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BONE HEALTH, resulting in, indirectly affects, used as, needed for, blocks…

- - - - Vitamin D
      - Vitamin K
      - Calcium
      - Phosphorus
      - Magnesium
      - Fluoride
- - - - Bone Formation
      - Bone maintenance
      - Nerve transmission
      - Blood clotting
    - - Increases/Enhanced
        
        Lactose
        
        Forms absorbable complex
        
        Younger people absorb better than the elderly
        
        Estrogen
        
        enhances synthesis of Vit. D
        
        Increased need = Increased % absorbed
        
        Periods of growth
        
        pregnancy
      - Occurs in duodenum
        
        slightly acidic
        
        Increased solubility
        
        Transcellular absorption
        
        Depends on
        
        active Vitamin D in intestinal cells
      - Decreases
        
        Food Constituents
        
        High fibre diets
        
        Phytic acid in whole grains/legumes
        
        oxalic acid in vegetables
        
        Very high fat intake
        
        Steatorrhea
        
        Vitamin D deficiency
        
        Polyphenols
        
        Supplement Use
        
        Magnesium & Phosphorus
        
        Iron & Zinc
        
        % absorbed proportional to intake
        
        Menopause
        
        Old age
    - - Deficiency
        
        causes
        
        Osteoporosis
        
        behave as
        
        increase bone fragility
        
        increase risk of fracture ( usually in hip, wrist or spine--more trabecular bone)
        
        decrease bone density
        
        a naturally occurring degenerative bone disease
        
        features
        
        silent disease
        
        a pediatric disease waiting until old age to manifest itself
        
        multifactorial etiology
        
        greatest risk population
        
        the elders especially in women
        
        maximizing potential for building peak bone mass early in life is crucial to reduce the risk for the debilitating effects of osteoporosis later in life
        
        In North America
        
        1 of every 4 women and 1 of every 8 men over the age of 50 years
        
        Factors affecting risk for Osteoporosis
        
        Age/gender/hormones
        
        bones are strongest and most dense in young adulthood
        
        sex hormones protective of bone
        
        2 more items...
        
        Genetics/Race
        
        heredity
        
        2 more items...
        
        Physical activities
        
        weight-bearing and resistance exercise benefits bones
        
        hormones involved in muscle growth are also involved in bone growth
        
        bone lose overnight
        
        Body weight
        
        under-weight women at increased risk for developing osteoporosis (naturally light or females living with anorexia nervosa)
        
        Smoking & Alcohol
        
        both toxic to bone
        
        2 more items...
        
        Calcium Nutrition&Associated Nutrients
        
        Low intake of Calcium during childhood, adolescence and young adult years and throughout adult years
        
        decrease circulating active Vitamin D --> decrease in Calcium absorption
        
        Low Fluoride intake (during infancy/childhood/youth)
        
        Calcium with Vitamin D supplements advisable for people not consuming milk and milk products (maximum 500 mg Calcium/dose)
        
        Excess Sodium, Caffeine, and protein intake
        
        4 more items...
        
        prevented by
        
        therapies exist to help reduce the rate of loss of Calcium
        
        estrogen
        
        Vitamin D
        
        Calcitonin
        
        Bisphosphonate
        
        Features of therapies
        
        each therapy have side effects
        
        can be expensive
        
        need make in consultation with your primary health care provider
        
        factors associated with reducing the potential for fractures
        
        Young Women
        
        adequate intake of Calcium, Phosphorus, Magnesium, Fluoride and vitamin D&K
        
        regular menstrual cycle and ovulation
        
        moderately active lifestyles; limited exposure to sum
        
        Adults Women and Men
        
        moderately active lifestyles, especially weight-bearing activites
        
        adequate intake Calcium, Phosphorus, Magnesium, Fluoride and vitamin D&K
        
        quit smoking, moderate alcohol intake
        
        Menopausal Women
        
        adequate intake of nutrients as above and appropriate therapy determined in consultation with health care professional
        
        remain physically active; make health lifestyle choices
      - Toxicity
        
        Effects
        
        Hypercalcemia
        
        high blood(the urinary) calcium levels
        
        calcium deposits to soft tissue-kidneys, heart, arteries
        
        can cause irreversible damage to organs
        
        People most effected
        
        peoples with Kidney disease
        
        Causes
        
        Hyperparathyroidism
        
        over-abundant production and secretion of parathyroid hormone causes kidneys to conserve calcium in blood and bone to release calcium into blood
    - - Types
        
        Including
        
        Forms
        
        Tablets
        
        Chewable
        
        Liquid
        
        Effervescent
        
        Different type—different amount of calcium
        
        Different types—different bioavailability
      - Doses
        
        Divided dose per day
        
        Maximum 500mg Ca/dose
        
        Absorption plateaus around 500mg Ca/dose
      - Absorption
        
        30% for all supplements
        
        Except citrate ~35%
        
        Calcium citrate have grater solubility can be taken without food
        
        Take calcium carbonate (e.g., Caltrate) with food
      - Mineral-mineral interactions and timing
        
        Take when low Calcium and iron intake
        
        Decrease absorption of other minerals (e.g., Iron,Magnesium)
        
        When rely on supplement — take everyday (out of reach to children)
        
        Take before bed-overnight, calcium loss from the bold and exits body in urine
    - - High in Calcium
        
        Milk and milk product
        
        Except for cottage cheese
        
        Most calcium densed
        
        Skim milk
        
        Goat cheese
        
        Fortified soy and other plant-based beverage
        
        Calcium-fortified bars
        
        Tofu made with calcium sulfate
- - - - Overall bone health
      - Fluid balance
      - Blood and tissue Phosphorus
    - - Increases/Enhanced by
        
        Vitamin D
      - Efficient at 60-90%
        
        Depends on needs of the body
    - - Deficiency
        
        unlikely with varied and well-balanced diet
      - Toxicity
    - - Uncommon
    - - Animal products
        
        Meat
        
        Fish
        
        Poultry
        
        Milk and milk products
      - Plant products
        
        Legumes
        
        Cereal
        
        Bran
        
        Nuts
      - Soft drinks
- - - - Hormone Action
        
        Vancouver: May-September
        
        5-10 minutes
        
        2-3x week during summer
        
        Vancouver: October-April
        
        Summer synthesis & stores not adequate
        
        Need dietary/supplemental Vitamin D
    - - Vitamin Action
        
        Dietary Vitamin D in pro-active form
        
        hydroxylated in liver & kidneys
        
        transported to cells for use
        
        Calcitriol
        
        3 major sites of action
        
        Intestines
        
        Bone
        
        Kidneys
        
        Increases absorption/retention of calcium
        
        associated with maturation of immune cells
    - - Regulates blood calcium
      - Regulates bone mineralization
      - Immune function
    - - deficiency
        
        causes
        
        in Children
        
        Rickets
        
        shows as
        
        improper mineralization and shaping of bones during formation
        
        leg bones most frequently bend out "bowed legs‘ when infant starts walking. effect of gravity; can also see 'knock-knees'
        
        caused by
        
        infant born with ~9 month Vitamin D stores depending upon maternal diet
        
        breast milk is low in Vitamin D
        
        low dietary intakes combined with little exposure to sun
        
        increase prevalence in Canada
        
        in Adults
        
        Osteomalacia (soft bones)
        
        definition of osteoid
        
        protein matrix matrix secreted by osteoblasts into which minerals are deposited to form bone
        
        caused by
        
        improper function of osteoid
        
        1 more item...
        
        low intakes of vitamin D and little exposure of skin to sun
        
        kidney, liver, intestinal disease
        
        close spaced, repeated pregnancies
        
        effects
        
        see progressive weakness with increasing pain in lower back and legs
        
        treatment
        
        increased dietary intake
        
        supplements
        
        controlled exposure of skin to sun
      - Toxicity
        
        Causes
        
        Most likely reason
        
        Supplement use
        
        Amount of intake
        
        250 ug/day over several months
        
        Effects (same as toxicity for Ca2+)
        
        Hypercalcemia
        
        high blood calcium levels
        
        calcium deposits into soft tissue-kidneys,heart, arteries
        
        can cause irreversible damage to organs
        
        Features
        
        Relatively narrow safety range
        
        Because
        
        Most toxic nutrients when consumed in leased amount above the DRI-RDA
        
        When there is solar exposure of skin
        
        Non-toxic
        
        Body down-regulates endogenous synthesis of Vitamin D when circulating levels are adequate
        
        Prolonged exposure degrades 7-dehydrocholesterol
        
        Food intake
        
        Safe, not toxic at Norma, intake levels
        
        People most affected
        
        infants given inappropriate amount of supplements by parents
    - - Doses
        
        Adults over age 50
        
        400IU (10 ug ) addition to what they get int her diet
        
        Can be in one dose/day
      - Types
        
        Form including
        
        Tablets
        
        Softgels
        
        Liquid
        
        Available as
        
        Vitamin D2
        
        Ergocalciferol: plant based
        
        Vitamin D3
        
        Cholecalciferol: animal based
        
        Both forms well absorbed, but Vitamin D3 most effective in the body
      - Absorption
        
        Comparable to food intake
        
        50-80% of ingested amount
        
        Fat-solvable vitamin- chylomicron
    - - High in Vitamin D
        
        animal food
        
        Egg yolks
        
        Liver
        
        Fish oil and fish
        
        Plant food
        
        Fortified milk
        
        Margarine
        
        Orsnge juice
      - Relatively stable to heat, storage and processing
- - - - Enhance bone and teeth mineralization
        
        by creating a stronger crystal through replacing hydroxyl group
        
        Hydroxyapatite (Calium and phosphate) crystals in bonds —> Fluorapatite
      - Fluoride best taken before teeth erupt
        
        20th week of pregancy
        
        Baby thresh forming
        
        3-4 years of age
        
        Permanent teeth forming
        
        8-10 years of age
        
        Wisdom teeth forming
    - - Risk of dental caries
      - Inability to chew properly
    - - Fluorosis: permanent white or brown streak on teeth
      - Create stiffness/brittleness in skeletal bones
    - - Seafood, seaweed, brewed tea, water, dental health products
      - DRI-AI
        
        Male: 4 mg/day
        
        Female: 3 mg/day
      - DRI-UL
        
        Male and Female: 10 mg/day
- - - - Bone and teeth
        
        Calcium balance
        
        action of vitamin D
        
        production of parathyroid hormones
        
        holds calcium in teeth
        
        reducing dental caries
        
        mineral crystal in bone
      - blood and tissue
        
        enzyme systems
        
        phosphate in ATP
        
        neurotransmitter activity
        
        muscle contraction
        
        blood clotting
      - hypertension
        
        vasodilator
        
        lowering blood pressure
        
        heart diseases
    - - causes:
        
        heavy perspiration for long time
        
        alcoholism, renal disease
        
        continuously vomiting, diarrhea, diuretics
      - symptoms
        
        irregular heartbeat
        
        weakness, irritability, disorientation
        
        hypertension
        
        tetany
    - - animal food
        
        milk, yogurt, halibut
      - plant food
        
        green, grain, legumes, tofu, nuts
      - hard water
      - chlorophyll
    - - DRI-RDA
        
        19-30 years
        
        females
        
        310mg/day
        
        males
        
        400mg/day
        
        31+years
        
        females
        
        320mg/day
        
        males
        
        420mg/day
      - DRI-UL
        
        350mg/day
- - - - calcium mineralization of bone
        
        oesteocalcin
        
        a calcium-binding hormone made in osteoblasts that promotes calcium mineralization
      - blood clotting
        
        Consists of
        
        4 of the 13 fibrin clot consist protein require Vitamin K for synthesis
        
        Important for
        
        Infants who are bone with a sterile gut-no bacterial synthesis
        
        Solved by
        
        Infant receive a dose of Vitamin K shortly after birth to prevent hemorrhaging
        
        Takes a few weeks to establish bacterial synthesis of vitaminK
    - - infants
        
        no vitamin K synthesis at birth-sterile gut
        
        low levels in breast milk
        
        low gut bacteria level
      - adults
        
        antibiotic use
        
        fat malabsorption conditions
        
        excessive intake of vitamin E impairs the role of Vitamin K in blood clotting
        
        Rarely happened
    - - rare, non-toxic
      - RBC hemolysis, Jaundice, brain damage
      - Coagulation effects can hinder effects of anti-coagulant medications
    - - leafy green, liver, egg, milk
      - bacterial synthesis in large intestine
    - - DRI-AI
        
        females: 90mg/day
        
        males:120mg/day
    - - In forms of
        
        Quinones
        
        Animal
        
        Menaquinone
        
        Plant
        
        Phylloquinone
      - 40-80% been absorbed
      - Stored in
        
        Liver
        
        Adipose tissue
      - Used as
        
        Coenzymes for protein synthesis
      - Sources
        
        Exogenous
        
        Diet
        
        Endogenous
        
        Bacterial synthesis
        
        Antibiotic use can increase dietary need