Transcript HS 4572 * Chapter 8 Water, Minerals and Osteoporosis

HS 4572 – CHAPTER 8
WATER, MINERALS AND
OSTEOPOROSIS
Valerie Schulz, MMSc, RD, LD/N, CDE
INTRODUCTION – WATER AND MINERALS
“Ashes to ashes, dust to dust” – when we die, what is
left behind becomes nothing but a pile of ashes.
 Carbon atoms in carbohydrates, fats, proteins, and vitamins combine with
oxygen to produce carbon dioxide, which goes into the air.
 Hydrogens and oxygens form water, and along with body water, this
evaporates.
 Ashes are about 5 pounds of
minerals.
WATER
 Water is the most
indispensable nutrient
 Makes up about 60 percent of
an adult’s weight
Water is the most indispensable nutrient
WHY IS WATER THE MOST INDISPENSABLE NUTRIENT?
Water
 Carries nutrients throughout the body
 Serves as the solvent for chemicals in the body
 Cleanses the tissues and blood of wastes
 Participates in chemical reactions
 Acts as a lubricant around joints
 Serves as a shock absorber inside eyes, spinal cord, joints, and
amniotic sac
 Aids in maintaining the body’s temperature
QUENCHING THIRST AND BALANCING LOSSES
DEHYDRATION
On the next slide, notice the percentages:
 Below 5% is mild dehydration, above 5% is severe
 Consider a 100# person – 5% would be a 5# loss; that’s a lot of fluid!
 An assessment question might ask you to consider: “ a 100# person has
lost x pounds of water weight...”; I won’t land right on 5% as that would
be confusing.
 Notice that severe dehydration includes confusion. A very
common admitting diagnosis for older folks is UTI (urinary tract
infection) where they have become septic (infected systemically),
are feverish, not drinking, have lost extra fluid and are now
confused. As soon as the IV fluids and antibiotics begin to work,
the person usually regains their wits.
QUENCHING THIRST AND BALANCING LOSSES
ARE SOME KINDS OF WATER BETTER FOR MY HEALTH THAN
OTHERS?
Hard water – high concentrations of calcium and
magnesium
Soft water – high sodium, and it dissolves cadmium
and lead from pipes
Which one do you think is better?
Why? What do those minerals lead to?
CONSUMER CORNER: BOTTLED WATER
 Cost: 250 to 10, 000 times the cost of tap water
 Regulation and safety:
 Only bottled water sold ACROSS state lines is regulated by the
FDA (yearly tests for purity and adherence to sanitation
standards)
 Bottled water sold within same state it was bottled in is not
regulated by FDA
 Standards for bottled water less rigorous than tap water (for
example, bottled water not tested for asbestos like tap water is)
 In response to research findings, FDA’s regulation of bottled
water has expanded to include yearly tests for fecal bacteria,
arsenic, uranium, and disinfectants
WATER SOURCES
All drinking water
originates from surface
water or ground water that
is vulnerable to
contamination from
human activities.

WATER TERMS
 Read table 8-3, pg 286 for water terms.The heading is Consumer Corner,
Bottled water, right after Body fluids and Minerals.
 Particularly notice:
 Seltzer, club soda and tonic water are legally soft drinks and are not regulated as
water
 Mineral waters: usually contain some natural sodium. San Pellegrino has
57mg/liter and Perrier has 9mg/liter
 Vitamin water: does not provide the phytochemicals from eating whole fruits and
vegetables, and may contribute to vitamin overload in people taking supplements
or using vitamin enriched foods.
SODIUM AND BLOOD PRESSURE
 The relationship between salt intakes and blood pressure is
direct – the more salt a person eats, the higher the blood
pressure goes.
 Stronger effect among people:
 with diabetes, hypertension, or kidney disease
 People of African descent
 History of parents with hypertension
 Anyone over 50 years of age.
 Higher blood pressure is related to heart disease and strokes.
 DASH (Dietary Approaches to Stop HTN) diet reduces blood pressure:
 8-10 servings Fruit/Vegetables per day
 2-3 calcium servings per day
 4-5 servings (per week) nuts/seeds
POTASSIUM AND BLOOD PRESSURE
Low potassium intake on its own raises blood
pressure, whereas high potassium intake appears to both
help prevent and correct hypertension.
POTASSIUM
MAGNESIUM
 A major mineral and yet there is only about 1 ounce in a 130-pound person,
over half in the bones.
 Most of the body’s magnesium is in the bones and can be drawn out for all the
cells to use in building protein and using the energy nutrients.
 Calcium promotes contraction, magnesium helps muscles relax afterward.
 Deficiency seen mostly in people using diuretics; deficiency can cause
hallucinations. Frequently needs to be replaced in hospitalized pts who have
been diuresed (xs fluid drawn off to lower blood pressure or restore ability to
breathe in fluid overloaded pts)
MAGNESIUM
WHAT HAPPENS TO A PERSON WHO LACKS IRON?
 Iron-deficiency anemia is a problem worldwide
POSSIBLE OUTCOME TO A PERSON WHO LACKS IRON…
 Pica – a curious appetite for non-food substances such as
ice, clay, paste, soil, or corn starch.
 Most often seen in poverty-stricken women and children, mentally ill, and
people with kidney failure.
 Postings from http://www.peoplespharmacy.com/2007/10/27/cause-forcorns/
 “I begin eating cornstarch about 5 years ago. I consume about 5 boxes a week. I now
use a straw. I think it has contributed to weight gain, and I am positive it causes
constipation. Would love to kick the habit.”
 “I gained weight from eating a box of cornstarch a day. Sometime I would eat 2 boxes
a day. I went to my primary care doctor and he tested my blood and discovered that
my iron, b12 and potassium were extremely low. He prescribed me some iron pills,
gave me a b12 shot and I now have to have a glass of orange juice and eat a banana
every day for my potassium. I have been doing this for a month and I still crave for
cornstarch. It is hard, but I don't want to keep gaining weight.”
(1 box of corn starch ~= 1600 kcal)
CAUSES OF IRON DEFICIENCY AND ANEMIA
 Worldwide, iron deficiency is the most common nutrient
deficiency, affecting more than 1.2 billion people
 Usually caused by malnutrition
 Either from lack of food or from high consumption of the wrong foods
 Toxicity:
 Iron supplements are a leading cause of fatal accidental poisonings among
U.S. children under six years old. Iron pills MUST be kept away from young
children.
CALCIUM
 For the last part of this mineral slide show, we’re going to
focus on calcium.
 Notice on food picture chart, foods source of calcium if:
 Small or canned fish only if the bones are eaten.
 Tofu only if it has been “set or firmed up” with calcium salts.
 Food Feature chart:
 Bok Choy, cabbage, kale, brussels sprouts, mustard and turnip greens
don’t have as much calcium as dairy products, but the calcium they do
have is absorbed at a higher rate than dairy.
 Spinach, rhubarb and Swiss chard have very poorly absorbed calcium
due to their oxalate content.
CALCIUM IN BODY FLUIDS
 Only about 1 percent of the body’s calcium is in the fluids
that bathe and fill the cells, but this tiny amount plays these
major roles:
 Regulates the transport of ions
 Helps maintain blood pressure
 Plays a role in blood clotting
 Essential for muscle contraction
 Allows for secretion of hormones, digestive enzymes, and
neurotransmitters
 Activates cellular enzymes
HOW MUCH CALCIUM DO I NEED?
FOOD
FEATURE:
MEETING THE NEED
FOR CALCIUM
STRONG BONES
Protein matrix: mostly collagen
Hardened by minerals: mostly calcium, phosphorus,
also magnesium, sodium, fluoride, other minerals
Require:
 Protein and vitamin C to maintain collagen
 Calcium and other minerals to ensure solidity
 Vitamin D to maintain calcium and phosphorus levels
© 2012 JOHN WILEY & SONS, INC. ALL
RIGHTS RESERVED.
BONES
© 2012 JOHN WILEY & SONS, INC. ALL
RIGHTS RESERVED.
TOWARD PREVENTION – UNDERSTANDING
THE CAUSES OF OSTEOPOROSIS
 Causes:
 Gender
 Advanced age
 Genetics
 Environment
 Poor calcium and vitamin D nutrition
 Estrogen deficiency in women
 Lack of physical activity
 Being underweight
 Use of tobacco and abuse of alcohol
 Possibly, excess protein, sodium, caffeine, and soft drinks; and inadequate
protein, vitamin K, and other nutrients
BONE DENSITY AND THE GENES
A strong genetic component contributes to
osteoporosis, reduced bone mass, and the increased risk
of fragility of bones.
Over 170 genes are under investigation and each may
interact with others and with environmental factors,
such as vitamin D and calcium nutrition.
BONE DENSITY AND THE GENES
 Risks of osteoporosis differ by race and ethnicity:
 African American women may lose bone at just half the rate of white
women.
 The bone density of Mexican Americans falls somewhere in between.
 Asians from China and Japan, Hispanics from Central and South America,
and Inuits from St. Lawrence Island all have lower bone densities than do
northern Europeans.
NEXT 2 CHARTS
 First chart:
 Women’s bone mass remains lower than that of men
 Peaks between age 30-35
 Women’s bone mass falls off more sharply between age 50-60, right after menopause
 Second chart:
 Woman A did a better job getting to peak bone mass, ~ at age 35
 That gives her a longer space before she enters the danger zone; both women will lose
mass at menopause, but woman A is still above the danger zone at age 70
 Woman B has already entered osteoporosis at age 60 because her peak mass was
lower to start
 Moral to this story: consider the risk and protective factors shown on the previous
slide, and take in enough calcium. (Upcoming calcium log will show your intake)
 Men are also susceptible to osteoporosis if a heavy drinker/smoker/poor eater
BONES
© 2012 JOHN WILEY & SONS, INC. ALL
RIGHTS RESERVED.
CALCIUM AND VITAMIN D
ANIMAL /DAIRY VS VEGETABLE
 We need protein for strong bones. There is controversy in the literature
whether a higher animal protein diet causes more problems with fractures
than when protein in the diet comes from vegetable sources.
 http://iontheworld.wordpress.com/2011/02/05/the-truth-about-dairy-what-
vegans-dont-want-you-to-read/
 http://iontheworld.wordpress.com/2011/02/05/the-truth-about-bone-
density-and-animal-protein-fighting-veganvegetarian-disinformation/
 The following chart has a big question mark because of this controversy.
 I am asking you to just skim the information in each of these sites, so that
you get the gist of the benefit to risk ratio of animal vs vegetable protein on
bone health. BMD stands for bone mineral density.
ANIMAL VS. VEGETABLE PROTEIN SOURCES
?
CALCIUM SUPPLEMENTS
 Please read pg 322 – 323, under the heading Calcium Supplements, in the
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Controversy 8 section
Note that the UL for calcium is 2500 mg/d.; more than this causes other
problems (see Table C8-4: Calcium Supplement Risks)
Most pills are 500 – 600 mg each, and should not be taken more than one at
a time, and well-spaced during the day to allow best absorption
Supplements can be checked for dissolvability by dropping into 6oz of
vinegar; should dissolve within 30 minutes
1 cup of calcium-fortified OJ delivers ~same amount of calcium as 1 cup of
milk, but without the lactose. Absorbability is similar IF the form in the OJ is
calcium citrate malate
Supplements of calcium carbonate, calcium citrate or calcium phosphate are
absorbed equally well (not better) than the calcium in dairy products
Other sources (like bone meal or oyster shell) are NOT well absorbed
Food is always the better calcium choice; supplements deliver the isolated
minerals, while foods deliver the minerals AND the protein AND the
phytochemicals AND the vitamins, etc, etc