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 57 mg/liter and Perrier has 9 mg/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/causefor-corns/ “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, b 12 and potassium were extremely low. He prescribed me some iron pills, gave me a b 12 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 Controversy 8 section Note that the UL for calcium is 2500 mg/d. ; more than this causes other problems (see Table C 8 -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 6 oz 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