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Now we're going to take a look at major minerals.
Keep in mind that the minerals classification is broken down
into a couple of different areas.
We have major minerals, and then we have trace minerals.
We also have something called ultra-trace minerals, which
I'm not really going to talk too much about.
When we speak about minerals, keep in mind
that these are naturally occurring
and that they're inorganic.
So if you remember back to high school chemistry, if you took
it, or even just seeing the periodic chart,
you'll see all the different little squares.
And they talk about silicone and nickel,
and all of these other elements.
That's what we're talking about here.
They're chemical elements.
And they're going to be integrated
into all of the foods that we eat,
especially things that have grazed on the soil.
So it could be livestock, and anything grown in dirt,
basically.
As I mentioned, there are major minerals.
And these are found in the body in certain amounts.
And that's what makes them a major mineral.
It's not necessarily the amount we need from the diet.
So when we look at the major minerals,
these are found in the body in amounts more than five grams.
So that might give you some ideas
about where we're going to find them in large body structures.
Then we have trace minerals.
And these are found in that smaller amounts,
less than five grams in the body.
And that's really the distinction
between these two groupings.
And then, as I mentioned, the ultra-trace minerals.
And these are found in infinitesimal amounts
in your body.
And we don't encourage people to seek these out in any way,
because your diet is naturally going
to contain enough of them.
So let's talk about some of the major minerals.
First one I want to mention is calcium,
and this is the one that is most abundant in the human body.
And that might make sense if you think about the way
we're put together.
We have this really incredible skeletal system.
And that is a really big reservoir of calcium.
If you look at the food sources, we're
probably most familiar with dairy products
as being a good source of calcium,
so we have that up there.
We have a glass of milk.
We also have a lot of other sources.
So even for someone who doesn't choose to eat dairy products,
they should not have a problem with calcium.
And we want to get people around the idea of using
green leafy vegetables or green vegetables
in general for some of their calcium requirement.
Additionally, I want to talk about some of the roles
with calcium.
So as I mentioned, it is the most abundant mineral
in the body.
And you're going to find most of this in the bones and teeth,
although you will find some of it
intercellularly and in serum.
It's an important electrolyte.
It's really essential for contraction of muscle,
and then also heartbeat.
So you see it playing this role as an electrolyte
to help maintain that heartbeat.
It also is involved in hormones and digestive enzymes
and neurotransmitters and all of these smaller
roles and regulation.
It's also and enzymatic component.
I want to spend a little bit of time
now that we have a basic about calcium--
and I'm going to run through some of those basics
pretty quickly on these major minerals so
that I can talk about some of the pathology
that we see when people don't have enough
of any of these major minerals.
So in order to talk about that with calcium,
I just want to say our status with calcium in the US.
And we aren't doing very well, to be honest with you.
Women achieve about 1/3 of the RDA.
And men are doing a little bit better, they get about 3/4.
So there's a lot of room for improvement here.
When we talk about deficiency, we're
going to see a lot of the same kinds of problems
we saw with vitamin D deficiency.
Keep in mind that these should be very, very well linked
in your mind, because they have this integral role together.
So when we don't have enough, we see a lot of problems
with skeletal health, which we should make sense for you.
Bone loss-- especially in adults-- as people age,
you're going to see this.
You can see high blood pressure when people don't have enough.
And then also, sometimes the formation of kidney stones.
That's something that we also see as a problem.
As I mentioned, really milk in dairy products
is probably the number one source in the US.
And when you think about the shifts that
have happened in our food supply,
and then also the foods we're choosing, especially
with young children, they're choosing more fruit juice
and more soda and even drinking more water.
So overall, milk consumption has declined.
And we see a corresponding decrease
in bone health for a lot of folks.
Now, when I talk about that dairy group,
even people who don't choose to drink milk
can still use a lot of those dairy products
that are calcium-rich.
Things like yogurt, that's an excellent source,
and some cheeses.
Especially if the problem is lactose intolerance,
because the bacteria in the yogurt
actually ferment that lactose, so most of it is about 99%
lactose free.
I also said that dark green vegetables are a good source.
There are few exceptions to that, so take note of this
if these are some foods you're eating.
Spinach and Swiss chard, and also rhubarb.
And of course, we're eating the stalks of the rhubarb, never
the leaves.
They're poisonous.
But what happens is that there's a competitive binding here.
And those particular greens contain
chemicals that are going to bind the calcium so that it passes
through the body unabsorbed.
So we want to be a little bit careful
if people are trying to meet their calcium
needs from these particular greens.
Other things are a great source, so if someone
is choosing something like kale, really high in calcium,
good choice.
Also broccoli-- not a leafy green, but still
a very good source of calcium.
I told you that bone loss was a particular concern
with calcium.
And so I just I wanted to talk to you a little bit about some
of the issues that we're seeing with adult bone loss.
We call it osteoporosis.
You might also see it referred to as osteopeonia, which
is considered a similar issue.
And when we look at what happens in terms of people's skeleton,
you can see here we have a 50-year-old woman
and then we have someone who's 80.
And there's a real, real, decrease in her stature
over time, because there isn't enough calcium in those bones.
You tend to get compression and micro-fractures
in this compaction, so people lose height.
And we want to avoid that if we can.
Now, we have a picture of a woman
here, because really this is a disease that affects women
disproportionately to men.
And one of the big reasons for that
is menopause, and the lack of estrogen.
As women age, without that estrogen
we see particular bone loss.
It's very precipitous.
And so we really want women to start out their early years
with sufficient calcium.
There are some other risk factors
to consider that are not things we can really change--
so gender, advanced age, genetics plays a role.
So if your grandmother has had osteoporosis,
it's a little hint to you to be really careful
about your calcium and vitamin D intake.
Also environmental factors.
And when I talk about environmental factors,
I actually spelled out a nice list here.
We put poor nutrition under an environmental factor.
And really, what we're talking about here
is poor calcium and vitamin D intake.
But when we look at just overall quality of diet,
we want somebody consuming a very, very well-rounded,
adequate diet in all of the other micronutrients.
I mentioned estrogen.
Lack of physical activity also plays a role,
being underweight.
So this is an area where higher BMI
is protective against osteoporosis.
People that tend to overindulge in alcohol or use tobacco
products have lower bone mineral density.
And there are quite a few studies
pointing to these other sources.
So excess protein, sodium, caffeine intake, and soft
drinks with a lot of phosphorus, that's the agent
there, as being implicated in osteoporotic development.
And then inadequate vitamin K intake.
We'll talk a little bit about the relationship there.
But take a look back at the role that vitamin K plays.
It has to do with blood clotting,
and it's also involved in bone health.
Now I want to shift gears away from calcium
and talk about phosphorus.
And this is one that is well-supplied in the diet.
It's very widespread.
There are plenty of good food sources to this.
So we can see cottage cheese, for instance,
dairy products, meats, really a lot of high protein foods
are rich in phosphorus.
So this isn't one I have to ask people to seek out in any way.
It's implicated in bone health, just like calcium.
So calcium and phosphorus are going
to both be critical minerals for bones.
This is the second most abundant major mineral in the body.
And again, we're going to see if this
is found in bones and teeth, and has
a couple of particular roles in acid-base balance.
That phosphorus acts as a buffer.
It's also part of DNA and RNA, so there's genetic proteins.
It's going to also be involved in some metabolic processes.
So when we look at that conversion from food
into energy, that's where phosphorus
is going to play this important role.
It's also involved in lots and lots
of different enzymatic activities.
Generally, we call these phosphorylation activities,
where phosphate groups are added or taken away.
And this is even how we store glucose.
So if you think back to our glycogen conversation,
in order to keep that glucose in the cell
we add a phosphate group to it which anchors it.
And then we can build that glycogen from there.
So that's another role for it.
And then we see it's part of the phospholipid complex.
So we talked about phospholipids being two fatty acids, and then
that carbohydrate or glycerol backbone,
and the phosphate group.
So it allows that particular type
of fat to complex with water, if you recall that conversation.
It's also present in some proteins.
So that's really it for phosphorus.
I want to move on to magnesium and talk
about this one a little bit.
Magnesium, again, widespread in the diet.
So you would think that probably Americans don't
have too much trouble with this.
But we have a little bit of trouble,
and I'll talk about why that is.
But this should not be a problem for someone
on a particular diet plan.
If they're vegan, or if they're lactose
free or gluten free, or any of these dietary traditions,
magnesium should not be an issue.
Leafy greens tend to be very high in magnesium,
so that's always a good choice, and even legumes.
So again, it should be pretty widespread in the diet.
This particular mineral also, just like the phosphorus
and calcium, has a lot of different roles
to play in the body.
It's really active in enzymatic reactions
and releasing energy from food.
It's also going to be important in the metabolism
and use of different kinds of vitamins, and also calcium,
which is one of the minerals.
It acts in soft tissues and the cells there.
You need it for the functioning of muscles.
And it's also going to help you prevent tooth decay.
We often just think of fluoride as doing that.
But here, we have magnesium playing a role in that as well.
Now the needs of magnesium are really
very easily mapped by most diets.
So deficiency, or frank deficiency,
is really unknown, or generally unknown,
especially in Western societies.
But instead, what we see is low intake sometimes.
So we have to be a little bit concerned with that.
Now, we can have some reasons why
people might be low, or somewhat deficient, in magnesium.
And they tend to have to do with illness.
So if someone is experiencing prolonged vomiting or diarrhea,
or even if they just have very, very low intake.
Alcoholism, protein malnutrition-- again,
the protein malnutrition is pretty rare in the US.
Alcoholism, unfortunately, is a little bit more common.
And then the use of diuretics.
So these are some medications to help remove excess body fluids,
especially for someone who's maybe
dealing with congestive heart failure.
That might be a drug that they're on.
Some of the deficiency symptoms we
see a little bit surprising-- hallucinations.
Now, if you went your doctor and said you have hallucinations,
the doc is not going to say, I think it's a magnesium problem.
So this again is where we really want patients and consumers
to be very, very aware of their diet.
Now, this is quite rare, again, I
want to say-- especially in normal, healthy people.
But what we do you see is that about 75% of Americans
are not meeting their recommended intake.
There are reasons why this happens.
One of them is that magnesium is easily
lost during food processing.
It could be as simple as washing and peeling--
like carrots or potatoes, or something like that.
Of if people are eating a diet that's really high in processed
foods, they're going to see that they're not
getting the magnesium that naturally would
be in those foods if they were less processed.
Generally speaking, we don't lose minerals
through processing.
It's vitamins that we're concerned about.
This is an exception to that rule.
Now, with toxicity, this is only going
to be a really significant issue if people
are taking supplements.
Sometimes certain medications, magnesium salts
may be something that somebody's taking
for some reason, accidental poisonings also.
And some of the toxicity symptoms that we see, again,
a lot of the ones that are similar to deficiency.
You can have problems with GI distress, vomiting
and diarrhea, also acid-base balance and dehydration.
And magnesium is an electrolyte, so that's
part of the puzzle there around dehydration.
Let's talk a little about sodium.
Now, sodium is a little bit of a-- now
I'm grappling for the right word here.
This is a cautionary mineral.
We have to be kind of concerned with our sodium intake.
And if you look at our food supply,
it is just so rich with sodium.
We see table salt.
We also see all kinds of processed foods being very high
in sodium.
And it's very, very hard for people on a low-sodium diet
to actually avoid it.
Most of the places where people are getting their sodium
tend to be these processed foods.
Although if you look at things like celery or cauliflower
or cabbage, or any of those vegetables
that are grown very intimately in the soil,
you're going to see that they all contain sodium.
It's just part of the natural part
of this process of absorbing nutrients from the soil.
Now when we look at the different kinds of functions,
this is one of the really critical positive ions
in the body.
So it has a really big role to play as an electrolyte.
It's also involved in all of these other areas-- so
fluid balance, so if you think about
if you have a little extra sodium on board,
you may be retaining water.
So again, this is a concern for people with congestive heart
failure or other kinds of conditions.
It's important in extracellular fluid balance,
acid-base balance, muscle contraction,
nerve transmission.
This is one that you really want to make sure
that you have enough of.
And luckily, our body regulates this
without us even having to think about it.
If anything, I really have to get people away from sodium.
Deficiency is really unknown.
No diet lacks sodium.
So that's the good news, in some ways.
And the body absorbs it very easily.
The kidneys are really efficient for the most part,
in a healthy individual, at making sure
that the sodium balance stays exactly where should it.
So in times when there might not be enough sodium,
or someone's on a very low sodium diet,
the kidneys will conserve that.
We do lose some sodium through sweat.
And this will sound a little gross,
but some people tend to excrete more sodium during exercise
or during periods of heavy sweating than other folks.
And so if you're curious if you're
somebody who tends to lose more electrolytes,
just lick your arm and you'll know.
You can even just feel it, like in the summer if you're out
running or biking, or something like that.
You can feel that grit, that sodium on your skin.
And that will give you a little bit of a hint
sometimes if it's something you actually
need to stop and have a snack.
For most folks, it's not a problem.
Now, I told you that we need to limit sodium.
And one of the ways that we can do this
is actually fairly painless, luckily.
We need something called the DASH diet.
And that stands for Dietary Approaches
to Stopping Hypertension.
And the idea here is that we want
people to make specific choices not just about the amount
of sodium in their diet, but also about the foods they're
choosing.
So I want to talk to you about what this diet looks like.
It's very, very similar to the Mediterranean diet,
which has a strong reliance on fruits and vegetables,
and uses a little bit of nuts and fish and whole grains.
And not too much dairy, and the dairy that is there
tends to be lower fat.
And we really want people to use very sparingly
red meats, butter, and other high fat foods and sweets.
So it's not just about the sodium,
it's about an overall healthy diet.
The good news here is that this is delicious.
I mean, all these whole foods are absolutely tasty.
But it tends to be a little bit expensive for people.
There are ways to make it much more reasonable.
It also involves a little more preparation and cooking.
But what we've found here is that the importance
of this diet really rests in the amount of potassium in it.
Now, potassium, we haven't talked about this one yet.
It's found in fresh fruits and vegetables.
Most people say, oh, bananas are rich in potassium.
And they are.
But there are many, many other sources in the diet,
especially things like potatoes, believe it or not,
are rich in potassium.
The way this works is that potassium and sodium
are antagonists, which means that they're
going to counteract the mechanism of each one.
So if you can balance these two, you
tend to be able to control hypertension, or high blood
pressure, a little bit more.
So with the sodium reduction, you
might get this level of response with controlling hypertension.
With having more potassium, you're
going to reach up just a little bit further
than you would have just based on sodium restriction.
And I should also mention that not every single individual
is salt sensitive.
So people that have high blood pressure, often the blanket
recommendation is avoid sodium.
But we also want to tell them, make
sure they're getting more potassium in your diet.
Because that's going to play that critical role as well.
Now we want to talk about potassium now that we've
introduced that idea, move on from sodium.
So we mentioned bananas are a good source, and potatoes.
But also Lima beans-- which are probably one of your favorites,
right?
You can also find it in other kinds of fruits and vegetables
as well.
People should not have a potassium problem.
And yet we do.
Because we don't consume enough of these particular food
groups.
The average American gets about one, maybe one
and a quarter servings of fruits a day.
And vegetables, we're not doing much better,
it's about one serving.
We really need to get more traction
in that particular area.
Now this, again, is another one of those charged ions.
It has an important role to play in fluid balance, electrolytes,
maintaining all those cellular functions,
and especially in heartbeat.
When we do see deficiency, there are particular reasons
why it might happen.
And sometimes the result is sudden death.
And this is-- and I want to underline this-- very, very
rare.
It might happen for someone that maybe has been in a starvation
situation and we're refeeding them.
So it's associated with refeeding syndrome very often.
And we we're very, very good at doing this now.
So it's not such a threat.
But your book talks about it a little,
so I just wanted to mention it.
A couple of things that we do see with potassium in terms
of low intake, especially related to high blood pressure,
is that we see that people who already have established
hypertension-- or even undiagnosed hypertension, which
is quite common-- low potassium tends
to increase that blood pressure.
So it's going to worsen that.
You can also see some smaller issues
there surface with deficiency, especially
around glucose impairment.
But again, these are much lower level.
Really want I want to focus on is that relationship
with sodium and hypertension.
Now, we can have too much potassium.
And it's not going to happen from foods.
You could have 10 bananas a day, you're
not going to poison yourself with potassium.
Might have some GI trouble, but it's not
going to be a potassium problem.
One of the ways that we see some toxicity surfacing
is with lethal injection.
And again, this isn't something that's very common.
But it's just kind of interesting
and helps us to understand how this functions.
When there's a huge blast of potassium, what can happen
is that it fills up all the channels, all
of those ion channels in the heart.
And you're not able to actually maintain heart rhythm.
And we're using specific types of potassium
there, so potassium chloride.
We don't want to take any over the counter potassium
supplements or salt replacers that contain potassium
without a specific doctor's advice.
And a lot of these are marketed without any warning.
So be very, very careful with those kinds of things.
Let's move on to talk about chloride a little bit.
This is another one of those important ions.
And if you think about where you might find chloride,
maybe you're familiar with NaCl.
So that's just what we call table salt, that's
the chemical formula.
So we're finding this in table salt,
and in any processed foods that contain sodium.
So again, there should be no reason
why any diet is lacking in chloride.
And I should also mention that chloride
is different from chlorine, OK?
So it's a different form.
OK, this is chloride that we find just naturally occurring
in foods and, as I said, in table salt.
Chloride's role is in acid-base balance, electrolyte balance.
OK, also this is one of those important electrolytes.
And it's a component of hydrochloric acid,
which is found in our stomach.
I mentioned that the main source is going to be salt.
And in terms of deficiency, we're
not going to see deficiency.
It's just not really a problem.
I'll talk a little bit about sulfate as well.
This one, again, is one that is ubiquitous in the diet.
It's required for several different functions
with antioxidants, with thiamine metabolism.
Thiamine is one of those vitamins
that we've talked about.
And also in the production of sulfur-containing amino acids.
Because sulfur and sulfate, you should link those up
in your mind.
Deficiencies here are relatively unknown.
You would only really see it in someone
that's starving and has an absolutely protein-free diet.
And even then, I'm not sure that you would see it.
There's not too much in the literature
about sulfate deficiency.
We can see toxicity though, especially
from water contamination.
Sometimes people's wells will have a lot of sulfur.
And you can smell that.
It smells a little bit like eggs.
And so we encourage people to test well water
if they're using a home water source.
And that can result in some folks having diarrhea, and even
colon damage and lower GI tract issues.
Sulfate, again, it's found in any protein-rich food.
So that shouldn't be a problem for most people in the diet.
So those are our major minerals.
And then we'll move on and talk about the trace minerals.