NMDF121 SN18 Lecture Minerals2 · PDF file · 2017-02-23lymph, and the intra and extracellular fluid. ... Activity o Watch the following video on electrolytes part 1 (10 mins)

© Endeavour College of Natural Health endeavour.edu.au 1

NMDF121

Session 18

MACROMINERALS

PART 2

Naturopathic Medicine

Department


Topic Summary

• Macrominerals

• Electrolytes

• Potassium

• Sodium

• Chloride


Electrolytes

• Potassium, sodium and chloride = electrolytes

• “Conduct electricity when dissolved in water”

(Reavley 1998)

• Distributed throughout all body fluids including the blood, lymph, and the intra and extracellular fluid.


Electrolytes

• Functions:

• Water Balance

• Muscle contraction

– Affect skeletal and cardiac

muscles with calcium

– Regulate the heartbeat

• Acid-alkali balance

• Nerve impulse transmission


Activity

o Watch the following video on electrolytes part 1

(10 mins)

https://www.youtube.com/watch?v=vvGyHBWcQQ

U

https://www.youtube.com/watch?v=vvGyHBWcQQU


Sodium

http://commons.wikimedia.org/

wiki/File:Sodium_sulfate.png

http://upload.wikimedia.org/wikipedia/commons/1/12/Sodium_sulfate.png

http://upload.wikimedia.org/wikipedia/commons/1/12/Sodium_sulfate.png


Sodium SourcesFood Levels

Chicken 0.86mg/g

Fish 0.78mg/g

Beef 0.57mg/g

Pork 0.47mg/g

Fruit and vegetables <0.1g/kg

• Most of the sodium in the diet is found in table salt and

processed foods.

• Dietary recommendations include a moderate intake of

table salt and sodium, as excesses may aggravate

hypertension.


Sodium Sources

Rolfes, Pinna & Whitney, 2009


Sodium

• Sodium is one of the primary electrolytes in the body

and is responsible for maintaining fluid balance.

• Sodium is the principal cation of the extracellular fluid

and the primary regulator of its volume.

• 93% of cations in the body are sodium

(Whitney 2011)


Functions

o Involved in regulation of fluid

balance – primary regulator of fluid

volume

o Essential to nerve impulse

transmission and muscle

contraction – during nerve impulse

transmission Na+ and K+ trade

places across the cell membrane

o Co transporter

o Cofactor(Kohlmeier, 2003)


Factors Increasing Demand

• Adrenal insufficiency

• Chronic diarrhoea and vomiting

• Dehydration

• Excess water intake

• Heavy sweating


Hyponatremia

• A serum sodium ion concentration <135 mmol/L

o Type 1 – Hypervolemic hyponatremia

• Total body sodium is increased, but total body water

(intracellular and extracellular fluid) is

disproportionately expanded, resulting in hyponatremia

and oedema.

• Seen in CHF, cirrhosis and renal failure


Hyponatremia

o Type 2 – Euvolemic hyponatremia• Excessive ADH release produces renal water reabsorption, and

the body’s intracellular and extracellular fluid compartments are

expanded, resulting in hyponatremia. Na is unchanged and

therefore diluted

• Seen in cancer, CNS disorders, pulmonary disease, nausea,

postoperative pain, HIV, infection

o Type 3 – Hypovolemic hyponatremia• Loss of water and Na. Diuretic-induced hyponatremia is one of

the most common causes of hypovolemic hyponatremia and is

associated with high urinary sodium.


Hyponatremia

Hypovolaemic hyponatremia

• Dry mucous membranes

• Decreased skin turgor

• Tachycardia

• Postural hypotension

• Raised blood urea and

plasma renin

Hypervolaemic hyponatremia

• Peripheral/sacral oedema

• Ascites

• Pulmonary oedema

(Smith 2000)


Hyponatremia

• The symptoms are primarily neurological and relate to

the rapidity of fall of serum sodium:

o Acute hyponatremia

• Headaches, nausea, vomiting, muscle cramps, restlessness,

disorientation and depressed reflexes can be seen if serum

sodium falls below 125 mmol/L.

• When severe hyponatremia evolves over a period of hours,

seizures, coma, permanent brain damage, respiratory arrest,

brain-stem herniation and death may occur

o Chronic hyponatremia is often asymptomatic irrespective

of the degree of hyponatremia. Symptoms may only

occur if there is an acute exacerbation of hyponatremia,

or if the serum sodium falls below 110mmol/L


Deficiency Symptoms

• Salt cravings

• When sodium is deficient, mammals alter their behaviour

towards salt by avidly consuming it, even at concentrations

animals typically choose to avoid. (Lundy 1998)

• Metabolic acidity

• Reduced muscle pH occurs with low sodium levels

(Ray 1996)

• Falls

• Mild chronic hyponatremia induces a high incidence of

falls, possibly as the result of marked gait and attention

impairments (Renneboog 2006)


Toxicity

o Ingestion of large amounts of salt - nausea, vomiting,

diarrhoea, and abdominal cramps.

o Hypernatremia generally develops from excess water

loss, accompanied by an impaired thirst mechanism or

lack of access to water.

o Symptoms of hypernatremia associated with fluid loss

include - dizziness or fainting, low blood pressure, and

diminished urine production. Severe hypernatremia may

result in oedema, hypertension, rapid heart rate, difficulty

breathing, convulsions, coma, and death.

o Hypernatremia is rarely caused by excessive sodium

intake (Higdon 2003)


Recommended Intake

AI Adults

• Men - 460-920 mg/day (20-40 mmol)

• Women - 460-920 mg/day (20-40 mmol)

• Salt (sodium chloride) is about 40% sodium; 1 tsp of salt

is equivalent to about 6 gms so 1 tsp of salt contributes

about 2300 mg of sodium (Whitney 2012).

• Australian UL is 2300 mg; however, 1600 mg has been

set as SDT (suggested daily target) for chronic disease

prevention.


Results from Children’s Nutrition and

Physical Activity Survey (CNPAS) 2007

Age CNPAS

Sodium

intake mg1

NRV

AI

mg2

NRV

UL

mg2

NRV

SDT

mg2

2-3yo 1675 200-400 1000

4-8yo 2161 300-600 1400

9-13yo 2694 400-800 2000

14-16yo 3161 460-920 2300 1600

1. DoHA. National Children's Nutrition and Physical Activity Survey User Guide 2007. AGPS,

Canberra. 2008.

2. NHMRC. Nutrient Reference Values for Australia and New Zealand. Including

Recommended Dietary Intakes. 2006:317.


Therapeutic Uses of low Sodium diet

• Research has found that a high sodium diet is

associated with increased urinary cortisol,

hypertension, insulin resistance, dyslipidaemia and

hypoadiponectinaemia individual and collective

predictors of metabolic syndrome

(Baudrand 2013)

• A diet that includes modest salt restriction while

increasing potassium intake serves as a strategy to

prevent or control hypertension and decrease

cardiovascular morbidity and mortality

(Aaron & Sanders 2013)


Review Questions

1. List the foods highest sodium

2. What are the main functions of sodium?

3. Which factors may increase the demand for

sodium intake?

4. How might excessive sodium intakes manifest?

5. Name some of the signs of sodium deficiency?


Chloride

http://commons.wikimedia.org/w

iki/File:Acetyl-chloride.png

http://upload.wikimedia.org/wikipedia/commons/d/d8/Acetyl-chloride.png

http://upload.wikimedia.org/wikipedia/commons/d/d8/Acetyl-chloride.png


Chloride

• 88% is found in extracellular fluid, 12% is

intracellular.

• Neutralises the positive charge of sodium.

• Foods rich in sodium also rich in chloride.

• Abundant in most foods particularly processed

foods.


Functions

• Electrolyte balance

• The major anion in ECF and helps to maintain

osmotic pressure

• Transport

• Some cell membrane transporters rely on chloride for

uptake of nutrients and metabolites

• Acid production

• Large amounts of chloride is used for the production

of gastric acid, however requires adequate zinc.


Functions

• Enzyme activation

• Like sodium it is important for maintaining ionic

strength in the ECF

• Also specifically required for angiotensin-1 converting

enzyme (ACE)

• Immune defence

• Required for the generation of hypochlorous acid by

white blood cells, used in their oxidative blast of

pathogens – “respiratory burst”

(Kohlmeier, 2003)



• Water overload

• Diarrhoea and vomiting

• Wasting and trauma

• Burns

• Cystic fibrosis

• Diuretic use

• Bartter syndrome


Deficiency may cause or be

associated with:

• Hypochlorhydria

• Reduced fluid volume –

dehydration

• Metabolic alkalosis

• Potassium deficiency


Deficiency Symptoms

• Deficiency is rare.

• Losses can occur with vomiting, diarrhoea or heavy

sweating.

• Dehydration due to water deficiency can

concentrate chloride to high levels.


Review Questions

1. List the foods highest in chloride

2. What are the main functions of chloride?


chloride intake?

4. Name some of the signs of chloride deficiency?


Potassium

http://commons.wikimedia.o

rg/wiki/File:Potassium_bisulf

ite.png

http://upload.wikimedia.org/wikipedia/commons/7/7b/Potassium_bisulfite.png

http://upload.wikimedia.org/wikipedia/commons/7/7b/Potassium_bisulfite.png


PotassiumFood Levels

Avocados 6.3mg/g

Tuna 5.7mg/g

Spinach 5.6mg/g

Mackerel 4.1mg/g

Bananas 4mg/g

Salmon 3.8mg/g

Oats 3.5mg/g

Rye flour 3.4mg/g

Beef 3.0mg/g

Chicken 2.4mg/g

Wheat 1.5mg/g

Eggs 1.2mg/g


Functions

• Major intracellular mineral

• Kidneys regulate blood levels through excretion

• Aldosterone from adrenal glands increases excretion while

decreasing Na and Cl excretion

• Excitation

• Polarisation of excitable tissues more negative charge

outside than inside cell due to K fluxing out and Na in

• Assists in nerve impulse transmission and muscle

contractions

• Maintains heartbeat


Functions

• Maintains normal fluid balance

• With Na and Cl

• Co-factor in reactions

• Supports cell integrity



• Gastrointestinal disease

• Kidney disease

• Weight loss diets

• Magnesium deficiency

• Diuretics (potassium-wasting)

• Metabolic acidosis and alkalosis

• Exercise(Zimmerman, 2001)


Deficiency Symptoms

• Hypertension

• Salt sensitivity

• Kidney stones & accelerated bone turnover (Rolfes

2012)

• Low body temperature (Vargas 2000)

• Growth retardation (Zargar 2002)

• Reduced levels of growth hormone and IGF-1


Deficiency Symptoms

• Irritability and confusion (McGuire 2011)

• Glucose intolerance

(Meisinger 2013)

• Abnormal ECG (Kohlmeier, 2003)

• Cardiac arrhythmias

(Cortesi 2005)

• Low intake associated with

increased risk of stroke (Green 2002)


Toxicity

• Occurs with intakes of >12g

• Acute

• Cardiac arrhythmia, CNS paralysis, diarrhoea, fever,

polydipsia, renal necrosis, tonoclonic seizure

• Chronic

• cardiac and central nervous system depression,

flaccid paralysis of extremities, mental confusion,

tingling, weakness


RDI

NHMRC, 2009


Therapeutic Uses

• Hypertension

• Significant reduction in systolic BP in

hypertensive patients with intake of

90-120mg/day (Aburto 2013)

• Stroke

• Higher intakes of potassium

associated with 24% reduced risk of

stroke (Aburto 2013)

• Cardiac arrhythmias

• Increasing potassium levels may

attenuate arrhythmias caused by

potassium-wasting diuretics (Manz

and Susilo, 2002)


Activity

o Watch the following video on electrolytes part 2

(10 mins)

https://www.youtube.com/watch?v=G7lDP6ygGBE

https://www.youtube.com/watch?v=G7lDP6ygGBE


Review Questions

1. List the foods highest in potassium

2. What are the main functions of potassium?


potassium intake?

4. How might we recognise a potassium deficiency?

5. Name some of the therapeutic uses of potassium

in the research?


Activity• Consider your intake of sodium and potassium from

the previous 2 diet diaries you have entered into your

diet analysis programme and answer the following

questions –

1. Are there any notable differences between the 24 hour and 3

day average intake?

2. Which foods in your diet have the highest levels of sodium

and potassium?

3. In which instances would you recommend increased or

decreased intakes from the RDI? Think specific and patient

related and also from a more general context

4. Is there any specific dietary recommendations you would

make to optimise your intake? Include specific food choices

and quantities to reach your target.


References

• Aaron and Saunders. 2013. Role of dietary salt and potassium intake in cardiovascular health and

disease: a review of the evidence. Mayo Clin Proc. 88: 9; 987-95.

• Aburto et al. 2013. Effect of increased potassium intake on cardiovascular risk factors and

disease: systematic review and meta-analyses. BMJ. 346; f1378

• Braudrand et al. 2013 High sodium intake is associated with increased glucocorticoid production,

insulin resistance and metabolic syndrome. Clin Endocrinol (Oxf). Epub ahead of print

• Gropper and Smith, 2013. Advanced Nutrition and Human Metabolism. 6th Ed. Wadsworth

Cengage Learning. USA.

• Higdon J. 2003. An Evidenced Based Approach to Vitamins and Minerals. Thieme Publishing, UK.

• Kohlmeir M. 2003. Nutrient Metabolism 1st Ed. Elsevier, UK.

• Manz and Susilo. 2002. Therapy of cardiac arrhythmias. Clinical significance of potassium- and

magnesium aspartate in arrhythmias. Fortschr Med Orig. 120: 1; 11-15

• Meisinger et al. 2013. Serum potassium is associated with prediabetes and newly diagnosed

diabetes in hypertensive adults from the general population: the KORA F4-study. Diabetologia 56:

3; 484-91.


References

• Thomas, J.D., M. Garrison, and T.M. O'Neill, (2004) Perinatal choline supplementation attenuates

behavioral alterations associated with neonatal alcohol exposure in rats. Neurotoxicology and

Teratology, 26(1): p. 35-45.

• Tsujinaka, K., et al., (2005) Diet high in lipid hydroperoxide by vitamin E deficiency induces insulin

resistance and impaired insulin secretion in normal rats. Diabetes Research and Clinical Practice,

67(2): p. 99-109.

• Upston, J.M., L. Kritharides, and R. Stocker, (2003) The role of vitamin E in atherosclerosis.

Progress in Lipid Res, 42 405-22

• Whitney and Rolfes 2012. Understanding Nutrition 13th Ed. Gerling Publishing. USA.

• Wilson, D.C., et al., (2001) Treatment of vitamin K deficiency in cystic fibrosis: Effectiveness of a

daily fat-soluble vitamin combination. Journal of Pediatrics, 138(6): p. 851-855.

• Winklhofer-Roob, B.M., et al., (2003) Effects of vitamin E and carotenoid status on oxidative stress

in health and disease. Evidence obtained from human intervention studies. Molecular Aspects of

Medicine, 24(6): p. 391-402.


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Documents

NMDF121 SN18 Lecture Minerals2 · PDF file · 2017-02-23lymph, and the intra and extracellular fluid. ... Activity o Watch the following video on electrolytes part 1 (10 mins)