (1/3 of total)

Water Content Varies Water Content Varies By TissueBy Tissue Lean muscleLean muscle FatFat BonesBones

Water Content Varies: Water Content Varies: By AgeBy Age NewbornNewborn AdultAdult ElderlyElderly

Water Content Varies Water Content Varies DailyDaily Salt intakeSalt intake HormonalHormonal 2 cups fluid = 1 2 cups fluid = 1

poundpound Kidneys excrete Kidneys excrete

excessexcess

Functions of WaterFunctions of Water

Almost universal solventAlmost universal solvent DissolvesDissolves

– NutrientsNutrients– WastesWastes– UreaUrea– Carbon dioxideCarbon dioxide

Functions of WaterFunctions of Water Removal of body wasteRemoval of body waste

– Via urineVia urine– Excrete 1-2 quarts/dayExcrete 1-2 quarts/day– Urea excretionUrea excretion– Sodium excretionSodium excretion– Avoid concentrated urineAvoid concentrated urine

21/2 cups --- dark yellow21/2 cups --- dark yellow Can promote kidney stonesCan promote kidney stones

Functions of WaterFunctions of Water

Body temperature regulationBody temperature regulation– Metabolism generates heatMetabolism generates heat– Buildup is dangerousBuildup is dangerous– Water absorbs any excess heatWater absorbs any excess heat– Body secretes fluid via perspirationBody secretes fluid via perspiration– Skin is cool as perspiration Skin is cool as perspiration

evaporatesevaporates

Functions of WaterFunctions of Water

LubricantLubricant– JointsJoints– Synovial fluidSynovial fluid

Shock absorberShock absorber– Amniotic fluidAmniotic fluid– Cerebrospinal fluidCerebrospinal fluid

Are You Drinking Are You Drinking Enough?Enough? Recommend 1ml per 1kcalRecommend 1ml per 1kcal ½ oz / pound body weight½ oz / pound body weight

Daily Water LossesDaily Water Losses

Urine – largest lossUrine – largest loss Skin –ongoing evaporationSkin –ongoing evaporation Lungs – vaporLungs – vapor FecesFeces

Sources of WaterSources of Water

FluidsFluids– WaterWater– Other beveragesOther beverages

FoodFood– Fruits and vegetablesFruits and vegetables– MeatMeat– All but dried foodsAll but dried foods

MetabolismMetabolism– Energy nutrients Energy nutrients → →

carbon dioxide, carbon dioxide, energy, waterenergy, water

The Thirst MechanismThe Thirst Mechanism

Not reliableNot reliable Concerns for infants, older adults, athletesConcerns for infants, older adults, athletes Athletes need to monitor their fluid statusAthletes need to monitor their fluid status Weigh themselves before and after Weigh themselves before and after

trainingtraining Goal is to consume 3 cups for every pound Goal is to consume 3 cups for every pound

lostlost Illness (vomiting, diarrhea, fever)Illness (vomiting, diarrhea, fever)

Ignoring ThirstIgnoring Thirst

Shortage of water in the bodyShortage of water in the body Increase fluid conservationIncrease fluid conservation Antidiuretic hormone Antidiuretic hormone

– From the pituitary gladFrom the pituitary glad– Forces the kidney to conserve water Forces the kidney to conserve water

(reduce urine flow)(reduce urine flow) AldosteroneAldosterone

– Responds to the drop in blood pressureResponds to the drop in blood pressure– Signals the kidney to retain sodium (water)Signals the kidney to retain sodium (water)

ThirstThirst

Signal is not triggered until person Signal is not triggered until person loses 1%-2% of body weight in fluidloses 1%-2% of body weight in fluid

Lost of 4% causes muscle to lose Lost of 4% causes muscle to lose significant strength and endurancesignificant strength and endurance

Lost of 10%-12% causes heat Lost of 10%-12% causes heat intoleranceintolerance

Lost of 20% results in coma and deathLost of 20% results in coma and death Dark yellow urine is a sign of Dark yellow urine is a sign of

inadequate fluidsinadequate fluids

Water SafetyWater Safety Most municipal tap water is safeMost municipal tap water is safe The Environmental Protection The Environmental Protection

Agency and local municipalities Agency and local municipalities look for contaminantslook for contaminants

Power to local and state authorities Power to local and state authorities to advise publicto advise public

Water SafetyWater Safety

Chlorine and ammonia are added Chlorine and ammonia are added to kill most microbesto kill most microbes

Small cancer risk (2/1 million Small cancer risk (2/1 million people)people)

Chlorine can be evaporated via Chlorine can be evaporated via boiling or standingboiling or standing

Much higher risk in using Much higher risk in using untreated wateruntreated water

Water SafetyWater Safety Rural areas may need to have their water Rural areas may need to have their water

tested due to well contamination due to tested due to well contamination due to agricultural runoffagricultural runoff

Estimated that 10 million Americans may Estimated that 10 million Americans may drink water that doesn’t meet EPA guidelinesdrink water that doesn’t meet EPA guidelines

Cryptosporidium, a parasite, sickened Cryptosporidium, a parasite, sickened 400,000 people in Milwaukee; not killed by 400,000 people in Milwaukee; not killed by chlorinechlorine

High risk people are advised to boil their High risk people are advised to boil their drinking water for one minute prior to use for drinking water for one minute prior to use for drinking (HIV-AIDS, chemotherapy patients)drinking (HIV-AIDS, chemotherapy patients)

Alternatives to Alternatives to Chlorinated Tap WaterChlorinated Tap Water

BoilBoil Store overnightStore overnight

FiltersFilters Activated carbonActivated carbon Reverse osmosisReverse osmosis DistillationDistillation UV sterilizationUV sterilization OzoneOzone

Bottled WaterBottled Water

ExpensiveExpensive Environmental impactEnvironmental impact

– ManufactureManufacture– TransportTransport– LandfillLandfill

Bottled Water SourcesBottled Water Sources

75% springs/wells75% springs/wells– OzoneOzone

25% municipal tap water25% municipal tap water– Carbon filteredCarbon filtered

Bottled WaterBottled Water

Independent testingIndependent testing– 1/3 was contaminated1/3 was contaminated– BacteriaBacteria– ArsenicArsenic– Organic elementsOrganic elements

Check labelCheck label Source Source TreatmentTreatment State-interstate FDA regulatedState-interstate FDA regulated

Water SafetyWater Safety

Let cold water run for a Let cold water run for a minute or two before minute or two before drinking or using in cooking; drinking or using in cooking; will reduce risk of lead will reduce risk of lead exposureexposure

Don’t use hot water for food Don’t use hot water for food preparationpreparation

Water and MineralsWater and Minerals

Related 3 waysRelated 3 ways– Hard/soft waterHard/soft water– Fluid balanceFluid balance– Acid base balanceAcid base balance

Fluid BalanceFluid Balance

Water shifts freely in and out of the cellsWater shifts freely in and out of the cells Controlled by the electrolyte concentrationControlled by the electrolyte concentration ““Where ions go, water is sure to follow”Where ions go, water is sure to follow” Intracellular water volume depends on Intracellular water volume depends on

intracellular potassium and phosphate intracellular potassium and phosphate concentrationsconcentrations

Extracellular water volume depends on Extracellular water volume depends on extracellular sodium and potassium extracellular sodium and potassium concentrationsconcentrations

Na+, K+, Cl-Na+, K+, Cl-

Attract waterAttract water Dissolve in waterDissolve in water Electrical charge = electrolytesElectrical charge = electrolytes

Cell MembranesCell Membranes

Water permeableWater permeable Impermeable to mineralsImpermeable to minerals

OsmosisOsmosis The passage of a solvent The passage of a solvent

such as water through a such as water through a semi-permeable membrane semi-permeable membrane from a less concentrated from a less concentrated compartment to a more compartment to a more concentrated compartmentconcentrated compartment

OsmosisOsmosis

Water moves across membraneWater moves across membrane– Low concentration to highLow concentration to high– Equalizes solute concentrationEqualizes solute concentration

Minerals do not moveMinerals do not move– Draw water across membraneDraw water across membrane

Acid-Base BalanceAcid-Base Balance

Blood pH 7.35-7.45Blood pH 7.35-7.45 DeathDeath

– pH 8.0 alkalosispH 8.0 alkalosis– pH 6.8 acidosispH 6.8 acidosis

BuffersBuffers– ProteinProtein– ElectrolytesElectrolytes– Gather/release hydrogen ionsGather/release hydrogen ions

Minerals: DefinitionMinerals: Definition

Inorganic (contain no carbon)Inorganic (contain no carbon) Separate elementsSeparate elements Required in small amountsRequired in small amounts

Functions of MineralsFunctions of Minerals

CofactorsCofactors Bone and Bone and

connective tissueconnective tissue BloodBlood MetabolismMetabolism Growth & Growth &

reproductionreproduction Function/Function/

formation nerves formation nerves & muscles& muscles

Cell membrane Cell membrane transporttransport

Minerals function Minerals function together:together:– Bone formationBone formation– ElectrolytesElectrolytes– BloodBlood

Minerals in the BodyMinerals in the Body

Mineral ClassificationMineral Classification

Major mineralsMajor minerals– Require >100 mg /day (1/50 of a Require >100 mg /day (1/50 of a

teaspoon)teaspoon)– Calcium, phosphorusCalcium, phosphorus

Trace mineralsTrace minerals– Require < 100 mg/dayRequire < 100 mg/day– Iron, zincIron, zinc

Bioavailability of Bioavailability of MineralsMinerals Not all ingested minerals can be Not all ingested minerals can be

absorbedabsorbed Example: only 5% of the calcium Example: only 5% of the calcium

in spinach is absorbed because in spinach is absorbed because spinach contains oxalic acidspinach contains oxalic acid

About 25% of dietary iron is About 25% of dietary iron is absorbed (better absorbed from absorbed (better absorbed from dairy products)dairy products)

Bioavailability of Bioavailability of MineralsMinerals Presence of binders and Presence of binders and

dietary fiberdietary fiber Minerals in animal products are Minerals in animal products are

better absorbedbetter absorbed The more refined a food is, the The more refined a food is, the

fewer mineralsfewer minerals Only iron is added back to Only iron is added back to

enriched grain productsenriched grain products

Fiber-Mineral Fiber-Mineral InteractionsInteractions Phytic acid (phytate) in grain Phytic acid (phytate) in grain

fibers can limit absorption of fibers can limit absorption of some minerals by binding to themsome minerals by binding to them

Oxalic acid: substance in plants Oxalic acid: substance in plants (spinach) that binds minerals(spinach) that binds minerals

High fiber diets can decrease the High fiber diets can decrease the absorption of iron, zinc, absorption of iron, zinc, magnesium, and other mineralsmagnesium, and other minerals

Bioavailability of Bioavailability of MineralsMinerals Mineral content of plant foods Mineral content of plant foods

reflects the soil in which is it grown reflects the soil in which is it grown Mineral/mineral competition: too Mineral/mineral competition: too

much of one mineral can interfere much of one mineral can interfere with the absorption of anotherwith the absorption of another– Zinc interferes with copper absorptionZinc interferes with copper absorption

Presence of vitamins: example, Presence of vitamins: example, vitamin C enhances absorption of vitamin C enhances absorption of ironiron

Toxicity of MineralsToxicity of Minerals

Trace minerals are more toxicTrace minerals are more toxic Result of supplementationResult of supplementation Presence of contaminants in Presence of contaminants in

supplementssupplements Look for the United States Look for the United States

Pharmacopeia (USP)-approved Pharmacopeia (USP)-approved brandsbrands

Iron ToxicityIron Toxicity

Men in general and older Men in general and older women should avoid women should avoid multivitamin-mineral multivitamin-mineral supplements with iron supplements with iron because of the risk of iron because of the risk of iron toxicitytoxicity

Major MineralsMajor Minerals

SodiumSodium

Table salt (NaCl): 40% Table salt (NaCl): 40% sodium, 60% chloridesodium, 60% chloride

SodiumSodium

95% of ingested sodium is absorbed95% of ingested sodium is absorbed Major positive ion in Major positive ion in extracellularextracellular

fluidfluid AldosteroneAldosterone regulates sodium regulates sodium

balancebalance Key for retaining body waterKey for retaining body water Excretion regulated by the kidneysExcretion regulated by the kidneys Muscle contractionMuscle contraction Conduction of nerve impulsesConduction of nerve impulses

Deficiency of SodiumDeficiency of Sodium

RareRare Persistent vomiting/ diarrheaPersistent vomiting/ diarrhea Excessive perspiration (losing 2-3% Excessive perspiration (losing 2-3%

of body weight)of body weight) Depletion of sodium in the bodyDepletion of sodium in the body Muscle cramp, nausea, vomiting, Muscle cramp, nausea, vomiting,

dizziness, shock, comadizziness, shock, coma Normally kidney will respond by Normally kidney will respond by

conserving sodiumconserving sodium

Correcting DeficiencyCorrecting Deficiency

Pedialyte for Pedialyte for childrenchildren

Gatorade for Gatorade for adultsadults

Salt foodsSalt foods

Dietary Sources of Dietary Sources of SodiumSodium Average American eats 4-6 grams Average American eats 4-6 grams

sodium in foods and softened watersodium in foods and softened water 20% comes from salt added in 20% comes from salt added in

cooking or at the tablecooking or at the table 35-80% comes from processed foods35-80% comes from processed foods 4-27% comes from water (issue at 4-27% comes from water (issue at

500 mg level if water contains more 500 mg level if water contains more than 40 ppm (40 mg or 2 mEq/liter)than 40 ppm (40 mg or 2 mEq/liter)

Sodium Content of Sodium Content of Fresh FoodsFresh Foods

Plain pasta or rice

<10 mg

Fruit (any) <10 mg

Vegetables, unsalted

<75 mg

Milk 1 cup 125 mg

Meat, poultry, fish unsalted

<90 mg

Sodium Content of Sodium Content of Processed FoodsProcessed Foods

Potato chips 1 oz 180 mg

American cheese 1 sl 300 mg

Italian dressing 2 T 510 mg

Instant noodle soup 1170 mg

KFC chicken pot pie 2160 mg

Meat lover’s stuffed pizza 2 slices

2850 mg

Sodium NeedsSodium Needs

Body only needs 100-200 mg/dayBody only needs 100-200 mg/day Minimum requirement is 500 Minimum requirement is 500

mg/daymg/day Daily ValueDaily Value is 2400 mg/day is 2400 mg/day Typical intake is 4000-7000 Typical intake is 4000-7000

mg/daymg/day

Sodium AdaptationSodium Adaptation

Today’s salt is tomorrow’s Today’s salt is tomorrow’s urineurine

People can adjust to the People can adjust to the lower salt tastelower salt taste

““Salt Sensitive”Salt Sensitive”

10%-15% of adults are (particularly 10%-15% of adults are (particularly African Americans)African Americans)

High sodium intake leads to fluid High sodium intake leads to fluid retention and high blood pressureretention and high blood pressure

Recommend 2-3 gm sodium per dayRecommend 2-3 gm sodium per day Recommended for all individualsRecommended for all individuals High intake of sodium (>2000 mg) High intake of sodium (>2000 mg)

increases calcium lossincreases calcium loss Check your blood pressure regularlyCheck your blood pressure regularly

PotassiumPotassium

Positive ion in thePositive ion in the intracellular intracellular fluidfluid

Functions in fluid balance and nerve Functions in fluid balance and nerve impulse transmissionimpulse transmission

Associated with lowering blood Associated with lowering blood pressurepressure

90% of potassium consumed is 90% of potassium consumed is absorbedabsorbed

Food Sources and Food Sources and Need for PotassiumNeed for Potassium

Found in fruits, vegetables, milk, Found in fruits, vegetables, milk, grains, meats, dried beansgrains, meats, dried beans

Minimum requirement is 2000 Minimum requirement is 2000 mg/daymg/day

Daily ValueDaily Value is 3500 mg/day is 3500 mg/day Typical intake is 2000-3000 mg/dayTypical intake is 2000-3000 mg/day Excess potassium is excreted by the Excess potassium is excreted by the

kidneyskidneys

Potassium PyramidPotassium Pyramid

High Potassium FoodsHigh Potassium Foods

Baked potato: Baked potato: 844 mg844 mg

Milk: 377 mgMilk: 377 mg Raisins: 825 mgRaisins: 825 mg Spinach: 419 mgSpinach: 419 mg Sweet potato: Sweet potato:

397 mg397 mg Tomato: 254 mgTomato: 254 mg

Tomato Juice: 400 Tomato Juice: 400 mgmg

Beer: 128 mgBeer: 128 mg Coffee: 96 mgCoffee: 96 mg Chocolate: 174 mgChocolate: 174 mg Waffle: 146 mgWaffle: 146 mg Eggnog: 420 mgEggnog: 420 mg Vegetable soup: Vegetable soup:

337 mg337 mg

Potassium DeficiencyPotassium Deficiency

RareRare Use of diuretics Use of diuretics Alcoholic, anorexia nervosa, Alcoholic, anorexia nervosa,

bulimia nervosabulimia nervosa Loss of appetite, muscle cramps, Loss of appetite, muscle cramps,

confusion, constipation, irregular confusion, constipation, irregular heart beatheart beat

ChlorideChloride

Negative ion for the Negative ion for the extracellular fluidextracellular fluid

Components of hydrochloric acid Components of hydrochloric acid (HCl), immune response, nerve (HCl), immune response, nerve functionfunction

Excess is excreted by the Excess is excreted by the kidneys/perspirationkidneys/perspiration

ChlorideChloride

Minimum requirement is 700 Minimum requirement is 700 mg/daymg/day

Much is obtained from salt Much is obtained from salt consumption (table salt is 60% consumption (table salt is 60% chloride)chloride)

High intake may cause high blood High intake may cause high blood pressurepressure

HypertensionHypertension

Systolic blood pressure/diastolic Systolic blood pressure/diastolic blood pressureblood pressure

Optimal is less than 120 / 80 mm Optimal is less than 120 / 80 mm HgHg

HTN is a sustained systolic HTN is a sustained systolic pressure of >140mm Hg or >90 pressure of >140mm Hg or >90 mm Hg for diastolicmm Hg for diastolic

HypertensionHypertension

95% of all HTN 95% of all HTN have no clear have no clear cause (primary or cause (primary or essential HTN)essential HTN)

Secondary HTN: Secondary HTN: related to other related to other conditions, like conditions, like kidney diseasekidney disease

Why Control Blood Why Control Blood Pressure?Pressure? Silent disease (may have no Silent disease (may have no

symptoms)symptoms) Causes cardiovascular disease, Causes cardiovascular disease,

kidney disease, stroke, kidney disease, stroke, retinopathy, declining brain retinopathy, declining brain functionfunction

African Americans most at riskAfrican Americans most at risk

Causes of HTNCauses of HTN

AgingAging AtherosclerosisAtherosclerosis Obesity (increased fat mass and Obesity (increased fat mass and

circulation)circulation) Elevated insulin (insulin resistant Elevated insulin (insulin resistant

adipose cells)adipose cells) InactivityInactivity Excess alcohol (usually reversible)Excess alcohol (usually reversible)

Sodium and Blood Sodium and Blood PressurePressure Unclear if it is sodium or chloride Unclear if it is sodium or chloride

that is responsiblethat is responsible Increases blood pressure with intakeIncreases blood pressure with intake Consume no more than 2400 mg/dayConsume no more than 2400 mg/day Increased blood pressure to excrete Increased blood pressure to excrete

sodium needed for sensitive people?sodium needed for sensitive people? Fluid retention leads to increased Fluid retention leads to increased

blood volumeblood volume

Lifestyle Interventions Lifestyle Interventions in Hypertensionin Hypertension Weight loss of as little as 10-15 Weight loss of as little as 10-15

pounds may normalize blood pounds may normalize blood pressurepressure

Regular physical activityRegular physical activity Avoid excess alcoholAvoid excess alcohol

Other Minerals and Other Minerals and HTNHTN >1000 mg calcium a day lowers >1000 mg calcium a day lowers

blood pressureblood pressure 2-4 gm of potassium a day lowers 2-4 gm of potassium a day lowers

blood pressureblood pressure Magnesium may lower blood Magnesium may lower blood

pressurepressure DASH diet: low in sodium, high in DASH diet: low in sodium, high in

fruits, vegetables, whole grains, fruits, vegetables, whole grains, includes lowfat dairy productsincludes lowfat dairy products

Medication and HTNMedication and HTN

DiureticDiuretic– Reduce blood volumeReduce blood volume– Increase urine outputIncrease urine output

Slows heart rateSlows heart rate– relaxation of the blood vesselsrelaxation of the blood vessels

CalciumCalcium

99% is in bones and teeth99% is in bones and teeth Makes up 40% of all the Makes up 40% of all the

minerals present in theminerals present in the

bodybody

Absorption of CalciumAbsorption of Calcium

Amount in the body is dependent on Amount in the body is dependent on amount absorbedamount absorbed

Requires a slightly acidic environmentRequires a slightly acidic environment Presence of dietary glucose and lactosePresence of dietary glucose and lactose Increased needIncreased need Upper part of the small intestine is the Upper part of the small intestine is the

site of absorptionsite of absorption Availability of vitamin DAvailability of vitamin D

Absorption of Calcium Absorption of Calcium

Normally absorb 25% of calcium Normally absorb 25% of calcium in foodin food

Increase to ~60% during time of Increase to ~60% during time of need (pregnancy, infancy)need (pregnancy, infancy)

Estrogen increases absorptionEstrogen increases absorption Parathyroid hormoneParathyroid hormone

Factors Decreasing Factors Decreasing Calcium AbsorptionCalcium Absorption Rapid intestinal motilityRapid intestinal motility High fiber intakeHigh fiber intake Excess phosphorusExcess phosphorus Fat malabsorptionFat malabsorption

Factors Decreasing Factors Decreasing Calcium AbsorptionCalcium Absorption Vitamin D deficiencyVitamin D deficiency Polyphenols (tannins) in teaPolyphenols (tannins) in tea MenopauseMenopause AgingAging AchlorhydriaAchlorhydria

Blood Calcium is Blood Calcium is RegulatedRegulated

Blood level is maintained at Blood level is maintained at the price of bone calciumthe price of bone calcium

Blood level will be Blood level will be maintained despite maintained despite inadequate calcium intake inadequate calcium intake (by drawing from bones)(by drawing from bones)

Setting stage for future bone Setting stage for future bone fracturesfractures

Functions of CalciumFunctions of Calcium

Blood clotBlood clot Nerve impulse transmissionNerve impulse transmission Muscle contractionMuscle contraction Cell metabolismCell metabolism

–Activates various enzymesActivates various enzymes

Building Higher Bone Building Higher Bone MassMass Adequate dietAdequate diet Healthy body weightHealthy body weight Normal mensesNormal menses Weight-bearing physical activityWeight-bearing physical activity Moderate intakes of protein, Moderate intakes of protein,

phosphorus, sodium, caffeinephosphorus, sodium, caffeine Non-smokerNon-smoker Lower the use of certain medicationsLower the use of certain medications

Other Roles of CalciumOther Roles of Calcium

May lower blood pressureMay lower blood pressure May reduce colon cancerMay reduce colon cancer May reduce PMS symptomsMay reduce PMS symptoms May lower blood cholesterolMay lower blood cholesterol May reduce kidney stonesMay reduce kidney stones Reduce lead absorptionReduce lead absorption

OsteoporosisOsteoporosis

Calcium deficiencyCalcium deficiency ““A pediatric disease with A pediatric disease with

geriatric consequences”geriatric consequences” Leads to ~1.3 million fractures Leads to ~1.3 million fractures

/ year/ year Slender, inactive women who Slender, inactive women who

smoke are most at risksmoke are most at risk ““Less bones”Less bones”

OsteoporosisOsteoporosis

Bone StructureBone Structure

Bone StrengthBone Strength

Dependent on bone mass and Dependent on bone mass and bone mineral densitybone mineral density

The more there is, the stronger The more there is, the stronger the bonethe bone

Bone Growth and MassBone Growth and Mass

Rapid and continual throughout Rapid and continual throughout adolescenceadolescence

Peak bone mass: highest attainable Peak bone mass: highest attainable densitydensity– First 3 decades of lifeFirst 3 decades of life

Determined by gender, race, Determined by gender, race, familial pattern, other genetic familial pattern, other genetic factorsfactors

Bone Growth and MassBone Growth and Mass

Bone loss begin ~age 30 Bone loss begin ~age 30 Women experience increased Women experience increased

bone loss after menopausebone loss after menopause DEXA bone scanDEXA bone scan No noticeable symptomsNo noticeable symptoms

Types of OsteoporosisTypes of Osteoporosis

Type I (postmenopausal)Type I (postmenopausal)–Occurs after menopauseOccurs after menopause

Type II (senile)Type II (senile)–Occurs with age in men Occurs with age in men and womenand women

Risk Factors for Risk Factors for OsteoporosisOsteoporosis AgeAge GenderGender RaceRace InactivityInactivity Low body weightLow body weight Diet low in calciumDiet low in calcium Family historyFamily history Early menopause; Early menopause;

absence of mensesabsence of menses

Low testosterone Low testosterone levels in menlevels in men

Anorexia, bulimiaAnorexia, bulimia Some medicationsSome medications Cigarette smokingCigarette smoking Excessive alcohol Excessive alcohol

consumptionconsumption Caffeine, sodiumCaffeine, sodium High protein dietHigh protein diet

Diet and Lifestyle Diet and Lifestyle FactorsFactors Adequate diet (Ca, vitamin D)Adequate diet (Ca, vitamin D) Healthy body weightHealthy body weight Correct hormonal irregularitiesCorrect hormonal irregularities Normal mensesNormal menses Weight-bearing and resistance Weight-bearing and resistance

physical activityphysical activity Don’t smokeDon’t smoke Limit excessive intake of protein, Limit excessive intake of protein,

phosphorus, sodium, caffeine, wheat phosphorus, sodium, caffeine, wheat bran, and alcoholbran, and alcohol

PreventionPrevention

Regular menstruationRegular menstruation Weight-bearing exercise (but does Weight-bearing exercise (but does

not compensate for lack of not compensate for lack of menstruation)menstruation)

Smoking lowers estrogen Smoking lowers estrogen concentration in the bloodconcentration in the blood

Alcohol is toxic to bone cellsAlcohol is toxic to bone cells Estrogen replacement therapiesEstrogen replacement therapies Accurate measurement of heightAccurate measurement of height

MedicationMedication

EstrogenEstrogen– Slows bone turnoverSlows bone turnover

Fosamax (bisphosphonates)Fosamax (bisphosphonates)– Slows bone breakdownSlows bone breakdown

Evista (selective estrogen receptor Evista (selective estrogen receptor modulators)modulators)– Slows bone turnoverSlows bone turnover

CalcitoninCalcitonin– Inhibits bone breakdownInhibits bone breakdown

Side effectsSide effects

Diet and Lifestyle Diet and Lifestyle FactorsFactors Adequate diet (Ca, vitamin D)Adequate diet (Ca, vitamin D) Healthy body weightHealthy body weight Normal mensesNormal menses Weight-bearing physical activityWeight-bearing physical activity Don’t smokeDon’t smoke Limit excessive intake of protein, Limit excessive intake of protein,

phosphorus, sodium, caffeine, phosphorus, sodium, caffeine, wheat bran, and alcoholwheat bran, and alcohol

Food Sources of Food Sources of CalciumCalcium

Dairy productsDairy products Kale, collard, mustard greensKale, collard, mustard greens Calcium fortified foodsCalcium fortified foods Tofu (Tofu (ifif made with calcium made with calcium

carbonate)carbonate) Canned fishCanned fish

Food Sources of Food Sources of CalciumCalcium Dairy foods Dairy foods

provide 75% of provide 75% of the calcium in the calcium in the American the American dietdiet

Calcium SupplementCalcium Supplement

Recommended for people who cannot Recommended for people who cannot incorporate Ca+ into their dietsincorporate Ca+ into their diets

Not recommended with high iron mealNot recommended with high iron meal Calcium carbonate (40% calcium)Calcium carbonate (40% calcium)

– For those with ample stomach acidFor those with ample stomach acid– Found in antacidsFound in antacids

Calcium citrate (21% calcium)Calcium citrate (21% calcium)– Enhanced absorption due to acidity contentEnhanced absorption due to acidity content– Recommended for elderlyRecommended for elderly

Risk With Calcium Risk With Calcium SupplementsSupplements Lead contamination Lead contamination No FDA regulationNo FDA regulation Oyster shellOyster shell BonemealBonemeal Look for Look for United States United States

PharmacopoeiaPharmacopoeia seal of approval seal of approval

Calcium NeedsCalcium Needs

Daily ValueDaily Value is 1000 mg/day is 1000 mg/day Adequate Intake is 1000 -1200 Adequate Intake is 1000 -1200

mg/day for adultsmg/day for adults Adequate Intake is 1300 mg/day Adequate Intake is 1300 mg/day

for adolescents (9-18 yrs. old)for adolescents (9-18 yrs. old) Average intake range from 600-Average intake range from 600-

800 mg/day for women and 800-800 mg/day for women and 800-1000 mg/day for men1000 mg/day for men

PhosphorusPhosphorus Body absorption is based on body’s Body absorption is based on body’s

need (70%-90%)need (70%-90%) No disease associated with No disease associated with

deficiencydeficiency May contribute to bone loss in May contribute to bone loss in

elderly womenelderly women Vitamin D enhances absorption Vitamin D enhances absorption Component of ATP, cell membrane, Component of ATP, cell membrane,

and boneand bone

Food Sources of Food Sources of PhosphorusPhosphorus

Widely available in foodsWidely available in foods Dairy, bakery products, sodas, and meatsDairy, bakery products, sodas, and meats Some from food additivesSome from food additives Most difficult to limit intake Most difficult to limit intake RDA is 700 mg/day for adultsRDA is 700 mg/day for adults Daily Value is 1000 mgDaily Value is 1000 mg Current intake exceeds RDACurrent intake exceeds RDA Deficiency highly unlikelyDeficiency highly unlikely

Toxicity of PhosphorusToxicity of Phosphorus

Problem for individuals with Problem for individuals with inefficient kidney functioninefficient kidney function

Phosphate ions bind calciumPhosphate ions bind calcium Chronic imbalance may lead to Chronic imbalance may lead to

bone loss (Ca+/phos ratio)bone loss (Ca+/phos ratio) Upper Level is 3-4 g/dayUpper Level is 3-4 g/day

MagnesiumMagnesium

Primarily in green leafy plantsPrimarily in green leafy plants Absorption based on body’s needs Absorption based on body’s needs

(40%-60%)(40%-60%) Absorption enhanced by vitamin DAbsorption enhanced by vitamin D Kidneys regulate blood concentration Kidneys regulate blood concentration

of magnesiumof magnesium Alcohol increases loss in the urineAlcohol increases loss in the urine Much stored in the bones Much stored in the bones

Functions of Functions of MagnesiumMagnesium Aids in many enzyme reactions Aids in many enzyme reactions Potassium and calcium metabolismPotassium and calcium metabolism Proper nerve and cardiac functionsProper nerve and cardiac functions Insulin release from the pancreasInsulin release from the pancreas May dilate arteriesMay dilate arteries May prevent heart rhythm May prevent heart rhythm

abnormalitiesabnormalities

Deficiency of Deficiency of MagnesiumMagnesium Develops slowlyDevelops slowly Irregular heartbeatIrregular heartbeat Decreased blood pressureDecreased blood pressure Weakness, muscle spasms, Weakness, muscle spasms,

disorientation, nausea, vomiting, disorientation, nausea, vomiting, seizuresseizures

Food Sources of Food Sources of MagnesiumMagnesium Plant products: Whole grains, Plant products: Whole grains,

vegetables, nuts, seedsvegetables, nuts, seeds Hard tap waterHard tap water Dairy, chocolate, meatDairy, chocolate, meat RDA for women is 320 mg/day RDA for women is 320 mg/day RDA for men is 400 mg/dayRDA for men is 400 mg/day Daily Value is 400 mgDaily Value is 400 mg Average intake is lower than the RDAAverage intake is lower than the RDA

Magnesium PyramidMagnesium Pyramid

Too Much or Too Little Too Much or Too Little MagnesiumMagnesium

Magnesium loss Magnesium loss – Heavy perspirationHeavy perspiration– Long-standing diarrhea or vomitingLong-standing diarrhea or vomiting– AlcoholismAlcoholism– Disorientation, weakness, muscle pain, poor Disorientation, weakness, muscle pain, poor

heart functionheart function Toxicity Toxicity

– Caused by medicationCaused by medication

SulfurSulfur

Found in amino acids and Found in amino acids and vitaminsvitamins

Acid-base balanceAcid-base balance Drug detoxifying pathwaysDrug detoxifying pathways Part of a natural diet, primarily Part of a natural diet, primarily

from proteinfrom protein Used to preserve foodsUsed to preserve foods