Water and MineralsDr Shatha Hammad

Our note in PURPLE

Water and Body Fluids• Water (Fluids (يعني

• Adult: 60 percent of weight

• Children?? More than 60% (danger risk of dehydration)

• Function in body fluids

1) Carries nutrients and waste products

2) Maintains the structure of large molecules

لانه بحافظ على البيئة اللي ذايبين فيها بالتوازن الخاص فيها مثل البروتين

3) Serves as the solvent for: metabolic reaction لانه من خلاله بصير

• Minerals, vitamins, amino acids, glucose, and many other small

molecules so that they can participate in metabolic activities

1. Blood 2. ICF3. ECF4. etc…

Water and Body Fluids (cont’d.)• Function in body fluids

4)Participates in metabolic reactions

و ) ( رح أضيف ) ( أوخليهم ) ( مثلا لما بدي أكسر الـ

) (باخذ منه ) ( لما بدي أعمل

5)Maintains blood volume

6)Aids in normal body temperature regulation (via sweat)

7)Acts as a lubricant and cushion (around joints and inside

the eyes, spinal cord)

Starch molecule

Glycogen

Glucose

H2O

H2O

Such as hyper and hypotension

Water and Body Fluids (cont’d.)• Water balance

• Water intake regulation

• Survive for only a few days without water

• The body controls both water intake and water excretion to

maintain water equilibrium (if it can)

• When the blood becomes too concentrated→ thirst

• Must pay attention to the thirst signal and take the time to get a drink

• Water excretion

• Regulated by the brain and kidneys, how?

To avoid dehydration

اذا طنشت عطشك مع الوقت رح توصل لمرحلة ما تميزّ انك عطشان او لأ

By hypothalamus ( غدد العرق) and kidney (↑ADH/↓Aldosterone )

Shows how fluid intake and output are naturally balanced out

Intake Output

ؤ

ملاحظة انهم

اعلى مقدار

تقريبا نفس المقدار

زي البطيخ

اللي بتطلع من الكلى هي المسؤولة عن التخلص من معظم السوائل اللي بديش ياها500اهم شي لازم اعرفه انه الـ

Water and Body Fluids (cont’d.)• Body fluids

• Electrolyte solutions

• Regulated closely, why?

• Proteins in the cell membranes: move ions into or outof the cells

• Kidneys regulate sodium and water

• How does the body’s total electrolytes compare to the urinary electrolytes?

• Sudden loss of large amounts of fluid and electrolytes!

) ( و بالتالي تنظيم الـ) ( لاني بحاجة اني انظم الـ

و الصوديوم اللي بخليه يرجع و ياخذ معاه الماء ( ) داخله مثل ال Aldosterone Electrolyte Body fluid

Regulated closely أشهر

1. Acid base balance 2. Electrolyte balance

Body electrolyte: الهم نسبة أو عدد معين

Urinary electrolyte:ما اله نسبة محددة ولكن اللي بتحكم فيه هو الايوانات بالجسم

فلو عنا صوديوم زيادة بالجسم رح يتم طرحه عن طريق الكليتين وهيك يعني

Common in diaries and vomiting

Water and Body Fluids (cont’d.)

• Water imbalances

• Dehydration

• Aging & dehydration

• Water intoxication: hyponatremia

• Most common in…??

بتبدأ لما بقعد اشخص أيام ما بشرب مي كفاية

الاطفال و كبار السن

↓ concentration of Na in blood

- Edema - Hypo and hypertension - Heart failure - Pulmonary disease - etc

edema تعتبر الـ

water imbalanceفي الـ

و لكنها موجودة عند الاشخاص

chronic disease المصابين بـ

Thirst ما ببدأ بالـ sever الـلأنه تعدى هاي الاعراض

• What factors attribute to the varying water needs per

individual??

• Adequate Intake (AI) for total water

• Men: 3.7 liters/day

• Women: 2.7 liters/day

• Sources (of total fluid intake)

• Water, foods, milk, juices, etc.

• What is considered a liquid?

• Caffeinated beverages?

Water and Body Fluids (cont’d.)

ممكن يتغيروا من شخص لآخر ولكن

هاض عبارة عن افريج

Temperature, environment, what person drink and eat, etc…

الناس بطلت تشرب مي بشكل كافي بسبب وجود عصائر و مشروبات بديله ولكن لا يوجد عن الماء بديل

خضار و فواكه اكثر شي

Increase execration in small amount

اي اكل اذا تركته بالحرارة رح يتحول لسائل

Yogurt, jelly, pudding, icecream

The Major Minerals• What is the distinction between major minerals andtrace minerals?

• Does not mean that one group is more important than the other

• A deficiency of the few micrograms of iodine neededdaily is just as serious as a deficiency

of the several hundred milligrams of calcium.

• All major minerals

• Influence the body’s fluid balance

• Have other specific roles e.g. nerve transmission, muscle contractions, structure of the bones

and energy metabolism, among others.

- Electrolyte is mineral but mineral is not electrolyte.- Electrolyte is not essential.

بحتاجهم بكمية كبير بحتاجهم بكمية قليلة

الكمية ما بتعكس الاهمية

100mg بحتاجهم بكمية اقل من mineral اي

Trace mineral عبارة عن

The Major and Trace Minerals

لازم نعرف انه حتى

Mineralلو

Traceمن ضمن الـ

و لكنه مهم جدا لجسمنا

لازم نعرف

اكثر واقل

major & trace

نيوترشن A ودي أجيب

بس أنا مش فاهمها

ودي انجح بيها

بس انا مش دارسها

Sodium

• Main electrolyte in the extracellular fluid

• main regulator of the extracellular fluid volume

• What are other roles?

• Sodium AI

• 1500 mg/day (19-50 yr)

• Dietary guidelines?

• Average U.S. والاردن كمان intake: 3400 mg/day

Major mineral هسا رح نبدأ بالـ

1. Maintaining acid base balance.2. Electrolyte balance.3. Regulating blood pressure. بعطش بس يوكل كمية كبيرة من ملح الطعام

2300-2500 mg/day

Adequate intake & dietary guideline ليش في عنا

مغ بالاكل ما رح يكون مستساغ او زاكي بالعامية1500لانه

بتحكيلنا ملحوا الاكل بس لا تتعدو هاي الارقام2500-2300فالـ

و طبيعي الواحد بعطش و رح يعوض هاي الزيادة

ولكن اذا عند الشخص مرض بمنع من التخلص من الصوديوم

1500فاحنا بنخليه يوخذ

Adequate intake

Sodium

• Deficiency is very unlikely, why??

• What does processing do to the sodium and potassium contents

of foods?

• Top contributors of sodium

• Breads, processed meats, pizza, poultry, soups, canned food, etc.

لانه موجود بكل مكان حولينا وبكل اكلنا

Edema ممكن يصير عن الاشخاص المصابين بـ

Hyponatremia زي symptom رح يصير

Processing food سواء الاكل مالح او مش مالح زي الفواكه المعلبة وهي عبارة عن

preservative شكلرح يكون فيها صوديوم بكميات كبيرة على

Processing food الـMajor source هي الـ

للصوديوم

وديوم مشكلتنا الثانية بالمعلبات هي البواتسيوم وهو بشتغل تقريبا عكس الص

Regulating BP. & bld. Volume من ناحية الـ

Acid base balance & electrolyte balance وكمان

في صناعة المعلبات مش بس بقللوا نسبة البوتاسيوم

بل ايضا زيادة الصوديوم بتطغى عليه

• What is the correlation between sodium intake and

hypertension?

• “How To” Cut Salt Intake??

• DASH approach??

Risk of hypertension كل ما ارتفع الصوديوم برتفع عنا

اسوء Control of BP. واذا الشخص مصاب اساسا بالضغط كل ما اخذ صوديوم اكثر كل م كان

↓Control↑Consequence

By eliminate process food if I can’t I should deal with it in a careful manner.

مثلا الـ canned foodاغسلها مرتين وثلاثة مشان اقلل الصوديوم

Sodium

Dietary Approach to Stop Hypertension

High Potassium & Low Sodium

By consumption of healthy food.

Chloride

• Major negative ion of the extracellular fluids

• Maintains fluid, electrolyte, and acid-base balances

• Is part of hydrochloric acid (??)

• Major source: as sodium

مش هنحكي كتير عن الكلورايد لانه فعليا مربوط بالصوديوم و حتى دوره بالجسم هو باماكن بكون فيها الصوديوم

بتيجي اكثر ) ( تركيزهم بتيجي بنفس الاماكن مثلا بالوظائف و لكن مش نفس

( ) بشتغلو الثنين بال

HCL المميز اله هوMaintains fluid, electrolyte, and acid-base balances

ECF

ما رح اقدر اهضم البروتين في المعدة ولا احرر الايرون و البيتويلف HCL بدون الـ

Potassium

• Principal positively charged ion inside the cells

• Maintains fluid and electrolyte balance and cell integrity

• Distribution inside and outside the cell is a high priorityfor the body

• Homeostasis including maintaining a steady HEARTBEAT

• The sudden deaths that occur with fasting, eating disorders, severe diarrhea, or severe

malnutrition in children may be due to heart failure caused by Potassium Loss.

nerve impulse transmission في موجود Muscle contraction القلب بتأثر بشكل خصوصي لأنه بال

موجود بشكل اساسي بكميات كافية

Potassium

• Best sources

• Fresh fruits and

vegetables

• Deficiency

• Increase in blood pressure,

salt sensitivity, kidney

stones, bone turnover, etc.

• irregular heartbeats,

muscle weakness

• What are the causes of

potassium deficiency?

• Toxicity (very rare)

• Result of

overconsumption of

potassium salts or

supplements,

diseases, or

medications

• Overconsumption

of food??

• Hypertension

• DASH approach

اذا الشخص باخذ دايت

فيه الـ

Minimal fruits & vegetables Legume

بكون نادر حدوث

النقص

بس اذا كان الشخص

ماشي على دايت مش

صحي

Malnutrition dearie and vomiting Burns

Diuretic drug

يعتبر الـنقص

Secondaryلانه بحصل بسبب شي

ثاني

مش دايما بكون

Supplement احيانا بكون على شكل

Salt مثلا في ناس بتاخذ

Salt substituteبديل الملح

مشان الناس اللي بتقلل

الملح بطعامها

فبعطوهم ملح مبني

اساسا من البوتاسيوم

بدلا من الصوديوم مشان

يكون الاكل دلع

و بنفس الوقت بوخذوا

potassium sparing diureticsفوقتها بتراكم بكميات

. عالية جدا

Calcium• Most abundant mineral in the body

• Integral part of bone structure and serves as a calciumbank

(99% of body calcium)

• Bone formation

• Calcium salts form crystals on a protein collagenmatrixc

• As the crystals become denser, they give strengthand

rigidity to the maturing bones.

• Why is it incorrect to think of bones as being inert,e.g., similar to rocks?

:مسؤولة عن كثير اشياء بالجسم 1%

) ( نقل الايونات بال

انقباض العضلات

المحافظة على ضغط الدم

Cell membrane

في % 99لو نقص الكالسيوم بالدم ع طول ال

.العظم رح تعوضني

لهيك بس يقل الكالسيوم ما بقل بالدم بل

بالعظم اذا رح يتأثر العظم مش الجسم

Rigidity مسؤولة عن

↑Ca↑ crystal↑ rigidity

Osteoporosis?

Risk factors?

Deficiency of calcium level

بس يكبر الشخص ما بقوي عظمه ولكنه لازم يضل محافظ على

مخزون الكالسيوم فيه لحتى اخر يوم بحياته

يعتبر الـنقص

Secondaryلانه بحصل بسبب شي

ثاني

• Deficiency of calcium level

• Older age

• Genetics

• Low Vitamin D.

• low body weight

• Smoking

• High consumption of sodium ( أهم وحدة)

• Female and estrogen deficiency

Calcium• Ionized calcium in body fluids

• Regulates the transport of ions across cellmembranes, helps maintain normal blood

pressure, is essential for muscle contraction (including heartbeat), etc.

• High blood calcium levels

• Deposited into bone

• Regulatory system to counter low blood calcium

1. Small intestine absorbs more calcium.

2. Bones release more calcium into the blood.

3. Kidneys excrete less calcium.

• How is blood calcium affected by a chronic dietarydeficiency of calcium?

اذا كان الشخص لسا ببني بالعظم

اذا لأ بطلعهم من الجسم لانه زيادة عن حاجته

طالما الشخص عم يقلل كالسيوم الدم ما رح يتأثر بينما العظم رح يتأثر

Calcium

• Disease prevention

• Hypertension (DASH), colon and rectal cancers, body weight control

• Calcium RDA

• Adults (19–50 yr): 1000 mg/day

• Men (51–70): 1000 mg/day

• Women (51–70): 1200 mg/day

Associated with normal BMI

Crystal لانه بعمل زي

مع بعض المواد السامة

Fecesو بطلعهم مع ال

She is in range age of menopause.

And estrogen deficiency.

• Milk and milk products

• Recommended: three cups of milk daily for adults

• Add Calcium to daily meals and ensure adequate vitamin D

• Sardines with bone

• Vegetables (dark green, leafy vegetables such as parsley, green cabbage),

are they a good source of calcium?

• Fortification & supplement

Calcium

Absorption حتى يساعد على

For Vegan people, they need modification source.

بس بوصفة طبية غير هيك رح يضر

يفضل ما يكون المصدر

ومالاساسي بغذائنا للكالسي

Phosphorus

• Second most abundant mineral in the body

• Found in:

• Bones, teeth (bone crystals, >85% of totalbody phosphorus),

• All body tissues (as part of the body’s buffer systems (phosphoric acid))

• Best sources

• Animal protein, milk, and cheese

• very rare to be deficient in anyone’s diet (abundant in food)

كثير نادر اني اسحب فسفور من العظم لأنه موجود بالدايت تبعنا بكميات

كبيرة و بقدر اجيبه بسهولة

PhosphorusFunctions:

• Healthy bones

• Part of DNA and RNA, thus phosphorus is necessary for all growth.

• Plays many key roles (ATP) in the transfer of energy that occurs during cellular

metabolism

• Phosphorus-containing lipids (phospholipids) help transport other lipids in the blood.

[emulsifiers]

• Phospholipids are also principal components of [cell membranes].

اي دايت فيه كميات كافية من

يه الطاقة و البروتين فهو بالـتأكيد ف

كميات كافية من الفسفورز

For maintain structure in cell membrane Or as buffer for acid base balance بدونه ما في حياة

Magnesium• The least quantity of all major minerals

• Found in bones, muscles, heart, liver, and other soft tissues; small amount in body

fluids

• Functions

• Enzyme functions and other cellular functions.

• needed for energy release in cells and for protein synthesis.

• required for normal heart function.

• immune systemand inflammatory response.

• and functioning of themuscles.

نتذكر انه كمية كانت جدا قليلة و لكنها

موزعة بالجسم مش زي باقي المينرال

بتكون مركزة في بعض مناطق

If I don’t have prober Mg level, immune function will be hindered

Work with Ca, Ca do contraction & Mg do relaxation

Magnesium• Food sources (عكس الكالسيوم)

• Dark green, leafy vegetables; nuts; legumes; whole-grain breads and cereals; etc.

• Easily lost from foods during processing

• Deficiency

• Results from inadequate intake, vomiting, diarrhea, alcohol abuse, or malnutrition.

• Low blood calcium ( hypocalcemia) ; muscle cramps andseizures.

• May increase the risk of stroke and sudden death by heart failure

TOXICITY! Usually from supplement not diet or pathological case.

احيانا الغسيل الزائد او الطبخ الزائد بالمماء رح

تخلي المغنيسيوم ينشال بالمي وبالتالي اخسره

تدرس لما

نيوترشنسلايد35

لما تدرس

ن اللجاتفريغات

سلايد 45عظيما ً_كن#

The Trace

Minerals

بيكونوا موجودين بالجسم

بكميات قليلة

Iron

• Component in:

• Hemoglobin

• Myoglobin

• Importance of iron in these proteins??

• Other functions:

• As part of many enzymes, iron is vital to the processesby which cells generate energy.

• Iron is also needed to make new cells, amino acids, hormones, and neurotransmitters.

carry and transport

انه يخليه موجود

carrier of o2 in RBCS (haemoglobin ) or in muscle cell (myoglobin )

Facilitate energy production

cognitive. هيك الناس يلي عندهم نقص حديد بيكون عندهم قليل عشان

neurotransmitters الحديد هو نقص الاشي يلي بيعكس

Iron

• Significant iron loss

• Bleeding

• What happens to iron when a red blood cell dies???

• Transferrin

• ferritin

• Only about 10 to 15 percent of dietary iron is absorbed

البروتين يلي بيتخزن جواه الحديد كل ما زاد كل ما

جسمي صنع حديد اكتر

short half life protein carry iron from GI to site of storage (liver or bone marrow

جواه وبيوديه علىالحديد يلي بيوخذ

جديدالجسممن وبيصنعهم Bone marrow

( loss RBCs mean loss iron )

ما دام الحديد امتص داخل الجسم صعب جدا

جدا صعب لانه هيك امتصاصه اخسره عشان

صعب يصرفه برة الجسم حماية للجسم من

زيادة كميته

in sufficient amount

• Hepcidin: central to iron balance

• Protein produced by the liver

• Helps to maintain blood iron within the normal rangeby limiting absorption from the

small intestine and controlling release from the liver, spleen, and bone marrow.

Iron

- When decreased iron level the percentage decrease than 10 - When iron level decreased the percentage increase above 15this

because maintain free radical that lead to oxidative reaction that risk factor of chronic disease

- Absorption of iron and the limit of iron - Increase hepcidin decrease absorption

Iron• Iron deficiency

• Most common nutrient deficiency

• Causes

• Inadequate intake and blood loss

• Assessment

• Low serum ferritin; increased transferrin level

• What is the difference between iron deficiency andanemia?

Hb level is not indicator to iron deficiency but indicator to iron deficiency anemia

In all age because consumption and absorption is low

(most accurate but most expensive)

Iron Status

63

Iron: Notes about picture *in overload iron the storage iron is excess but in RBCs and blood is full

*when decrease level of iron the Hb decrease

*in normal state the storage .RBCs blood is full

*in early stage of iron deficiency the ferritin decrease because storage iron decrease(test of ferritin is most accurate )

*when decrease iron level more the iron in transferrin decrease because decrease iron level in blood (Hb in normal range )عشان هيك فحص الهيموجلوبين لا يحدد النقص بالحديد

*in anemia stage the iron storage . blood . RBCS is decrease and RBCS become microcytic hypochromic

*when decrease iron(iron deficiency and iron deficiency anemia ) the transferrin increase لانه بيصير يدور على الحديد من اي مكان ويوخذه

*when decrease iron the ferritins decrease

Iron• Iron deficiency symptoms

• Fatigue, pale skin, pica

• Reduced physical energy and mental alertness

• Hemochromatosis: iron overload

• Caused by a genetic failure to prevent unneeded iron in the diet from being absorbed

• Apathy, lethargy, and fatigue (similar to deficiency symptoms → don’t self diagnose)

• Free-radical tissue damage

• Infections are likely because bacteria thrive oniron-rich blood

(long time)

(because decrease energy and neurotransmitters )

(consumption of non food component)

15مرتبط بمشاكل جينية مثلا بيزيد الامتصاص اعلى من

*iron deficiency and iron overload is shared symptom.

(bacteria love iron environment )

Iron• Iron poisoning

• Rapid ingestion of massive amounts

• Cause sudden death

• Iron recommendations

• Men: 8 mg/day

• Women (childbearing years): 18 mg/day

• Iron forms in foods

• Heme iron

• Nonheme iron, Vegetarians are at risk

• Enhancer? Inhibitors?(ex: ca .tannins .phytate ( fiberاي اشي فيه .*Rich of ca ,low in iron

,( plant and animal sources)الطحين المدعم

(absorbable food of iron /in animal sources : meat .fish but not in milk )الافضل

Vegitarieent is risk of deficiency

(ex: vitamin C)

Zinc

• Required by more than 50 enzymes

• Needed

• To perform tasks in eyes, liver, kidneys, muscles,skin, bones, and male reproductive organs;

for making genetic material; in blood clotting, metabolize carbohydrate, protein, and fat;

liberate vitamin A from storage in the liver, etc.

• How does the body’s handling of zinc differ from thatof iron?

الامتصاصناقل من الامعاء يلي بيتحكم بكمية كتير، بيحتاج زي الحديد بيحاول الجسم ما يمتصه

Decrease zinc , increase carrier Increase zinc , decrease carrier

Zinc transfer with albumin (no protein to synthesis albumin lead to deficiency of zinc )

No zinc , no new cellNo zinc , no vitamin A

تدخل في عمليات تفاعل كتيرة تبدا من عملية النمو

Zinc

• Deficiency

• Not widespread in developed countries

• High fiber consumption may lead to zinc deficiency, high risk group?

• Toxicity

• Produces copper-deficiency anemia

• Sources:

• Foods high in protein: shellfish, meats, poultry, and

milk products. Legumes??

(symptoms : immature reproductive system ,decrease immunity …)

(malnutrition )

from supplement

Hight zinc intake lead to stop absorption of copper / Person eat copper but not absorped

Most symptoms:

rich source is legunes but bioavailability is low because fiber

Selenium• Functions as an antioxidant nutrient

• Needed for:

• Enzyme glutathione peroxidase

• Proper functioning of the iodine-containing thyroid hormones

• Studies surrounding protection against cancer

• Selenium deficiency is associated with heart disease

• Toxic: high doses/ non-food sources or contamination

(no enough selenium lead to disease in thyroid hormones )

- keep the shape of RBCs- Prevent oxidation of RBCs

with selenium

Iodine• Integral part of the thyroid hormones

• Deficiency

• Goiter (enlarged thyroid gland, why?)

• Preventable mental retardation

• Source: ocean (water & seafoods) & ???

• Cabbage family and others that contain an antithyroid substance

• Excess

• Enlarges thyroid gland

(inhibitor to iodine )

Enlargement of thyroid occur in deficiency and excess

- In excess because increase iodine ,increase activity of thyroid.- In deficiency : increase size of thyroid to increase activity Similar to transferrin.

Copper

• Copper

• Primary function: constituent of enzymes

• Diverse metabolic roles

• Helps cells use iron

• Toxicity: may result from some genetic disorders

• Sources: organ meats, legumes, whole grains, seafood,nuts,

• and seeds

(food sources of protein )

No copper , no iron in Rbcs (copper deficiency anemia)

Other Trace Minerals (cont’d.)• Manganese

• Cofactor for many enzymes

• Facilitate numerous metabolic processes

• Fluoride

• Prevents dental caries

• Deficiency: high dental decay

• Sources: fluoridated water, toothpaste, etc.

• Chromium

• Essential in carbohydrate and lipid metabolism

• Enhances the activity of insulin

( don’t overwasth after toothpaste )

Associated with diabetes Not necessary take supplem

if decrease in early age affect strength of bone

(important in strength of bone )

THE ENDGOOD LUCK

لجان الدفعات

أهل الهمة

عظيما_كن#