NMDF121 SN21 Lecture Microminerals3...which prevent lipoprotein oxidation in men with lower than medial levels (Jones et al, 1997) –Raised copper enzymes SOD and ceruloplasmin •

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NMDF121

Session 21

MICROMINERALS

PART 3

Naturopathic Medicine

Department


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Topic Summary

• Microminerals:

• Manganese

• Copper

• Iron


Manganese

http://commons.wikimedia.org/wiki/File:Mang

anese(II)-chloride_tetrahydrate.png

http://upload.wikimedia.org/wikipedia/commons/4/4c/Manganese(II)-chloride_tetrahydrate.png

http://upload.wikimedia.org/wikipedia/commons/4/4c/Manganese(II)-chloride_tetrahydrate.png


Manganese

Food Amount Manganese (mg)

Wheat bran ½ cup 3.17

Brown rice, cooked 1 cup 1.68

Chickpeas 1 cup 1.60

Spinach 1 cup 1.60

Almonds ½ cup 1.53

Buckwheat ½ cup 1.05


Manganese

• Highest concentration in bones, liver, kidneys and

heart

• Found in the body between 12 and 20mg

• As with most trace elements, Mn is a cofactor for

many enzymes in the body

• Deficiency is rare and toxicity is typically from

excessive environmental exposure


Factors Increasing Demand

• Poor absorption – only

1-15%

• Limited by:

• Fibre and phytates

however to a lesser

degree than other

trace elements

• High levels of

calcium, phosphorous

and iron


Functions• Enzyme cofactor

• Manganese and magnesium may substitute each other in

many instances including transferases, kinases,

hydrolases, oxidoreductases, ligases and lyases

• Free radical control – mitochondrial MnSOD

• Cell apoptosis

• Nitrogen formation

• Involved in urea synthesis

• Also supports nitric oxide production


Functions

• Protein breakdown within the cytosol of cells

• Glycolysis and gluconeogenesis• Acetyl Co A oxaloacetate in Kreb’s cycle (Mn dependent)

• Assists in bone formation

• Cartilage formation• Required for manufacturing cartilage and other

connective tissues, including mucin


Deficiency Symptoms

• Scaly skin

• Poor bone formation in

childhood

• Faltering growth (McGuire 2011)

• Decreased cholesterol and

transient skin rashes in young

males

• Mild glucose intolerance in young

women

• Impaired reproduction and altered

CHO and fat metabolism in

animals (Insel 2011)


Toxicity

• Toxicities are associated with environmental contamination and most symptoms relate to nervous system dysfunction.

• Toxicity >1000mg

• Acute symptoms include muscle fatigue, impotence and anorexia.

• Chronic symptoms include anaemia, cirrhosis, dementia, hypertension and hypertensive headaches.


Recommended Intake

• 1mmol manganese = 55mg manganese

• RDI male adult = 5.5mg/day

• RDI female adult = 5mg/day

(NHMRC 2009)

• Safe range for therapeutic effect (adult) = 2-50mg


Review Questions

1. List the foods high in manganese

2. What are the main functions of manganese?

3. Which factors may increase the demand for

manganese intake?

4. Which nutrient may replace manganese in

numerous enzymatic reactions?

5. Name some of the signs of manganese deficiency?


Copper

http://commons.wikimedia.or

g/wiki/File:Copper.jpg

http://upload.wikimedia.org/wikipedia/commons/f/fb/Copper.jpg

http://upload.wikimedia.org/wikipedia/commons/f/fb/Copper.jpg


Copper

Food Amount Copper (mg)

Beef liver 85g 3.77

Peanuts ½ cup 1.59

Walnuts 1 cup 1.58

Sunflower Seeds ¼ cup 1.40

Sardines 1 can 1.01


Copper

• The copper content of food varies widely, reflecting

the origin of the food and the conditions under which

the food was produced, handled and prepared

• 50-80% absorption occurs through ingestion

• Absorption increases with decreased intake

• Amino acids histidine and cysteine enhance absorption

• Organic acids enhance solubility and hence absorption eg.

citric, lactic, acetic


Factors Increasing Demand

• Antacid usage

• Proton pump inhibitors

• Zinc supplementation

• >40mg impairs absorption and

diminishes status

• Copper supplementation for 2

months after discontinuation of

zinc supplementation >100mg for

10 months failed to correct

copper deficiency (Hoffman 1988)


Functions

• Connective tissue formation

• Lysyl oxidase generates cross-links between

connective tissue proteins collagen and elastin

• Dopamine to noradrenalin synthesis


• Activation of hormones

• Calcitonin, gastrin and CCK

• Tyrosine metabolism

• Melanin pigment production

• Antioxidant

• Ceruloplasmin

• CuZnSOD in cytoplasm

Functions


Functions

• Immune system function

• T cell function and

maturation

• Energy production

• Cytochrome c oxidase

• Electron transport chain

• Cardiovascular

• Heart muscle contractility

• Platelet function

• Capillary health


Deficiency Symptoms

• Hair and skin depigmentation

• Lack of eyelashes and eyebrows

• Inelastic skin

• Distended blood vessels

(Ryan 1996)

• Hypochromic anaemia when unresponsive to iron

therapy

• Copper is required for iron metabolism


Toxicity

• >250mg Acute

• Fever, hypotension, oliguria, tachycardia,

uraemia.

• Wilson’s disease

• Results in cirrhosis, copper deposits in the brain

causing tremors, rigidity, dysarthria, and

eventually dementia.

(Shils et al, 2006)


Therapeutic Uses

• Cardiovascular disease

• Copper supplementation increases the activity of enzymes

which prevent lipoprotein oxidation in men with lower than

medial levels (Jones et al, 1997)

– Raised copper enzymes SOD and ceruloplasmin

• Increased HDL’s and decreased homocysteine levels in

men with high cholesterol levels

• Supplementation also lowered mean oxidised LDL values,

but not consistently (DiSilvestro 2012)


Therapeutic Uses

• Antioxidant

• Copper may protect red blood cells from oxidation, but not

through Cu/Zn superoxide dismutase activity

– May occur from changes in membrane antioxidant content

(Rock 2000)

• Burn injury

• Copper may marginally attenuate the loss of ceruloplasmin

due to burn injuries. (Cunningham 1996)


Recommended Intake

• 1 mmol copper = 63.5 mg copper

• RDI

• Adult male = 1.7mg/day

• Adult female = 1.2mg/day

• Safe range for therapeutic effects = 2-5mg

• UL 10mg/day


Review Questions

1. List the foods high in copper

2. What are the main functions of copper?

3. How has copper been utilised therapeutically in the

research?

4. Name some of the signs of copper deficiency?


Iron

http://commons.wikimedia.org/wiki/File:%C5%BDelezo.PNG


Iron

Food Levels

Beef 0.019mg/g

Chicken 0.012mg/g

Pork 0.009mg/g

Tuna 0.009mg/g

Baked beans 0.003mg/g


Iron• Haeme iron

• Found in foods that are from the flesh of animals (meat, poultry, and fish)

• Represents only 10% of a day’s iron consumption, but has an absorption rate of 25%

• Nonhaeme iron

• Found in plant-derived and animal-derived foods

• Has an absorption rate of 17%

• Haeme iron is better absorbed but nonhaeme iron

absorption can be enhanced


Iron

© 2009 Cengage - Wadsworth


Iron

• Number of factors that assist

in enhancing iron absorption:

• MFP factor

• Vitamin C

• Citric and lactic acid from

foods

• HCl from the stomach

• Sugars


Functions

• Oxygen transport and storage

• Haemoglobin and myoglobin

• Energy production• Involved in ATP production via the electron transport chain

• Free radical metabolism• Free iron is a particularly strong catalyst for the generation

of various oxygen free radicals.

• Iron-dependent enzymes catalase and peroxidase can

neutralise the free radicals generated by free iron.


Functions

• DNA synthesis

• Thyroid hormone synthesis

• Vitamin A metabolism

• Converts beta carotene to vitamin A

• Amino acid metabolism

• Catacholamines, melanin, carnitine, choline, nitric oxide,

procollagen synthesis


Factors Increasing Demand• Growth periods

• Vegetarians

• Coffee and tea consumption

• Hypochlorhydria

• Heavy/chronic bleeding

• Athletes

• Chronic inflammation or illness

• Nutrient deficiencies – Vitamin A, B6, Cu (Zimmerman, 2001)


Absorption Inhibiting Factors

• Polyphenols can reduce nonhaeme iron absorption by up to 50%• Coffee consumption with or just after meals may reduce

absorption by 40%

• High levels of phytates and oxalates complex with iron leading to reduced absorption. • Fermentation of grains reduces phytate content

• Heating oxalates reduces binding capacity

• Other minerals• calcium, zinc, manganese

(Gropper 2013)


Deficiency

• Iron deficiency is the most common nutrient deficiency affecting a range of individuals in many stages of life.

• Women in reproductive years

• Pregnant women

• Infants and young children

• Teenagers


Deficiency• Iron deficiency = depletion of body’s iron stores.

• Iron deficiency anaemia (IDA) = severe depletion of iron

stores and is also known as microcytic (small) and

hypochromic (pale) anaemia.

• General symptoms of iron deficiency include:

• Fatigue and weakness

• Impaired cognitive function

• Behavoiural disturbances

• Pallor, listlessness


Deficiency Symptoms

• Iron Deficiency and Pica• Generally found in women and children from low-

income groups

• Eating ice, clay, paste, and other nonfood substances

• Eating nonfood substances will not correct the deficiency.

• Prevalent in some Australian Indigenous communities due to IDA.


Activity

o Watch the following video: Iron deficency

anemia diagnosis

https://www.youtube.com/watch?v=2duGAcN0n

qw

o While watching the video, make notes on:

• The roles of iron in the body

• The forms of iron tested, and

• The causes of iron deficiency

https://www.youtube.com/watch?v=2duGAcN0nqw


Toxicity

• Toxicity caused by• Haemochromatosis

• Repeated blood transfusions

• Massive doses of supplemental iron

• Rare metabolic disorders

• >1000mg acute• Fatigue, apathy, headaches and increased respiration.

• Chronic• Arthritis, anorexia, increased oxidative stress, cancer and

heart disease, liver damage, metabolic acidosis, Alzheimer’s and Parkinson’s disease.


Further Information

Log on to http://www.irondisorders.org/iron-

overload

and learn more about iron overload

http://www.irondisorders.org/iron-overload


Therapeutic Uses

• Iron deficiency on manifestations of CVD

• 200mg for 3 weeks only plus dietary recommendations

• Improvements in angina and tolerance to physical exercise

• Decreased severity of oedema, dyspnoea, palpitations

(Belousova 2012)

• Diarrhoea and respiratory infections in Chinese children

• Supplementation with iron and vitamin A in combination

significantly decreased illness more than either supplement

alone or placebo over 6 months

(Chen 2013)


Therapeutic Uses

• Lead poisoning

• Reduces risk

(Kwong 2004)

• Cognitive function in children with

poor iron status

• Improved verbal and non verbal learning

memory

• In both anaemic and non anaemic South

African children

(Baumgartner 2012)


Recommended Intake

• 1 mmol iron = 55.8 mg iron

• RDI

• Adult men = 8mg/day

• Adult women 19-50years old = 18mg/day

• Adult women 51+ years old = 8mg/day

• Pregnancy 27mg/day

• Breastfeeding 9mg/day

• Safe range for therapeutic effect = 15 to 45mg

• UL 45mg/day


Review Questions

1. List the foods high in iron

2. What are the main functions of iron?

3. Which factors may increase the demand for iron

intake?

4. How has iron been utilised therapeutically in the

research?

5. Name some of the signs of iron deficiency?


Activity

• Consider your intake of iron 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 iron?

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

• Baumgartner 2012. Effects of iron and n-3 fatty acid supplementation, alone and in combination,

on cognition in school children: a randomized, double-blind, placebo-controlled intervention in

South Africa. Am J Clin Nutr. 96: 6; 1327-38

• Belousova et al. 2012. The influence of correction of iron metabolism and erythron characteristics

in mild iron deficiency states on clinical manifestations of coronary heart disease. Klin Med (Mosk)

90:1; 41-6

• Chen et al 2013. Effect of simultaneous supplementation of vitamin A and iron on diarrheal and

respiratory tract infection in preschool children in Chengdu City, China. Nutrition. 29:10; 1197-203

• Cunningham, J. J., Lydon, M. K., Emerson, R. and Harmatz, P. R. (1996) Low ceruloplasmin

levels during recovery from major burn injury: Influence of open wound size and copper

supplementation, Nutrition, 12, 83-88.

• DiSivestro 2012. A randomized trial of copper supplementation effects on blood copper enzyme

activities and parameters related to cardiovascular health. Metabolism 61:9 1242-6


References

• Gropper et al 2013. Advanced Nutrition and Human Metabolism. Wadsworth Cengage Learning,

USA.

• Hoffman et al 1988. Zinc-induced copper deficiency. Gastroenterology. 94: 508-12

• Insel et al 2011. Nutrition 4th ed. Jones and Bartlett Publishers. USA

• Jones, A. A., DiSilvestro, R. A., Coleman, M. and Wagner, T. L. (1997) Copper supplementation of

adult men: effects on blood copper enzyme activities and indicators of cardiovascular disease risk,

Metabolism, 46, 1380-1383.

• Lowe, J. F. and Frazee, L. A. (2006) Update on Prostate Cancer Chemoprevention,

Pharmacotherapy, 26, 353-359.

• McGuire and Beerman 2011. Nutritional Sciences: From fundamentals to food. Wadsworth

Cengage Learning. USA.

• Rock, E., Mazur, A., O’connor, J. M., Bonham, M. P., Rayssiguier, Y. and Strain, J. J. (2000) The

effect of copper supplementation on red blood cell oxidizability and plasma antioxidants in middle-

aged healthy volunteers, Free Radical Biol Med, 28, 324-9

• Ryan AS, Goldsmith LA (1996) Nutrition and the skin. Clinics in Dermatology 14: 389-406.


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NMDF121 SN21 Lecture Microminerals3...which prevent lipoprotein oxidation in men with lower than medial levels (Jones et al, 1997) –Raised copper enzymes SOD and ceruloplasmin •