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BONE HEALTH, taking Ca supplements (high Ca intake) decreases absorption…

- - - - provides flexibility
- - - - Ca10(PO4)6(OH)2
        
        Crystal that deposits onto the protein matrix to add strength
- - - - very low x-ray energy scan of entire body or specific areas
      - non-invasive, painless, quick procedure
      - t-score is generated using a comparison with a healthy 30 year old of same gender and race
    - - a screening tool using sound waves to measure bone density in the heel
      - non-invasive, painless, quick procedure
      - used at health fairs
    - - a screening tool using x-ray to measure bone density in heel, wrist, finger
      - non-invasive, painless, quick
      - used at health fairs
- - - - secreted from parathyroid glands when Ca needed in blood
      - Stimulate activation of calcitriol (Vitamin D) in kidney
        
        acts on
        
        INTESTINE
        
        to increase Ca absorption
        
        KIDNEY
        
        to conserve Ca
        
        OSTEOCLAST CELLS
        
        to cause bone to release Ca into blood
        
        decreased calcitriol level decreases Ca absorption
        
        Calcitriol Hormones
        
        released by thyroid glands that inhibit loss minerals (Ca) from bone to blood by decreasing osteoclast actions
      - Act on osteoclast cells in bone to raise blood calcium
  - - - building peak been mass (teen years, 25-30) in early life reduces risk of debilitating effects from osteoporosis later
    - - sodium potassium ATPase pump in nerve cell membrane allow flow of ions across membrane to generate action potential
        
        ions release neurotransmitters (eg. acetylcholine, dopamine, serotonin, antidiuretic hormone)
        
        action potential travels along nerve fibre and stimulates muscle cells
        
        Ca flow into muscle cells cause contraction, Ca exit, then muscles relax
    - - lead to formation of fibrin and clot
  - - - carbonate, citrate, lactate, phosphate (must be refined to avoid heavy metals )
    - - skim milk (powder) is the most nutrient dense source, yogurt, cheese (except cottage cheese)
    - - orange juice, bar, tofu made from Ca sulphate (soy)
    - - white beans
    - - citrus punch, fruit punch
    - - broccoli, brussel sprouts, green cabbage, cauliflower, kale
      - some green leafy vegetables are high in Ca but also contain oxalic acid that decreases bioavailability
  - - - Rigour
        
        muscle can't relax
    - - over production & secretion of parathyroid hormone cause kidney to retain Ca in blood and bone to release Ca into blood
      - causes
    - - high blood and urinary Ca level -> Ca deposit in soft tissue and cause calcification (kidney stone or failure, in heart, arteries) --> can cause irreversible damage
  - - - Tetany
        
        spasmodic relaxation
    - - degenerative bone disease
      - decreased bone density
      - increased bone fragility
      - increased risk of fractures
        
        usually in hip, spine, wrist
      - Risk factors
        
        Age/ Gender/ Hormones
        
        peak bone mass (PBM) strongest in young adulthood
        
        as we age, osteoblasts become less active & osteoclasts continue function, so bone naturally lose density & strength over time
        
        women between 40 & menopause
        
        continuous slow bone loss rate; at menopause, the rate of bone loss is accelerated for 5-10 years due primarily to the effects of decreased estrogen levels
        
        at age 65
        
        rate of bone loss decrease to same rate before menopause
        
        bone fracture can be prevented beyond 5-10 years post-menopause with therapy & nutrient intake
        
        extreme dieting & exercise during/after adolescence can compromise bone health (osteoporosis, amenorrhea, eating disorder)
        
        men have lower risk as they have greater bone density, gradual decline in sex hormone testosterone
        
        slow bone loss begin at 30 years old
        
        Genetics/ Race
        
        heredity affects bone growth, PBM & rate of bone loss
        
        African Americans have denser bones than Caucasians
        
        Physical Activity
        
        weight bearing exercise increases muscle & bone strength, when muscle pulls on bone, it increases strength of trabecular bone
        
        hormones involved in muscle growth involved in bone growth
        
        Body Weight
        
        underweight women have increased risk
        
        Smoking & Alcohol
        
        smokers have lower body weight, female reach menopause earlier, more rapid estrogen breakdown
        
        Alcoholics have slower bone formation, lower bone density, increased risk of falling, excretion of Ca in urine
        
        alcohol is toxic to bones
- - - - major intracellular anionic electrolyte
    - - free phosphorus salt, phosphate
    - - very high energy phosphate bond (ATP)
      - phospholipids in cell membranes and lipoproteins to transport fat soluble nutrients in body
      - enzyme reactions
        
        active vitamin B when phosphate group added (coenzyme needed)
      - essential for DNA and RNA growth
  - - - meat, fish, poultry
- - - - smoking decreases estrogen levels that increase bone loss
- - - - 7 Dehydrocholesterol is converted to provitamin D3, which is converted to another inactive form of Vitamin D3
      - a 2 step hydroxylation process happens in the liver and then the kidney to allow inactive vitamin D3 to be converted to fully active form of Calcitriol
      - Factors that affect internal synthesis of Vitamin D
        
        skin colour
        
        age
        
        distance from equator
        
        pollution
        
        SPF >= 8
        
        time of day of exposure
      - ideally, we should get 5-10 min of exposing face + hands to sun 2-3 times /week in the summer
      - when skin is exposed to sun, vitamin D acts as a hormone
    - - must be consumed in provitamin inactive form, which is then activated using liver and kidneys to form active Calcitriol
    - - 50%
      - incorporated into chylomicrons for transport into lymph to blood
    - - bone health & maintenance of blood Ca
        
        regulates blood Ca & bone metabolism
        
        at low blood Ca levels, calcitriol causes increased Ca blood levels
        
        acts at 3 sites (intestines, bones, kidneys)
        
        help body absorb & retain Ca and phosphorus
        
        Ca absorption depends on active Vitamin D present in intestinal cells
        
        Vitamin D enhances phosphorus absorption
      - Non-Bone Roles
        
        immune function, helps reduce inflammation
        
        reduce cancer cell growth
    - - Children
        
        Rickets
        
        softening & weakening of bones from prolonged vitamin D deficiency
        
        results from poor mineralization & shaping of bones, bowed legs, malformed ribs
        
        symptoms
        
        painful bones, muscle weakness, slowed growth
        
        at risk
        
        breast milk is low in Vitamin D & they have little exposure to sun
        
        can be treated with increasing vitamin D & Ca intake
      - Adults
        
        Osteomalacia
        
        bone disorder that weakens bone
        
        soft bones & happens when osteoids don't mineralize properly & begin to accumulate
        
        symptoms
        
        progressive weakness
        
        increasing pain in lower back & legs
        
        bones that break easily
        
        muscle cramps
        
        at risk if:
        
        kidney, liver, intestinal disease
        
        low intake of vitamin D & little sun exposure
        
        closely spaced & repeated pregnancies
        
        can be treated with increase dietary intake & exposure to sun
    - - causes
        
        solar exposure
        
        non toxic as body regulates Vitamin D production
        
        food intake
        
        safe+ non toxic at normal levels
        
        supplement use
        
        most likely reason for toxicity
      - affects
        
        Hypercalcemia
        
        happens when Ca levels in blood are too high
        
        Ca deposits into soft tissue which can cause irreversible damage to organs
        
        create kidney stones
        
        people who are most affects
        
        children from unnecessary Vitamin D supplements
    - - Supplements
        
        tablets, soft gels, liquid
        
        available as Vitamin D2 (plant based) and Vitamin D3 (animal based)
        
        adults > 50 years take 400 IU daily
      - Food Sources
        
        little foods that contain Vitamin D naturally
        
        in animal foods
        
        egg yolks, liver, fish, fish oils, red meat
        
        fortified foods or supplements
      - Food processing
        
        stable when heated, stored, processed
  - - - quinones from plant and animal sources
      - absorption ~40-80%
    - - essential for blood clotting
        
        important for infants who are born with a sterile GI tract, which is why infants receive a dose of vitamin K after birth to prevent hemorrhaging
        
        needed for production of fibrin , which is a blood clotting protein
      - Calcium mineralization of bone
        
        needed for osteoblasts to produce osteocalcin, which is a Ca binding hormone, that promotes Ca mineralization (connection to Ca)
        
        needed for normal bone formation
    - - Infants
        
        low levels at birth & in breast milk
        
        low levels of gut bacteria to synthesize vitamin K
      - Adults
        
        rare but if it happens it is usually due to antibiotic use
        
        fat malabsorption disorders
        
        excessive Vitamin E intake can impair role of Vitamin K in blood clotting
    - - rare as food sources are considered non toxic
      - excessive Vitamin K can hinder effects of anticoagulant drugs
      - symptoms
        
        RBC hemolysis, jaundice, brain damage, anemia
    - - exogenous (diet)
        
        Plant sources
        
        green leafy vegetables (kale, spinach), peas, broccoli, green beans
        
        Animal sources
        
        liver, eggs, cow milk
      - endogenous (bacterial synthesis)
        
        bacterial synthesis in large intestine
      - resistant to loss during cooking
- - - - whole grains, nuts, legumes, peanuts, spinach, avocado
- - - - more resistant to decay
  - - - week 20 of pregnancy (baby teeth forming under the gums)
      - during the first 3-4 years of life (permanent teeth forming under the gums)
      - 8-10 years of age (when wisdom teeth form under the gums)
  - - - leads to an inability to chewing properly
  - - - causes white specks/ brown streaks on teeth
      - high intake of Fluoride during teeth development can lead to this
      - most at risk
        
        children consuming large amounts of toothpaste
      - makes bones more brittle or can cause stiffness / pain in joints