Please enable JavaScript.

Coggle requires JavaScript to display documents.

BONE HEALTH (FACTORS AFFECTING BONE HEALTH (Nutrients (Minerals (Calcium.,…

- - - - Deficiency
        
        Risk of deficiency is low since phosphorus is found in many foods.
        
        May cause neuromuscular, hematological and renal malfunction.
      - Toxicity
        
        No true toxic effect of high intake.
        
        More to do with low calcium intake in combination with high phosphorus intake.
        
        Can cause diarrhea and hardening of organs and soft tissue.
        
        Can affect ability to use other minerals (eg. iron, calcium, magnesium, zinc).
      - Roles
        
        Bone health and maintenance
        
        Form hydroxyapatite crystals which provide strength and rigidity.
        
        Fluid balance
        
        Major intracellular anionic electrolyte.
        
        Blood and tissue phosphorus
        
        Phosphate salts are found in cells and the bloodstream and act as a buffer.
      - Sources
        
        Protein rich foods
        
        Legumes, cereal, bran, nuts.
        
        All animal tissues
        
        Milk, eggs, fish, meat, poultry.
        
        Soft drinks.
      - Vitamin D and Phosphorus Interaction: Vitamin D stimulates phosphorus absorption and the transport of phosphorus into the extracellular layer.
    - - Deficiency
        
        Symptoms
        
        Irregular heart beat, loss of appetite, weakness, disorientation, hypertension.
        
        Tetany in extreme cases, muscle spasms, hypercalcemia or hypokalemia.
        
        Slow development due to magnesium stores in bone.
        
        Due to heavy perspiration, prolonged vomiting and/or diarrhea, prolonged use of diuretics, kidney disease and alcoholism.
        
        Rare in healthy adults.
      - Toxicity
        
        No known risks or side effects of toxicity.
        
        Kidneys can easily eliminate excess magnesium in urine which makes toxicity rare.
        
        High pharmaceutical doses can cause diarrhea, nausea and abdominal cramps.
        
        Risk increases with impaired kidneys functioning or kidney failure.
      - Roles
        
        Muscle contraction and blood clotting
        
        Inhibits blood clotting, acts as a ion antagonist to calcium.
        
        Required for neurotransmitter activity regulated by magnesium dependent adenylate cyclase enzyme system.
        
        Inhibits muscle contraction by blocking calcium gated ion channels.
        
        Acts as a catalyst
        
        For ATP synthesis, helps add the last phosphate to make ATP.
        
        Protein, fat, and nucleic acid synthesis.
        
        Cell membrane transport systems.
        
        Bone and teeth
        
        Used in mineral crystal structure of bone to replace calcium in hydroxyapatite.
        
        Bone acts as a magnesium reservoir.
        
        Helps hold calcium in tooth enamel, reduces dental caries.
      - Sources
        
        Animal foods
        
        Fish
        
        Halibut, tuna.
        
        Plant foods
        
        Leafy green vegetables
        
        Spinach, avocado.
        
        Whole grains, nuts, seeds, tofu, legumes, peanuts
        
        Cashews, almonds, oatmeal, pumpkin seeds.
    - - Roles
        
        Bone formation and maintenance
        
        Form hydroxyapatite crystals which provide strength and rigidity.
        
        Nerve transmission and muscle contraction
        
        Sodium-potassium ATPase pump in nerve cell membrane allows the generation of an action potential.
        
        Calcium flowing into muscle cell causes contraction and calcium flowing out of muscle cell causes relaxation.
        
        Blood clotting
        
        Calcium in body fluid is essential for the formation of fibrin and a clot in the blood clotting process.
      - Deficiency
        
        People at risk
        
        People between the ages of 30 to 40, when bone loss occurs and decreased stomach acidity makes calcium absorption less efficient.
        
        Affects 1 in 4 women and 1 in 8 men over the age of 50.
        
        Osteoporosis
        
        Degenerative bone disease characterized by the decrease of bone density, making bones fragile and more susceptible to fracture.
        
        Factors affecting risk of osteoporosis
        
        Age, Gender and Hormones.
        
        Women are more likely to have osteoporosis due to the rapid decrease of estrogen during menopause.
        
        Osteoblast activity decreases with age and osteoclast activity remains the same therefore there is more breakdown of bone than synthesis.
        
        Men will be less affected because the decrease of testosterone levels is more gradual.
        
        Genetics and race.
        
        Bone growth, peak bone mass and the rate of bone loss can be affected by heredity.
        
        Physical Activity.
        
        Weight bearing exercises will increase impact on bone and therefore increase muscle and bone strength.
        
        Exercise for force muscles to pull on bone which will increase the strength of trabecular bone.
        
        Body Weight.
        
        Women with low body weight are at a higher risk of osteoporosis.
        
        Smoking and Alcohol.
        
        Smokers tend to have lower body weight and women smokers will reach menopause earlier.
        
        Alcoholics will have slower bone formation therefore a lower bone density.
        
        Calcium Nutrition and Associated Nutrients
        
        Low levels of calcium and vitamin D intake will reduce overall absorption of calcium.
        
        High caffeine, protein and sodium consumption will pull calcium into the urine and increase calcium excretion.
        
        Prevention
        
        Decrease sodium, alcohol and caffeine intake.
        
        Increasing vitamin D and calcium intake in diet by eating foods such as fruits and vegetables.
      - Toxicity
        
        Constipation.
        
        Interferes with the bodies ability to absorb other nutrients.
        
        Increased risk of developing kidney stones and kidney dysfunction.
        
        Hyperparathyroidism, the overabundant production and secretion of parathyroid hormone caused by retention of calcium by kidneys and the release of calcium from bones.
        
        Hypercalcemia, high blood and urinary calcium levels, can cause damage to organs and calcium deposits into soft tissue.
      - Sources
        
        Milk and products (eg. milk, yogurt, cheese).
        
        Canned fish with bones.
        
        Leafy greens (eg. broccoli, bok choy, chard, kale).
        
        Legumes (eg. beans, lentils, tofu fortified with calcium salt).
        
        Supplements
        
        Avoid supplements with unrefined oyster shell, dolomite, coral or bone meal due to possible heavy metal levels.
        
        Only recommended if you are aware of the type, the dose, the absorption and the mineral-mineral interaction timing.
        
        Dose should be divided throughout the day, not more than 500 mg Ca/dose.
        
        Decreases absorption of other minerals (eg. iron and magnesium).
        
        Calcium carbonate should be taken with food, calcium citrate can be taken without food due to greater solubility.
        
        30% absorption for all supplements.
        
        Various forms: tablets, chewable, liquid, effervescent.
        
        Should be taken at time of low calcium and/or iron intake, for example at night.
        
        Citrus fruits (eg. orange juice).
      - Calcium and Phosphorus Interaction: A high calcium intake will inhibit phosphorus uptake from the gut whilst a high phosphorus intake can decrease calcium absorption due to the formation of calcium-phosphorus crystals. The kidneys regulate calcium and phosphorus homeostasis in the blood due to excess phosphorus excretion in urine.
      - Calcium, Phosphorus and Magnesium Interaction: These major minerals make up the major part of the bone mineral. Magnesium is important in bone and mineral homeostasis and aids in the metabolic processes of calcium and phosphorus, which act in biochemical reactions at the cellular level.
  - - - Sources
        
        Brewed tea, water
        
        Seafood, seaweed, fish and shellfish (crab, shrimp)
        
        Non-food items
        
        Gum
        
        Toothpaste, mouthwash
      - Roles
        
        Maintains health of bones and teeth
        
        Helps make teeth resistant to dental caries.
        
        Replaces hydroxyl group in hydroxyapatite crystal creating a stronger crystal, fluorapatite.
        
        Fluorapatite is more resistance to decay from acid erosion.
        
        Best taken during time of teeth and bone development
        
        Deciduous teeth form during 20th week of pregnancy.
        
        Age-permanent teeth form at ages 3-4.
        
        Wisdom teeth form at ages 8-10.
      - Deficiency
        
        Low fluoride in water supply can increase risk of dental caries
        
        Dental problems can decrease the ability to chew properly and consume a variety of food, which can decrease nutrient intake
        
        Causes tooth decay and low absorption of calcium and phosphorus in tooth enamel which increases bacteria activity and uses sugar and carbohydrates to produce an acid that wears away enamel
      - Toxicity
        
        Fluorosis
        
        Dental fluorosis
        
        Formation of white specks, mottling or brown streaks on teeth
        
        High fluoride intake during teeth development can cause mild dental fluorosis (white streaks and specks on enamel)
        
        Skeletal fluorosis
        
        High fluoride intake can cause abnormal hardening of bones which makes the skeleton very brittle
        
        Increases risk of osteoporosis and joint pain
      - Calcium, Phosphorus and Fluoride Interaction: These minerals all play a role in tooth teeth strengthening and preventing tooth decay. Calcium and phosphorus aid in the formation and maintenance of the hard structure, fluoride helps repair enamel by replenishing lost calcium and phosphorus. Fluoride absorbs calcium and phosphorus into the tooth enamel.
  - - - Deficiency
        
        Children
        
        Rickets
        
        Can lead to deformed skeletal and dental structures.
        
        Characterized by bowed legs and malformed ribs.
        
        Most likely due to low vitamin D in breastmilk and little sun exposure.
        
        Adults
        
        Osteomalacia
        
        Characterized by soft, flexible and brittle bones.
        
        Due to poor bone mineralization.
        
        Symptoms
        
        Lower back and leg pain.
        
        Causes
        
        Kidney, liver or intestinal diseases which decrease vitamin D absorption.
        
        Low vitamin D intake and little sun exposure.
        
        Treatment
        
        Increased dietary intake or careful exposure to the sun.
      - Toxicity
        
        Causes
        
        Solar exposure
        
        Body down regulates production of vitamin D when circulating levels are adequate, not toxic.
        
        Food intake
        
        At normal intake levels is it safe and non-toxic.
        
        Supplement intake
        
        Most common reason for toxicity.
        
        Effects
        
        Hypercalcemia
        
        High blood calcium levels, deposits into soft tissue and can cause damage to organs.
        
        People affected
        
        Children due to parents unnecessarily supplementing them with vitamin D.
      - Roles
        
        Calcium and phosphorus absorption
        
        Active vitamin D in intestinal cells enhances phosphorus and calcium absorption.
        
        Calcitriol, which acts at 3 sites (intestine, bone and kidneys), regulate absorption or retention of calcium in the body.
        
        Immune function
        
        Calcitriol is associated with maturation of immune cells.
      - Source
        
        Supplements
        
        Various forms: tablets, soft gels, liquid.
        
        Available as vitamin D2 (animal-based) or vitamin D3 (plant-based, more biologically effective).
        
        400 IU recommended daily for adult over the age of 50.
        
        Absorb 50-80% of ingested amount.
        
        Must be cautious taking regular high doses, can calcify and damage soft tissue.
        
        Exogenous
        
        The inactive form of vitamin D can be activated to calcitriol by the liver and kidneys.
        
        Not an essential nutrient.
        
        Vitamin D acts as a hormone when skin is exposed to sun.
        
        5-10 minutes of exposing face and hands about 2-3 times per week during the summer.
        
        During winter, there is not enough sunlight so vitamin D must be in diet.
        
        Diseases affecting the kidneys or liver can decrease vitamin D synthesis.
        
        Endogenous
        
        Fortified foods (eg. milk, margarine, orange juice, yogurt).
        
        Animal foods (eg. veal, beef, egg yolks, liver, fish).
      - Calcium and Vitamin D Interaction: The active form of vitamin D, calcitriol, helps calcium absorption from the intestine and breakdown and reabsorption of calcium in kidneys
    - - Deficiency
        
        Infants
        
        Low levels at birth due to inefficient transfer from placenta to baby.
        
        Low levels in breast milk.
        
        Low levels of gut bacteria to synthesize vitamin K for the first few weeks.
        
        Adults
        
        Individuals who suffer from fat malabsorption disorders such as celiac disease, cystic fibrosis and intestinal disorders are more at risk.
        
        Excess vitamin E intake can reduce vitamin K's blood clotting abilities.
        
        Deficiency is rare but most likely due to antibiotic use.
        
        Symptoms include excessive bleeding, easy bruising and dark stool.
      - Roles
        
        Synthesis of blood clotting proteins
        
        Important for infants who are born with a sterile gut with no bacteria synthesis.
        
        4 out of 13 protein in the fibrin clot require vitamin K for synthesis.
        
        Needed to produce fibrin, a blood clotting protein.
        
        Synthesis of bone
        
        Needed for calcium mineralization.
        
        Needed for osteoblasts to produce osteocalcin, a calcium binding protein that deposits the mineral into the collagen protein matrix.
        
        Needed to activate carboxylase enzyme.
        
        An adequate intake will reduce the rate of bone turnover and protect against bone fracture.
      - Toxicity
        
        Toxicity is rare.
        
        Symptoms include jaundice, red blood cell hemolysis and brain damage.
        
        Excessive vitamin K can reduce effects of anti-coagulant drugs, and other antibiotics such as cholesterol-lowering drugs and weight-loss drugs.
      - Sources
        
        Animal sources
        
        Liver, eggs, milk.
        
        Plant sources
        
        Green leafy vegetables such as kale, spinach, swiss chard.
        
        Peas, broccoli green beans.
        
        Some fruits such as bananas and kiwis.
        
        Vegetable oils such as canola oil and soybean oil.
        
        Non-food source
        
        Bacteria synthesis in the large intestine.
        
        Food preparation
        
        Very resistant to losses in cooking, not destroyed by high temperatures or light exposure.
      - Calcium and Vitamin K Interaction: Vitamin K is important for the production of osteocalcin which promotes calcium mineralization in bone. The ability for osteocalcin to bind to calcium ions is dependent of vitamin K.
- - - - More bone is made than broken down due to osteoblasts being more active than osteoclasts.
    - - Bones take on a specific shape.
    - - Bone is being broken down and rebuilt.
- - - - Important for structural support to keep body upright and protect major organs.
    - - Hydroxyapatite
        
        Deposited onto bone protein matrix.
    - - Calcium and phosphorus
        
        Needed to make hydroxyapatite.
  - - - Important for actions of impact on bone, shock absorption.
  - - - Composes 20% of skeletal weight.
      - Porous, network-like structure.
      - Found on ends of long bones, flat bones, and irregularly shaped bones such as vertebrae, pelvis and ribs.
      - Sensitive to hormones that regulate levels in blood calcium.
    - - Composes 80% of skeletal weight.
      - Found in long bones in limbs such as the humerus, femur, etc.
      - Very dense structure.
- - - - A, D and K.
    - - Calcium.
      - Magnesium.
      - Phosphorus.
      - Fluoride.
    - - Maintenance and development of the skeletal system.
- - - - Uses sound waves to measure bone density.
      - Most commonly used on heel.
      - Pros: non-invasive, painless, quick.
      - Cons: can only be used as a screening tool, not a diagnostic tool.
    - - Very low X-ray energy for complete body scans or or at different sites.
      - Pros: non-invasive, painless, quick.
      - Can be compared with a 30-year old person of the same race and gender to obtain a T-score.
    - - X-ray used to measure bone density in heel, wrist or finger.
      - Pros: non-invasive, painless, quick.
      - Cons: can only be used as a screening tool, not a diagnostic tool.
  - - - Low bone mass.
      - Increased risk of fracture.
      - T-score from -1 to -2.5.
      - A precursor to osteoporosis.
    - - Increased risk of fracture.
      - T-score lower than -2.5.
      - Occurs when too much bone is broken down and/or too little bone made.
      - More frequent in older women.
- - - - Important for vitamin D synthesis and activation
        
        Sources of vitamin D can be found in the diet or from the sun to the skin.
      - Active form of Vitamin D
        
        The pro-active form becomes active when it is hydroxylated in the liver and kidneys.
      - Acts on 3 sites to raise blood calcium levels
        
        Intestines
        
        Increases calcium absorption.
        
        Bone
        
        Increases osteoclast activity to break down bone and release calcium into blood.
        
        Kidneys
        
        Decreases calcium excretion in urine.
    - - Secreted by the parathyroid gland.
      - Secreted in response to falling blood calcium.
      - Stimulates final step of vitamin D activation.
      - With vitamin D, it stimulates the reabsorption of calcium in kidneys and increases the activation of osteoclasts to break down bone and release calcium into blood.
    - - Secreted in response to rising blood calcium.
      - Secreted by thyroid gland.
      - Inhibits vitamin D activation.
      - Decreases calcium reabsorption from kidneys and absorption in intestine.
      - Decreases osteoclast activity, decreases bone breakdown.
      - Important in infants and children
        
        Limits rising blood calcium levels due to large consumption of milk in small bodies.
        
        Less likely in adults since bodies are bigger and they are not as efficient at absorbing calcium.