Chapter 09

Nutrients Involved inFluid and Electrolyte Balance

Fluid & Electrolyte Balance: Lecture OutlineFluid & Electrolyte Balance: Lecture Outline

• Fluid– Intracellular vs.

Extracellular Fluid• Electrolytes

– Acid-Base Balance• Water

– Functions– Balance– Intake & Output– Sources

• Electrolyte Minerals– Sodium (Na)– Potassium (K)– Chloride (Cl)

• Nutrition and Your Health– Minerals and

Hypertension

Fluid and Electrolyte Balance:Fluid and Electrolyte Balance:Intracellular vs. Extracellular FluidIntracellular vs. Extracellular Fluid

•• Cell membranes are permeableCell membranes are permeable

•• Intracellular Fluid:Intracellular Fluid:

–– Water found inside the cellWater found inside the cell–– Accounts for 63% of body fluidAccounts for 63% of body fluid

•• Extracellular Fluid:Extracellular Fluid:

–– Water outside the cell is located in either:Water outside the cell is located in either:•• Fluid portion of blood (plasma) & lymph (7%) orFluid portion of blood (plasma) & lymph (7%) or•• Interstitial fluid, the fluid between cells (30%)Interstitial fluid, the fluid between cells (30%)

Water Movement Between Fluid Compartments

Digestive tract

Bloodstream BloodstreamTissue fluid Lymph

Intracellularfluid

Fluid and Electrolyte Balance:Fluid and Electrolyte Balance:Ion Concentration & ElectrolytesIon Concentration & Electrolytes

•• Ion concentration controls how much Ion concentration controls how much water is inside vs. outside of cellswater is inside vs. outside of cells

•• Ions dissolve in water and are Ions dissolve in water and are positively (+) or negatively (positively (+) or negatively (--) charged) charged

•• Charged ions transfer electrical Charged ions transfer electrical current and are called current and are called electrolyteselectrolytes

Fluid and Electrolyte Balance:Fluid and Electrolyte Balance:ElectrolytesElectrolytes

The primaryThe primaryextracellular ions are:extracellular ions are:

•• Sodium (NaSodium (Na++))

•• Chloride (Chloride (ClCl--))

The primary The primary intracellular ions are:intracellular ions are:

•• Potassium (KPotassium (K++))

•• Phosphate (POPhosphate (PO44--))

K+ HPO4=

Mg++

Protein

HCO3–

Cl–Na+

Na+

Ca++

HCO3–

SO4–

Cl– Organic acids

Negatively (–) charged electrolytesPositively (–) charged electrolytes

Extracellular Fluid

SO–4

Protein

Organic acids

HPO4–

Mg++Ca++ K+

Positively (+) charged electrolytes Negatively (–) charged electrolytes

Intracellular Fluid

OsmosisOsmosis

•• Passage of water from a low electrolyte Passage of water from a low electrolyte concentration to an area of high electrolyte concentration to an area of high electrolyte concentrationconcentration

–– If solute concentration inside cell is greater than If solute concentration inside cell is greater than outside: water flows in, causing the cell to swelloutside: water flows in, causing the cell to swell

–– If concentration outside cell is greater than inside: If concentration outside cell is greater than inside: water flows out, causing the cell to shrinkwater flows out, causing the cell to shrink

Electrolytes & Nerve FunctionElectrolytes & Nerve Function

•• Electrolytes control nerve impulse Electrolytes control nerve impulse conductionconduction

•• All membranes can pump sodium (NaAll membranes can pump sodium (Na++) from ) from inside to outside the cellinside to outside the cell

•• When NaWhen Na++ is pumped out of the cell, Kis pumped out of the cell, K++

enters to balance lose of + charged Naenters to balance lose of + charged Na++

•• Inside of cell then has slight Inside of cell then has slight –– chargecharge

•• Difference in charge allows for nerve Difference in charge allows for nerve impulse transmissionimpulse transmission

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K+

Cell body Nerve fiber

(a) Resting state

Direction of nerve impulse

(b) Depolarization

(c) RepolarizationPump

Na+

Na+

+ + + + - - - -- - - - -

- - - - - - - -+ + + - -

- - - - - - - -- - - - -

Electrolytes & AcidElectrolytes & Acid--Base BalanceBase Balance

•• pH is determined by concentration of pH is determined by concentration of HH++ ionsions

•• Acids are produced as byproduct of Acids are produced as byproduct of nutrient metabolismnutrient metabolism

•• Acids must be neutralized to maintain Acids must be neutralized to maintain pHpH

•• Normal extracellular pH: 7.4Normal extracellular pH: 7.4

Electrolytes & AcidElectrolytes & Acid--Base Balance: AcidosisBase Balance: Acidosis

•• Body accumulates too much acid Body accumulates too much acid →→ acidosisacidosis

•• Acidosis = pH below 7.35Acidosis = pH below 7.35

•• Symptoms: disorientation & fatigueSymptoms: disorientation & fatigue

•• Can occur in:Can occur in:

–– Poorly controlled diabetesPoorly controlled diabetes–– StarvationStarvation–– DiarrheaDiarrhea–– Excessive COExcessive CO22 production (ex: production (ex:

emphysema)emphysema)

Electrolytes & AcidElectrolytes & Acid--Base Balance: AlkalosisBase Balance: Alkalosis

•• When body loses too much acid When body loses too much acid →→ alkalosisalkalosis

•• Less often than acidosis, still criticalLess often than acidosis, still critical

•• Alkalosis = pH above 7.45Alkalosis = pH above 7.45

•• Symptoms: agitation & dizzinessSymptoms: agitation & dizziness

•• Can occur in:Can occur in:–– Diuretic useDiuretic use–– VomitingVomiting–– Breathing off too much OBreathing off too much O22 (ex: pneumonia (ex: pneumonia

or altitude sickness)or altitude sickness)

Buffers Resist Change in pHBuffers Resist Change in pH

•• Two classes of buffers / chemical or physiologicTwo classes of buffers / chemical or physiologic

•• Proteins are buffers: may bind & release HProteins are buffers: may bind & release H++ to control pHto control pH

•• Respiratory system is buffer: can Respiratory system is buffer: can ↑↑ or or ↓↓ amount of CO2 amount of CO2 exhaled during breathing exhaled during breathing

•• Electrolytes function in the kidneys to help buffer: they Electrolytes function in the kidneys to help buffer: they control release of acid & base in urine to maintain pH control release of acid & base in urine to maintain pH (exchange H+ for another (exchange H+ for another cationcation / in process excrete H+ to / in process excrete H+ to remove H+ from body)remove H+ from body)

1717

Some Words About WaterSome Words About Water……

•• HH22O: 2 molecules of Hydrogen, 1 OxygenO: 2 molecules of Hydrogen, 1 Oxygen

•• Most abundant molecule in your bodyMost abundant molecule in your body

•• Your body can lose water through lungs, Your body can lose water through lungs, skin, urine and fecesskin, urine and feces

•• Your body cannot store waterYour body cannot store water

•• Universal Universal solventsolvent: where other substances : where other substances can dissolvecan dissolve

Functions of WaterFunctions of Water• Medium for chemical reactions

• Participates in chemical reactions

• Distributes nutrients to cells

• Removes waste products from cells

• Lubricant for joints

• Moistens organs, GI tract, eyes, skin

• Maintains body temperature

• Maintains blood volume

Functions of WaterFunctions of Water

Acid-basebalance

Chemicalreactions

Lubricant

Distribution ofnutrients

Temperatureregulation

Removal of wasteproducts

Component ofbody fluids

2121

Water is the Main Constituent of the BodyWater is the Main Constituent of the BodyCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

74 pounds of water (57%)

17 pounds of protein (13%)

32 pounds of fat (25%)

7 pounds of minerals (5%)

1 pound of glycogen (<1%)

105 pounds of water (62%)

27 pounds of protein (16%)

27 pounds of fat (16%)

10 pounds of minerals (6%)

1 pound of glycogen (<1%)

Healthy Man (170 pounds) Healthy Woman (130 pounds)

© Digital Vision / Getty Images RF

Functions of Water:Functions of Water:Temperature RegulationTemperature Regulation

•• When overheated:When overheated:

–– Body perspiresBody perspires–– Sweat evaporates Sweat evaporates

through poresthrough pores–– Heat energy removed Heat energy removed

from skinfrom skin–– Body is cooledBody is cooled

Functions of Water:Functions of Water:Transports NutrientsTransports Nutrients

•• Transports nutrients to cellsTransports nutrients to cells

•• Removes waste products Removes waste products from cellsfrom cells

Functions of Water:Functions of Water:Transports Nutrients Transports Nutrients (1 of 2)(1 of 2)

•• Protein Protein

–– Protein breakdown produces HProtein breakdown produces H22O & COO & CO22

–– Nitrogen part of protein canNitrogen part of protein can’’t be used for t be used for energy energy –– has to be excreted as ureahas to be excreted as urea

–– ↑↑ protein intake requires protein intake requires ↑↑ water intakewater intake

Functions of Water:Functions of Water:Transports Nutrients Transports Nutrients (2 of 2)(2 of 2)

• Sodium

– ↑ sodium consumption = ↑ sodium excretion in urine

• Note: Amount of urine produced is determined primarily by

– excess protein / deaminate & excrete nitrogen– excess sodium / retain water / increase blood

pressure / renin inhibits aldosterone & sodium excreted from kidneys

Functions of Water:Functions of Water:Urine ProductionUrine Production

•• Typical urine production: 1Typical urine production: 1--1.5 liter1.5 liter

•• Less than 500 ml (2 cups) = concentrated Less than 500 ml (2 cups) = concentrated urine & urine & ↑↑ work by kidneyswork by kidneys

•• Best way to determine adequacy of fluid Best way to determine adequacy of fluid intake is to observe urine color:intake is to observe urine color:

–– Clear or light yellow is good hydrationClear or light yellow is good hydration–– Dark yellow and pungent is poor hydrationDark yellow and pungent is poor hydration

Functions of Water:Functions of Water:Urine ProductionUrine Production

Functions of Water: LubricantFunctions of Water: Lubricant

• Water-based lubricants include:

– Saliva: helps food pass from esophagus → stomach

– Mucus: protective coating through GI tract & lungs

– Lubricating fluids in knees & other joints

– Cerebral spinal fluid: spinal cord & brain

– Amniotic fluid

Water BalanceWater Balance

•• Muscle is 73% waterMuscle is 73% water

•• Adipose tissue is 10Adipose tissue is 10--20% water20% water

•• Bone is approximately 20% waterBone is approximately 20% water

•• Human body contains 50Human body contains 50--70% water70% water

•• As fat content As fat content ↑↑, % of lean tissue , % of lean tissue ↓↓ & total body water & total body water ↓↓

•• Extremely lean athletes = 70% body waterExtremely lean athletes = 70% body water

Water Balance:Water Balance:Increased Fluid NeedsIncreased Fluid Needs

•• AthletesAthletes

•• FeverFever

•• VomitingVomiting

•• DiarrheaDiarrhea

•• Older adultsOlder adults

•• Hot humid conditionsHot humid conditions

Water Balance:Water Balance:ThirstThirst

•• Controlled by your hypothalamusControlled by your hypothalamus

•• Thirst is an indicator you are Thirst is an indicator you are already dehydratedalready dehydrated

•• Hypothalamus sensitivity Hypothalamus sensitivity ↓↓ with with age = age = ↑↑ risk for dehydration in risk for dehydration in elderlyelderly

Water Balance:Water Balance:Hormones Hormones (1 of 2)(1 of 2)

•• AntidiureticAntidiuretic hormone (ADH)hormone (ADH)

–– Secreted by pituitary gland Secreted by pituitary gland when blood volume is when blood volume is ↓↓

–– Tells kidneys to Tells kidneys to ↓↓ water water excretion which in turn excretion which in turn ↑↑ blood blood volumevolume

Water Balance:Water Balance:Hormones Hormones (2 of 2)(2 of 2)

•• AldosteroneAldosterone

–– Produced by adrenal glandsProduced by adrenal glands

–– Tells kidneys to conserve sodium & waterTells kidneys to conserve sodium & water

Water Balance:Water Balance:DehydrationDehydration

• 1-2% body water loss → feeling of thirst

• 4% loss → tired, dizzy, headache

• 10% loss → heat tolerance ↓ & weakness

• Dehydration leads to:– Kidney failure– Coma– Death

Dehydration, Thirst, and Rehydration

The Effects of DehydrationThe Effects of DehydrationCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Bod

y w

eigh

t los

t (%

)

8

6

4

2

0

Stronger thirst, vague discomfort and sense of oppression, loss of appetite,increasing hemoconcentration.

Thirst.

Less movement.Lagging pace, flushed skin, impatience; in some, weariness and sleepiness,apathy; nausea, emotional instability.

Tingling in arms, hands, and feet; stumbling, headache; heat exhaustion(symptoms: faintness, dizziness, fatigue, nausea, headache, increased bodytemperature, pulse, and respiratory rate).

Labored breathing, dizziness, cyanosis (bluish color of skin caused bypoor oxygen flow in body).Indistinct speech.Increasing weakness, mental confusion.

Muscle cramps; inability to balance with eyes closed; general incapacity.Delirium and wakefulness; swollen tongue.Circulatory insufficiency; marked hemoconcentration and decreased bloodvolume; failing kidney function.

Increasing risk of death, especially if associated with illness or extreme heatand exercise.

> 10

10

Water IntakeWater Intake

•• Water AI for women: Water AI for women: –– 2.7 liters/day (11 cups)2.7 liters/day (11 cups)

•• Water AI for men: Water AI for men: –– 3.7 liters/day (15 cups)3.7 liters/day (15 cups)

•• Water comes from food & waterWater comes from food & water–– Fluid needs for women are therefore:Fluid needs for women are therefore:

•• 2.2 liters (9 cups)2.2 liters (9 cups)

–– Fluid needs for men are therefore:Fluid needs for men are therefore:•• 3 liters (13 cups)3 liters (13 cups)

Water Intake:Water Intake:Water Content of FoodsWater Content of Foods

3838

100%75%50%25%0%

% water by weight

BeerJam

HoneyChicken

SteakMilk

ButterOrange

AppleBananaTomatoLettucePotatoBread

Crackers

Key:GrainsVegetablesFruitsDairyProteinOils

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© Digital Vision / Getty Images RF

Water LossWater Loss

•• Through skin as perspirationThrough skin as perspiration

•• From lungsFrom lungs

•• Small amount lost in fecesSmall amount lost in feces

Fluid BalanceIntake

2,500 mL/dayOutput

2,500 mL/day

Metabolic water200 mL

Feces200 mL

Expired air300 mL

Cutaneoustranspiration

400 mL

Sweat 100 mL

Urine1,500 mL

Drink1,600 mL

Food700 mL

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Water BalanceWater Balance

Sources of WaterSources of Water

•• EPA regulates public water suppliesEPA regulates public water supplies

•• FDA regulates bottled waterFDA regulates bottled water

•• Safety: Safety:

–– bottled water and tap water are similar bottled water and tap water are similar in safetyin safety

–– bottled water is processed from tap bottled water is processed from tap waterwater

–– bottled water does not contain fluoridebottled water does not contain fluoride

Nutrients Involved in Fluid Nutrients Involved in Fluid and Electrolyte Balanceand Electrolyte Balance

•• Sodium (Na)Sodium (Na)•• Potassium (K)Potassium (K)•• Chloride (Chloride (ClCl))

Sodium (NaSodium (Na++))

•• Table salt = sodium chloride = Table salt = sodium chloride = NaClNaCl

–– 40% sodium40% sodium–– 60% chloride60% chloride

•• 1 tsp of salt = 2,400 mg sodium1 tsp of salt = 2,400 mg sodium

Sodium: FunctionsSodium: Functions

•• Adds flavor to foodsAdds flavor to foods

•• Preserves foodPreserves food

•• Helps maintain fluid balanceHelps maintain fluid balance

•• Helps nerve impulse conductionHelps nerve impulse conduction

•• Helps absorption of some Helps absorption of some nutrients (ex: glucose)nutrients (ex: glucose)

Sodium: DeficiencySodium: Deficiency

•• Groups at risk:Groups at risk:

–– Low sodium dietLow sodium diet–– Excessive sweating Excessive sweating

(ex: athletes)(ex: athletes)–– Persistent vomiting or Persistent vomiting or

diarrheadiarrhea

•• Symptoms:Symptoms:

–– Muscle crampsMuscle cramps–– Nausea and vomitingNausea and vomiting–– DizzinessDizziness–– Shock Shock –– ComaComa

Sodium: Nutrient NeedsSodium: Nutrient Needs

•• DRI:DRI:–– For adults under age 51: 1,300 mg/dayFor adults under age 51: 1,300 mg/day–– For adults aged 51For adults aged 51--70: 1,300 mg/day70: 1,300 mg/day–– For adults aged 71+: 1,200 mg/dayFor adults aged 71+: 1,200 mg/day

•• Average American consumption:Average American consumption:–– 2,300 2,300 -- 4,700 mg/day4,700 mg/day

•• DV on food labels based on:DV on food labels based on:–– 2,400 mg/day2,400 mg/day

•• To lower blood pressure:To lower blood pressure:–– 2,000 mg/day or less2,000 mg/day or less

Sodium Intake: 2010 Dietary Sodium Intake: 2010 Dietary Guidelines for AmericansGuidelines for Americans

•• <2,300 mg per day: <2,300 mg per day: –– General populationGeneral population

•• <1,500 mg per day:<1,500 mg per day:–– African AmericansAfrican Americans–– MiddleMiddle--aged or older adultsaged or older adults–– Those with hypertension, Those with hypertension,

diabetes or chronic kidney diabetes or chronic kidney diseasedisease

Food Sources of SodiumFood Sources of Sodium

•• High sodium foods:High sodium foods:

–– Packaged foodsPackaged foods–– Processed foodsProcessed foods–– Fast foodFast food–– Canned foodsCanned foods–– Frozen, ready Frozen, ready

prepared foods (ex: prepared foods (ex: pizza)pizza)

•• Low sodium foods:Low sodium foods:

–– Fruits & vegetablesFruits & vegetables–– Whole grainsWhole grains–– Meats w/o saucesMeats w/o sauces–– Unprocessed foodsUnprocessed foods

Food Sources of SodiumFood Sources of Sodium

* For adults; see the DRI table in the back of this book forage-specific recommendations.

ProteinDairyFruitsVegetablesGrains

Key:

Adult Male and FemaleAI = 1500 milligrams

Daily Value = 2400 milligrams%AI

Food Itemand Amount

SodiumContent

(milligrams)

AI*

Pepperoni pizza , 2 slices

Ham, sliced, 1 ounce

Chicken noodle soup,canned, 1 cup

V8 vegetable juice, 8 ounces

Macaroni salad, ½ cup

Hard pretzels, 1 ounce

Hamburger with bun, 1 each

Green beans, canned, ½ cup

Saltine crackers, 6 each

Cheddar cheese, 1 ounce

Peanut butter, 2 tablespoons

Nonfat milk, 1 cup

Seven-grain bread, 1 slice

Animal crackers, 1 ounce

Grape juice, 1 cup

1500

2045

1215

1106

620

561

486

474

390

234

176

156

127

126

112

10 1%

7%

8%

8%

10%

12%

16%

26%

32%

32%

37%

41%

74%

81%

136%

ChooseMyPlate.gov

100%

Added to foods duringfood processing or in

restaurant meals

77%

12%

6%

5%

Added to foods duringcooking at home

Added to food at the table

Present in foods naturally

Sodium in food

Sodium: ExcessSodium: Excess

•• ↑↑ urine output & can lead to dehydrationurine output & can lead to dehydration–– Normal 5g excreted dailyNormal 5g excreted daily–– Hypertension decreases Hypertension decreases reninrenin result in result in uptoupto

25g excreted daily25g excreted daily

•• ↑↑ blood pressure indicates high sodiumblood pressure indicates high sodium

•• UL: UL: 2,300 mg/day2,300 mg/day

–– Note that the DV (2,400 mg) is > ULNote that the DV (2,400 mg) is > UL–– Healthier goal: aim for the AI (1,500 mg)Healthier goal: aim for the AI (1,500 mg)

Potassium (K): FunctionsPotassium (K): Functions

•• Water BalanceWater Balance

•• Nerve impulse transmissionNerve impulse transmission

•• Principal positively charged Principal positively charged intracellular ionintracellular ion

•• ↑↑ potassium intake can help potassium intake can help ↓↓ BPBP

Potassium: DeficiencyPotassium: Deficiency

•• Can be caused from:Can be caused from:

–– Chronic diarrheaChronic diarrhea–– VomitingVomiting–– Laxative abuseLaxative abuse–– Alcohol abuseAlcohol abuse–– Eating disordersEating disorders–– Very low calorie dietsVery low calorie diets

•• Symptoms include:Symptoms include:

–– Loss of appetiteLoss of appetite–– Muscle crampsMuscle cramps–– ConfusionConfusion–– ConstipationConstipation–– Irregular heart beatIrregular heart beat

Potassium: Nutrient NeedsPotassium: Nutrient Needs

•• AI for adults:AI for adults:

–– 4,700 mg4,700 mg

•• DV used on labels:DV used on labels:

–– 3,500 mg3,500 mg

•• Typical North American consumption:Typical North American consumption:

–– 2,0002,000--3,000 mg/day3,000 mg/day

Food Sources of PotassiumFood Sources of Potassium

•• Unprocessed foodsUnprocessed foods

–– FruitsFruits–– VegetablesVegetables–– MilkMilk–– Whole grainsWhole grains–– Dried beansDried beans–– meatsmeats

•• Major contributors in Major contributors in the diet include:the diet include:

–– MilkMilk–– PotatoesPotatoes–– BeefBeef–– CoffeeCoffee–– TomatoesTomatoes–– Orange juiceOrange juice

Food Sources of PotassiumFood Sources of PotassiumAdult Male and Female

AI = 4700 milligrams

Daily Value = 3500 milligrams%AI

Food Itemand Amount

Potassium(milligrams)

100%AI*

Kidney beans, 1 cup

Winter squash, ¾ cup

Plain yogurt, 1 cup

Orange juice, 1 cup

Cantaloupe, 1 cup

Lima beans, ½ cup

Banana, 1 medium

Zucchini, 1 cup

Soybeans, ½ cup

Artichoke, 1 medium

Tomato juice, ¾ cup

Pinto beans, ½ cup

Baked potato, 1 small

Buttermilk, 1 cup

Sirloin steak, 3 ounces

* For adults; see the DRI table in the back of this book forage-specific recommendations.

VegetablesFruitsDairyProtein

Grains

Key:

7%

8%

8%

9%

9%

9%

9%

10%

10%

10%

11%

11%

12%

14%

15%

4700

715

670

570

495

495

480

470

450

440

425

400

400

385

370

345

ChooseMyPlate.gov

MyPlateMyPlate: Sources of Potassium: Sources of Potassium

5858

MyPlate:Sources of PotassiumChooseMyPlate.gov

Grains ProteinDairyFruitsVegetables

FruitsGrains

Dairy

VegetablesProtein

• Whole-wheatbread

• Whole-grainproducts

• Avocados• Spinach• Squash• Potatoes• Tomatoes• Lettuce• Lima beans

• Pears• Prunes• Peaches• Cantaloupes• Bananas

• Milk• Yogurt• Cottage cheese• Ricotta cheese

• Meat• Chicken• Fish• Shrimp• Beans

FruitsGrains

Dairy

VegetablesProtein

(tomatoes): © Brand X Pictures/PunchStock RF; (pears): © Corbis RF; (shrimp): © Comstock Images / Jupiterimages RF

Potassium: ExcessPotassium: Excess

•• Typical food intakes do not lead to Typical food intakes do not lead to potassium toxicity in people with potassium toxicity in people with healthy kidneyshealthy kidneys

•• If kidney function is poor: If kidney function is poor: potassium builds up in blood, potassium builds up in blood, inhibits heart function & inhibits heart function & ↓↓heartbeatheartbeat

•• No Upper Level (UL) has been setNo Upper Level (UL) has been set

Chloride (Chloride (ClCl): Functions): Functions

•• Primary negatively charged ion Primary negatively charged ion in the extracellular fluidin the extracellular fluid

•• Functions:Functions:

–– Component of stomach acid (Component of stomach acid (HClHCl))–– Immune responseImmune response–– Nerve functionNerve function

Chloride: DeficiencyChloride: Deficiency

• Prolonged vomiting (ex: bulimia or severe flu) can lead to acid-base disturbance due to large loss of stomach acid

• Deficiency is unlikely because dietary salt intake is so high

Chloride: Nutrient NeedsChloride: Nutrient Needs

•• AI for chloride is 2,300 AI for chloride is 2,300 mg/daymg/day

•• Based on 40:60 ratio of Based on 40:60 ratio of sodium: chloride in salt: sodium: chloride in salt: (1,500 mg sodium: 2,300 (1,500 mg sodium: 2,300 mg chloride)mg chloride)

•• DV used on food labels is DV used on food labels is 5,400 mg5,400 mg

Food Sources of ChlorideFood Sources of Chloride

•• Fruits & VegetablesFruits & Vegetables

•• Chlorinated waterChlorinated water

•• Salt (Salt (NaClNaCl))

Chloride: ExcessChloride: Excess

•• Plays a role in salt in Plays a role in salt in raising blood pressureraising blood pressure

•• UL is 3,600 mg/dayUL is 3,600 mg/day

•• Because of Because of ↑↑ salt intake, salt intake, average North American average North American intake of chloride is also intake of chloride is also ↑↑

Nutrition and Your Health:Nutrition and Your Health:Minerals and HypertensionMinerals and Hypertension

•• Elevations in blood pressure are strong Elevations in blood pressure are strong predictors of cardiovascular diseasepredictors of cardiovascular disease

•• 1 in 5 North Americans est. to have 1 in 5 North Americans est. to have hypertensionhypertension

•• 1 in 2 North Americans > 65 1 in 2 North Americans > 65 y.oy.o. have . have hypertensionhypertension

•• Often called Often called ““silent diseasesilent disease”” –– symptoms symptoms are not overtare not overt

Blood Pressure ReadingsBlood Pressure Readings

•• Systolic blood Systolic blood pressure:pressure:

–– First of two numbers First of two numbers (the higher number)(the higher number)

–– BP in arteries when BP in arteries when heart is contracting & heart is contracting & pumping blood into pumping blood into arteriesarteries

–– Optimal: 120 mm Hg Optimal: 120 mm Hg or lessor less

•• Diastolic blood Diastolic blood pressure:pressure:

–– Second of two Second of two numbers (the bottom, numbers (the bottom, lower number)lower number)

–– BP in arteries when BP in arteries when heart is relaxedheart is relaxed

–– Optimal: 80 mm Hg or Optimal: 80 mm Hg or lessless

Blood Pressure ReadingsBlood Pressure Readings

Benefits of Controlling BPBenefits of Controlling BP• ↓ cardiovascular disease risk

• ↓ kidney disease risk

• ↓ risk of stroke

• Prevent poor brain function

• Prevent poor blood circulation in legs

• Prevent vision problems

• Prevent sudden death

HypertensionHypertensionWhat Increases Risk?What Increases Risk?

•• SmokingSmoking

•• Elevated blood lipoproteinsElevated blood lipoproteins

•• African American & Asian African American & Asian Americans have higher Americans have higher risk than do Caucasiansrisk than do Caucasians

Risk Factors for HypertensionRisk Factors for Hypertension

• Family History• Age• Heart Disease• Overweight• Inactivity• Excess alcohol• High sodium intake

What Dietary Factors are Related to What Dietary Factors are Related to HTN & HTN Risk?HTN & HTN Risk?

•• ↓↓ risk of HTN & risk of HTN & ↓↓ BP BP in people with HTN:in people with HTN:

–– CalciumCalcium–– PotassiumPotassium–– MagnesiumMagnesium

•• ↑↑ risk of HTN & risk of HTN & ↑↑ BP BP in people with HTN:in people with HTN:

–– SodiumSodium–– Excessive alcoholExcessive alcohol

DASH DietDASH Diet

•• Dietary Approach to Stop HypertensionDietary Approach to Stop Hypertension

•• Diet is Diet is ↑↑ in: calcium, potassium, in: calcium, potassium, magnesiummagnesium

•• Diet is Diet is ↓↓ in saltin salt

•• Very high in fruits & vegetables Very high in fruits & vegetables (naturally (naturally ↓↓--salt, salt, ↑↑--potassium foods)potassium foods)

DASH DietDASH Diet

How to Lower BPHow to Lower BP