Chapter 13 Nutrients for Bone Healths3.amazonaws.com/prealliance_oneclass_sample/POgPrXw02M.pdf · 2014. 5. 27. · Enriched Instructor’s Manual to Accompany Understanding Nutrition,

Enriched Instructor’s Manual to Accompany Understanding Nutrition, First Canadian Edition 13-1

Chapter 13Nutrients for Bone Health

I F N O T H I N G E L S E , M Y S T U D E N T S S H O U L D L E A R N …

1. That the adequate intake of certain minerals (i.e., calcium, phosphorus, magnesium, and fluoride) is critically important for promoting and maintaining bone health.

2. The different dietary and nondietary sources for obtaining adequate amounts of vitamin D and K.

3. The basic development of osteoporosis and the various factors that contribute to the development of this degenerative bone condition. Students should develop an acute understanding that the provision of the bonehealth nutrients play an important role in diminishing agerelated losses in bone structure.

L E A R N I N G O B J E C T I V E S

Students should be able to:

• LO 13.1: Describe the role of calcium in the body and the factors that enhance or limit its absorption from the diet. [Understand/Apply]

• LO 13.2: Identify food sources of calcium and the recommended dietary intake of calcium. [Understand/Remember]

• LO 13.3: Describe the effects of calcium deficiency. [Remember]

• LO 13.4: Identify the role or phosphorus in the body, recommended intake, and food sources. [Understand/Remember]

• LO 13.5: Describe the uses of vitamin D in the body and the effects of deficiency and toxicity. [Understand/Remember]

• LO 13.6: Identify food and nonfood sources of vitamin D. [Remember/Apply]

• LO 13.7: Identify the role of magnesium in the body, food sources of magnesium, and the effects of inadequate intake. [Understand/Remember]

• LO 13.8: Explain the uses of fluoride in the body and its role in dental caries prevention. [Understand/Apply]

Copyright © 2013 by Nelson Education Ltd.


• LO 13.9: Identify the effects of fluoride toxicity and the major sources of fluoride to the body. [Understand/Remember]

• LO 13.10: Identify the role of vitamin K in the body and the effects of vitamin K deficiency and toxicity. [Understand/Remember]

• LO 13.11: List food and nonfood sources of vitamin K. [Remember/Apply]

• LO 13.12: Discuss osteoporosis, including bone development and disintegration and the two major types of osteoporosis. [Understand/Apply]

• LO 13.13: Identify the risk factors for the development of osteoporosis and the roles of physical activity and calcium intake. [Understand/Apply]

W H Y I S T H I S C H A P T E R I M P O R TA N T T O S C I E N T I S T S A N D H E A LT H C A R E P R AC T I T I O N E R S ?

“Of special interest to...” symbol key: = HealthCare Practitioners = Science Majors

• In order to prevent the development of osteoporosis, scientists have been conducting studies to examine ways to increase bone mineral density, especially in women. One way is to participate in regular physical activity, as this may be done through weight training or even gardening.

• Healthcare practitioners recognize and understand that maintaining an adequate supply of calcium in the diet is necessary in order to prevent the development of degenerative bone–related disorders in the later years of life.

• Vitamin D insufficiency is relatively common in Canada due to its northern geographical location, thereby affecting the magnitude of the sun’s energy in stimulating the skin to begin the body’s synthesis of this vitamin. For this reason, healthcare practitioners regularly counsel patients to make a conscious effort, particularly during the winter months, to increase their vitamin D intake.

• Obtaining adequate amounts of flouride in the diet is important for the development of strong bones and healthy teeth. Healthcare practitioners are well aware that an adequate intake of flouride is necessary for this function; however, excessive amounts of flouride will cause discolouration and pitting of the teeth.

• Although vitamin K deficiencies are rare, scientists are trying to determine its longterm effect on bone development and maintenance. Obtaining vitamin K, via green vegetables and vegetable oils, is recognized by healthcare practitioners to be an important part of one’s diet, as vitamin K synthesis in the gastrointestinal tract only supplies about half of our daily requirement.

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W H Y S H O U L D S T U D E N T S C A R E ?

• Vitamin D raises mineral levels in the blood, notably calcium and phosphorus, permitting bone formation and maintenance. People exposed to the sun make vitamin D from a cholesterollike compound in their skin; fortified milk is an important food source. A deficiency can cause rickets in childhood or osteomalacia in later life. Vitamin D is the most toxic of all the vitamins, and excesses are dangerous or deadly.

• Vitamin K is necessary for blood to clot, and a deficiency may lead to excessive bleeding. The bacterial inhabitants of the digestive tract produce vitamin K. Toxic levels of vitamin K can lead to jaundice.

• Calcium makes up bone and tooth structure and plays an important role in nerve transmission, muscle contraction, and blood clotting. Calcium absorption rises when there is a dietary deficiency or an increased need such as during growth.

• Most of the phosphorus in the body is in the bones and teeth. Phosphorus helps maintain acid–base balance, is part of the genetic material (DNA and RNA) in cells, assists in energy metabolism, and forms part of cell membranes. Under normal conditions, deficiencies of phosphorus are unknown.

• Most of the body’s magnesium is in the bones and can be drawn out for all the cells to use in building protein and using energy. Most people in North America fail to obtain enough magnesium from their food.

• Fluoride stabilizes bones and makes teeth resistant to decay. Excess fluoride discolors teeth; large doses are toxic.

W H AT A R E C O M M O N S T U D E N T M I S C O N C E P T I O N S / S T U M B L I N G B L O C K S ?

1. There is a common misconception that taking lots of vitamins is good for you. Students often do not realize that the fatsoluble vitamins are stored in the body and can potentially build up to toxic levels if fatsoluble vitamins are taken in excess.

2. Students often erroneously think that osteoporosis is a disease that affects females only. However, they should know that males can also be affected by the disease.

3. Although students realize that calcium is important, they often neglect to learn about the role of other minerals in bone metabolism. Handout 133 focuses on magnesium and the role this mineral has in the body.



W H AT C A N I D O I N C L A S S ?

There are a variety of activities that can be done in class. Listed below are some activities that will help introduce the topic of nutrition, and the students to each other.

Classroom Activity 131: ChapterOpening QuizObjective: Introduction to chapter Class size: Any

Instructions: As a way of introducing any new chapter, give a quiz to the class. This is a quiz designed to be projected overhead. For details, please see Chapter 1, Classroom Activity 14.

Classroom Activity 132: Examination of Nutrition Quackery Via the Internet1

Key concept: Evaluation of online nutrition information Class size: Any

Materials needed: Computer workstations with Internet access

Instructions: Instruct students to obtain information about a questionable nutritional product such as a nutrient supplement. To increase Internet skills, instruct students to obtain information via the Internet. Next, have students evaluate the claims regarding the product using antiquackery sites on the Internet (see Highlight 1 for ideas).

Classroom Activity 133: Osteoporosis Posture Simulation Key concept: Effects of osteoporosis Class size: Any

When discussing spinal fractures from osteoporosis and the resulting disfigurement, instruct students to sit up straight in their chairs. Then have them bend forward and show them by demonstrating this posture. Then tell students to try to take a deep breath. Ask students to talk about how they feel in this posture and the negative immediate and longterm health effects, including compression of organs and discomfort leading to pain. You may have a conversation regarding the negative effect on body image as well.

Classroom Activity 134: Using Bags of Flour to Display Bone Losses During OsteoporosisKey concept: Bone density Class size: Any

Materials needed: 6 clear plastic bags, 6 labels, 1 bag of flour (7250 mL/29 cups)

Instructions: Before class, obtain 6 clear plastic bags, labels, and a bag of flour. Add flour to each bag in the following amounts:

Newborn (27 grams calcium): 60 mL (¼ cup) flour

Age 10 (400 grams calcium): 875 mL (3½ cups) flour

Age 15 (800 grams calcium): 1750 mL (7 cups) flour

Adulthood (1200 grams calcium): 2750 mL (11 cups) flour

Osteoporosis (750 grams calcium): 1625 mL (6½ cups) flour

1 Activity provided by Nancy Cotugna, University of Delaware.

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When discussing the crippling disease of osteoporosis, share information regarding calcium contents in the skeleton at various life stages. State that flour is being used to represent the mineral calcium, which gives bone their strength and density.

Show the newborn bag and state that most babies are born with 27 grams of calcium in their bones. As bones grow, more calcium is needed and by age 10 (show bag) most bodies have about 400 grams of calcium. Major growth occurs during adolescence and by age 15, the bones have approximately 800 grams of calcium (show bag). By adulthood, bone density reaches a peak (show bag) of 1200 grams of calcium or 44 times more mineral than at birth. This amount is needed to support the skeleton of an adult. However, when osteoporosis occurs, people lose between 30 to 40 percent of peak bone mass and have approximately 750 grams of calcium (show bag).

This activity is an effective opening for a lecture and/or discussion regarding osteoporosis.

Classroom Activity 135: Consumer Brochures on Major Minerals2

Key concept: Nutrition messages on minerals Class size: Small to medium

Instructions: Ask students to select one of the minerals outlined in this chapter and write a threefold flyer on it that could be used for patient education.

This exercise allows students to select a mineral of interest and design a pamphlet for patient education. Limited words and creative design will be necessary so as to interest patients. The purpose of the assignment is to challenge students to limit their word usage in describing an issue or topic. This can be very challenging. Also important is the language that students use for the pamphlet, as many individuals do not understand beyond a seventh grade level of education.

Prepare the students for these factors. This type of assignment is not unusual in the dietetic profession. Help them to understand the constraints and help them to excel in language usage. When the students have completed their assignments, they should share them with their classmates so that everyone can benefit from the differing approaches to the project.

Critical Thinking Questions3

These questions will also be posted to the book’s website so that students can complete them online and email their answers to you.

1. You have been called by The Today Show, who has hired you to discuss facts about the vitamins critical for bone health. As a new media expert, you have done your homework and contacted the American Dietetic Association to ask about media training. They have given you all sorts of great information. You are ready to tackle this wonderful opportunity!

2 Activity provided by Kathleen Rourke.

3 Contributed by Kathleen Rourke.



What tips should a nutrition professional keep in mind when presenting information to the media? Write a practice “fact sheet” on the bonehealth vitamins that you could use as a basis for your presentation.

2. You are currently taking care of a patient who is a 65yearold female from Winnipeg, Manitoba. She presents with a fractured spine and states that she has lived closed up, inside, and alone for quite some time now since her husband died. Her appetite has been poor. From this information, what nutrient or nutrients might she be missing? What are your suggestions for her?

3. If an individual overdoes the intake of vitamin K, it can cause significant problems in the body. Discuss the problem with too much vitamin K for an individual physiologically.

4. Discuss the fatsoluble vitamins that play a role in bone health and outline their specific roles.

5. Discuss the relationship among the members of the following group of minerals: calcium, phosphorus, and magnesium. Discuss how the minerals are related and how the body will react to a deficiency of the minerals versus a toxicity.

6. Bone health is influenced at a young age. What can college students do to maintain excellent bone health now and into their older adult years of life?

W H AT O T H E R R E S O U R C E S A R E AVA I L A B L E ?

You can look up information about government policy as well as any health condition that you are interested in learning more about. Consult the following websites to get reliable information on the following:

• To learn more about the prevention and treatment of osteoporosis, go to the website for the Canadian Osteoporosis Society: (http://www.osteoporosis.ca). This site includes access to the most recent Canadian Medical Association guidelines for osteoporosis.

• The following link describes the Canadian government’s position on vitamin D and calcium intake: http://www.hcsc.gc.ca/fnan/nutrition/vitamin/vitadeng.php

• You can learn more about the role of fluoride in the prevention of dental caries at the Canadian Detntal Association website: http://www.cdaadc.ca/en/oral_health/faqs_resources/faqs/fluoride_faqs.asp

A N S W E R K E Y F O R A L L I N S T R U C T O R ’ S M A N UA L AC T I V I T I E S

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http://www.osteoporosis.ca/

http://www.cda-adc.ca/en/oral_health/faqs_resources/faqs/fluoride_faqs.asp

http://www.cda-adc.ca/en/oral_health/faqs_resources/faqs/fluoride_faqs.asp

http://www.hc-sc.gc.ca/fn-an/nutrition/vitamin/vita-d-eng.php


1. Answer: When talking to media experts, the nutrition professional should prepare about three “sound bites” that are short and easy to understand at a variety of consumer levels.

Second, when the media is confused or wants to approach controversial topics, the RD should stay focused on the three to four (at the most) sound bites. The RD should focus on the positive and speak in short, easytounderstand sentences for the consumers.

Students also should have also prepared a practice sheet on each of the bonehealth vitamins, such as for vitamin D, below. Each student should have his or her own practice sheet. This would be a good exercise to present in front of the class in roleplay.

Vitamin D: Known as the sunlight vitamin, vitamin D is activated in the body and works as a hormone to support bone growth and maintenance. Other functions include regulation of gene activity and cell growth. These activities influence several other areas of human illness, health, and wellness.

Milk is fortified with vitamin D; other food sources include egg yolks and fatty fish. Far and above, except for those that are bedridden, sunlight provides the best source of vitamin D.

Deficiency of vitamin D results in rickets, a bone disease that is common in third world countries. The body is very capable of regulating the level of vitamin D in the body; however, when an individual over consumes supplements of vitamin D with other sources, toxicity can occur.

2. Answer: Focusing on this chapter and the fatsoluble vitamins, one would focus on vitamin D and its role in bone health. As indicated from the small vignette, the patient has lived inside in an area that generally does not get a great deal of sunlight. She also indicates that she has stayed inside and kept to herself since her husband died. Furthermore, she has indicated that her diet has been poor, compromising her nutrient intake.

For this patient, it would be important to assess her vitamin D or calciferol status, given that she has remained inside much of the time. Chances are that she has received insufficient sunlight to activate her vitamin D, which has compromised her bone health. That, in addition to a poor diet, may have significantly compromised her bone status. While the patient is relatively young, comparatively speaking, given the information provided, it is conceivable that she has reduced her intake of vitamin D–fortified milk or other food sources. As an individual ages, lactose intolerance can become an issue. While it is unknown that this is the case with this patient, it would be important to perform a dietary assessment to determine the quantity of calcium and vitamin D intake in the diet.

Finally, it will be important to assess for any other underlying medical conditions as well as medications that could interfere with vitamin D absorption as well as calcium absorption and balance.



Assuming that the primary issues are lack of sunlight and poor diet, subsequent to the patient’s husband’s death, the patient should be put on vitamin D supplementation, encouraged to seek sunlight exposure for at least 30–60 minutes daily, and also advised to supplement her diet with vitamin D–fortified milk, assuming no dairy product issues. A calcium supplement is also recommended, especially with the added vitamin D. Longterm follow up with the patient is required to follow improvements on health status. This patient will also benefit from grief counselling and physical therapy, as allowed by her medical doctor.

3. Answer: Vitamin K functions in the body to help the blood clot, through a complex series of events. Some individuals do have problems with blood clotting and may take medication to assist their bodies in that activity. Should these same individuals also take supplemental vitamin K, they may potentiate their medications significantly.

4. Answer: Vitamins D and K all have a known role in bone health. Vitamin D has long been known for its role in bone development and maintenance, but as nutritional science has progressed, these other fatsoluble vitamins have demonstrated a role in bone health as well.

Vitamin D, most often associated with bone growth and maintenance, is a hormone that is activated in the kidneys and targets its actions on other organs such as the intestine (calcium absorption) and bone.

Vitamin D works very hard to maintain concentrations of key bone vitamins and minerals: vitamin K as well as calcium, phosphorus, magnesium, and fluoride. Through its work on target organs of the intestine, bone, and kidneys, vitamin D will ensure that the body has enough of these nutrients to support both bone health and their other functions.

Vitamin K, important for its role in the blood clotting cascade, now has another important role being accredited to it. Vitamin K participates in the development of osteocalcin, which is a marker of bone formation. Therefore, the role of vitamin K is vital to formation and maintenance of bone through its work with osteocalcin. Osteocalcin is secreted by the osteoblasts, which are the cells responsible for bone growth.

5. Answer: These three minerals are all involved in bone health in one way or another. Although many individuals think that only calcium is involved in bone health, there are actually many minerals and other nutrients involved.

While calcium is one of the primary minerals involved in bone health, for example, phosphorus is also important through its involvement in the mineralization of bone and also the entire process of calcium balance in the kidneys. The kidneys control calcium and phosphorus reabsorption. Many studies have been done on the effects of soda consumption on calcium and phosphorus, calcium consumption, and bone health. The findings conclude that those that drink lots of carbonated beverages do not have any different bone density that those that do not drink carbonated drinks at all.

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Many individuals do not consider magnesium a mineral that is involved in bone health. However, magnesium is very important in the development of bone mineralization. This is because magnesium is involved in many of the metabolic reactions that are involved in bone mineralization and bone health. So often, individuals downplay the role of dietetics in health care, yet diet is crucial to the health and wellness of each of the patients we treat. Beyond that, there is much overlap in all the minerals and how they assist each other.

6. Answer: Bone health is best influenced in the years of childhood and through the teen years. In the years between ages 8 and 12, the young child is accruing approximately 50 percent of their adult bone. Obviously, this is a critical period to influence bone growth as well as enhance what is already there.

Many young children have some advantages in that they love pizza, smoothies, and yogurtinfused treats. For those that don’t, it is a challenge for their parents. Making sure that the growing teenager consumes enough calciumrich foods can be tough but not impossible. Moreover, strong bones are key to a strong future.

During the unversity years, food habits are continually challenged as are sleep habits. Young adults should try to remember that food habits now influence their bodies later (though this is often the last thing on their minds). They should maintain a calciumrich diet by eating plenty of dairy products (and remember the evidence that calciumrich milk can help in weightloss efforts); exercise, especially using weightbearing sports; and receive adequate sleep. While sleep alone will not improve bone mass, stress does release many caustic chemicals that can change a body’s metabolism and eating habits to the disadvantage of the bones. While no one can avoid stress, longterm stress is not good for the body.

Foods and beverages that should be consumed in moderation or not at all include soft drinks and other caffeinecontaining beverages; soft drinks because of the phosphorus, and caffeine because of the potential issues with calcium absorption. Phytates in foods like spinach also tend to bind with calcium; therefore, trying to eat calciumrich meals separately from spinach salads is a good idea. Have fun with food and do not make it an enemy. It nourishes your body and mind so that you will be a better student and a healthier older adult.

Worksheet Answer KeyWorksheet 131: FatSoluble Vitamins’ Equivalent Measurements1. Twice as much.

2. In the United States, milk is fortified with 10 µg/quart of vitamin D, and there are 4 cups in a quart. If the glass holds 1 cup of milk, then 1 glass would contain 10 µg/4 = 2.5 µg = 100 IU vitamin D. Vitamin D AI for ages 950 = 5 µg/day, so you would need to drink 2 glasses of milk to obtain the AI.

3. Alphatocopherol is the only form of vitamin E that is active in the body, and the other forms are neither able to perform the same functions as alphatocopherol nor easily converted to alphatocopherol in the body.



4. Answers will vary; students may point out that about half of vitamin K needs are normally met by production of the vitamin by GI tract bacteria.

5. Answers will vary.

Worksheet 132: Chapter 13 Crossword Puzzle1. rickets

2. keratinization

3. hypercalcemia

4. xerophthalmia

5. osteomalacia

6. xerosis

7. teratogenic

8. hemolysis

9. acne

10. hemophilia

Worksheet 133: FatSoluble Vitamin Review (Internet Exercise)1. a) Toxicity can lead to increased pressure in the skull; b) Prevents damage to cell

membranes, c) Deficiency state in adults is called osteomalacia; d) Deficiency state can cause excessive bleeding.

2. False 3. True 4. a, b 5. False 6. a, b, d

Worksheet 134: How to Interpret Calcium Serum Levels (“General Research” questions)

1. 8.5 to 10.5 mg/dL

2. Ionized (active) and nonionized forms (nonactive)

3. Protein

4. Albumin

5. Magnesium, phosphate, vitamin D, and parathyroid hormone (PTH)

6. Kidney and liver

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WO R K S H E E T AC T I V I T I E S

Worksheet 131: FatSoluble Vitamins’ Equivalent Measurements

Vitamin A = 1 RAE (retinal activity equivalent) = 1 microgram of retinol = 3.33 IU (International Units) = 12 micrograms of dietary betacarotene = 2 micrograms of betacarotene supplements = 24 micrograms of other vitamin A precursor carotenoids

Vitamin D = 1 IU = vitamin D3 = 0.025 micrograms, 1 microgram of vitamin D3 = 40 IU

Vitamin E = 1 mg = 1 alphatocopherol unit

Vitamin K = DRI not defined but expressed as AI (Adequate Intake) = micrograms

There is so much discussion and confusion related to the measurements of fatsoluble vitamins that it becomes difficult for one to explain what the measurements actually indicate. In the table listed above are the common equivalent measurements for each of the fatsoluble vitamins. Consider these equivalent measurements when answering the questions below.

1. If you obtained your daily vitamin A intake from a precursor carotenoid source, how much would you have to consume as compared with obtaining your daily vitamin A from a dietary source of betacarotene?

2. How many International Units (IU) of vitamin D are contained in a glass of milk and how many glasses of milk would you have to drink in order to get the daily recommended intake of vitamin D?

3. When considering the fact that there are other tocopherols existing besides alphatocopherol in the body, why can’t you just use a food supplement containing one of them to get your daily recommended intake of vitamin E?

4. Since vitamin K does not have a specific equivalent measurement stated like the other vitamins, does it mean that the relative proportion contained in foods is less important?

5. Select one food item that you take in on a daily basis and then determine the relative equivalent measurements for the fatsoluble vitamins indicated above. Note whether or not the food items that you have selected meet the recommended dietary intakes for that nutrient.



Worksheet 132: Chapter 13 Crossword Puzzle

1 2

3

4 5

6 7

8

9

10

Across Down

1. The vitamin D–deficiency disease in children characterized by inadequate mineralization of bone

6. Abnormal drying of the skin and mucous membranes

8. Bursting of red blood cells9. A chronic inflammation of the skin’s

follicles and oilproducing glands10. A hereditary disease that is caused by a

genetic defect in which the blood is unable to clot, but has no relation to vitamin K

2. Accumulation of keratin in a tissue; a sign of vitamin A deficiency

3. High blood calcium that may develop from a variety of disorders

4. Progressive blindness caused by vitamin A deficiency

5. A bone disease characterized by softening of the bones; symptoms include bending of the spine and bowing of the legs

7. Causing abnormal fetal development and birth defects

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Worksheet 133: FatSoluble Vitamin Review (Internet Exercise)

Go to this website to answer questions 1–6: http://www.ext.colostate.edu/pubs/foodnut/09315.html.

1. Match the vitamin with its pertinent information.a. Ab. Ec. Dd. K

_____ Deficiency state can cause excessive bleeding_____ Deficiency state in adults is called osteomalacia_____ Prevents damage to cell membranes_____ Toxicity can lead to increased pressure in the skull

2. One retinol activity equivalent is equal to 10 mcg of betacarotene.a. Trueb. False

3. Symptoms of vitamin A toxicity are dizziness and blurred vision.a. Trueb. False

4. Which of the following are ways that we obtain vitamin D?a. From fortified food productsb. From sunlightc. From dark green leafy vegetables

5. The active form of vitamin K is alphatocopherol.a. Trueb. False

6. Which of the following individuals is at risk for decreased absorption of vitamin K?a. A person who is taking antibiotics for an infection.b. A person who has been having repeated bouts of diarrhea.c. A person who is eating large amounts of cauliflower.d. A person who is receiving anticoagulant therapy.


http://www.ext.colostate.edu/pubs/foodnut/09315.html


Worksheet 134: How to Interpret Calcium Serum Levels

Even though everyone recognizes the mineral calcium as being extremely important with respect to bone health, many people do not understand how calcium exists in the body; therefore, this application will help to improve your knowledge base with respect to serum calcium levels in the body. You will need to either look up the specific lab values in a laboratory diagnostic textbook or perform a Webbased search to obtain the following information.

General Research:

1. What is the total serum calcium level in the body for a healthy adult?

2. What types of calcium make up the total calcium level?

3. What macronutrient plays a role in whether or not calcium is considered to be in an active state in the body?

4. What major plasma protein is involved in the interpretation of how calcium is measured?

5. What other minerals, vitamins, and hormones play a role in calcium metabolism and should be evaluated for their impact on serum calcium levels?

6. What body systems should be evaluated for their impact on serum calcium levels?

Individual Research:

1. Determine how much calcium you take in over a twoday time period.

2. Have you met your daily recommended requirements? Why or why not?

3. What food groups are considered to be good sources of calcium in the diet?

4. Since calcium’s relationship with bone health is well established, do you take any type of calcium supplement in order to meet your dietary needs? If so, what type of calcium do you take?

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Handout 131: Iron and Calcium Intake

The two minerals most likely to fall short in the diet are iron and calcium. Interestingly, both are found in proteinrich foods, but not in the same foods. Meats, fish, and poultry are rich in iron but poor in calcium. Conversely, milk and milk products are rich in calcium but poor in iron. Including meat or meat alternates for iron and milk and milk products for calcium can help defend against iron deficiency and osteoporosis, respectively. Determine whether these food choices are typical of your diet.

Food Choices Frequency per Week

Calciumfortified foods (such as corn tortillas, tofu, cereals, or juices)

Dark green vegetables (such as broccoli)

Ironfortified foods (such as breads or cereals)

Legumes (such as pinto beans)

Meats, fish, poultry, or eggs

Milk or milk products

Nuts (such as almonds) or seeds (such as sesame seeds)

Small fish (such as sardines) or fish canned with bones (such as canned salmon)

Whole or enriched grain products

1. Do you eat a variety of foods, including some meats, seafood, poultry, or legumes, daily?

2. Do you drink at least 3 glasses of milk—or get the equivalent in calcium—every day?

Contributed by Sharon Rady Rolfes.



Handout 132: Why Does Calcium Accumulate Outside of the Teeth and Bones?

Q: What are calcifications?A: Calcifications are inappropriate deposits of calcium found in soft tissues outside of the bones and teeth. They can be made of calcium phosphate salts, calcium oxalate, and octacalcium phosphates.

Q: Where can calcifications be found?A: Calcifications can be found in kidney stones, skin, tendons, blood vessels, and heart valves (including prosthetic valves).

Q: What causes calcifications?A: Calcium deposits can occur due to injury, disease, and the aging process. Calcification in the blood vessels and the heart valves may be due to inflammation, which can stimulate white blood cells known as macrophages to secrete substances that encourage calcium deposits.

Arteriosclerosis is the stiffening of arteries that can be due to the build up of fatty plaques. These plaques can cause local inflammation of the blood vessels that can attract fibreproducing white blood cells. The resulting plaques can develop calcifications due to the buildup of calcium deposits around the fatty plaques. The calcium deposits in the arteries certainly contribute to the stiffening of the arteries that can lead to cardiovascular disease.

Q: How are calcifications treated?A: Most calcifications in the blood vessels are not treated but can be detected by imaging techniques that can detect the hard calcium deposits in soft tissue. Heart valves that have a large amount of calcification may not function properly and may need to be replaced.

Kidney stones can be removed surgically if they are larger. Smaller stones can be broken up by highenergy waves that are directed at the stones from outside of the body. The brokenup calcium deposits can pass into the urine.

Q: How can calcifications be prevented?A: People at risk of forming kidney stones are encouraged to limit their intake of organ meats that contain oxalate molecules. The oxalate molecule combines with calcium to produce the kidney stones. Calcium restriction is not necessary in order to prevent kidney stones.

People at risk for developing calcifications in their arteries are encouraged to eat a healthy diet that emphasizes fruits, vegetables, whole grains, and fish. These people may need to limit their intake of saturated fats and cholesterol as well. These dietary practices may limit inflammation of the blood vessels as well.

Some people have overactive parathyroid glands that may cause calcium levels in the blood to be too high. Such individuals can have surgery to remove some of the parathyroid gland.

Intake of calcium in the diet has very little impact in the development of calcium deposits.

References: (1) www.mayoclinic. com; (2) Giachelli, Cecila M., Ectopic Calcification: Gathering Hard Facts about Soft Tissue Mineralization. American Journal of Pathology. Volume 154. 1999, pages 671–75. (3) Shioi, Atsushi, et al. Induction of BoneType Alkaline Phosphatase In Human Vascular Smooth Muscle Cells. Circulation Research. Volume 91 (9) 2002.

Contributed by Mary Ellen Clark.

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Handout 133: Magnesium—Often Overlooked but Often Critical

Magnesium Fact Sheet

What is it? It is a mineral that is needed for many body functions.

What can it do? • Adequate levels may reduce the risk of developing diabetes.

• Adequate levels may reduce the risk of arrhythmias.• Adequate levels may reduce blood pressure.• Adequate levels may ensure strong bones.

How much per day? 400 milligrams

Sources? Whole, unprocessed foods such as spinach, yogurt, brown rice, almonds, salmon, wholewheat bread, skim milk

Do we get enough? Not usually, especially since people eat a lot of processed foods that have magnesium removed from them during processing.

Ways to get more? One should eat a lot of whole foods since any one food does not have a high level of magnesium present. Eating a variety of whole foods will help ensure that enough magnesium is taken.

Why it is so important? • Enzymes that help produce ATP energy and synthesize DNA need magnesium to function.

• Magnesium also helps to transport calcium and potassium into cells.

Used in Treatment of: High blood pressure, preeclampsia of pregnancy, heart attack, diabetes mellitus, osteoporosis, migraines, and acute asthma attacks

References: Tuft's University Health & Nutrition Letter, Volume 22 (4), June 2003, p. 1; Tuft's University Health & Nutrition Letter, Volume 21 (4), June 2003, p. 1; http://lpi.oregonstate.edu/infocenter/minerals/magnesium/

Contributed by Mary Ellen Clark.



Handout 134: RDA/AI and UL for Major Minerals Compared

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Chapter 13 Nutrients for Bone Healths3.amazonaws.com/prealliance_oneclass_sample/POgPrXw02M.pdf · 2014. 5. 27. · Enriched Instructor’s Manual to Accompany Understanding Nutrition,

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