Water and Minerals

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 OVERVIEW OF WATER
• Provides shape and structure to cells.
• Regulates body temperature.
• Aids in the digestion and absorption of nutrients.
• Transports nutrients and oxygen to cells.
• Serves as a solvent for vitamins, minerals, glucose, and amino
acids.
• Participates in metabolic reactions.
• Eliminates waste products.
• Is a major component of mucus and other lubricating fluids.

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 Water Balance
Water Output:
• On average, adults lose approximately 1750 to 3000 mL of water
daily.
• Extreme environmental temperatures (very hot or very cold), high
altitude, low humidity, and strenuous exercise increase insensible
water losses (immeasurable losses) from respirations and the skin.
• Water evaporation from the skin is also increased by prolonged
exposure to heated or recirculated air, for example, during long
airplane flights.
• Sensible water losses from urine and feces make up the remaining
water loss.
• To maintain water balance, intake should approximate output.

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Water Intake:
• Total water intake averages about 2½ liters per day, of which
approximately 80% is from fluids and 20% from solid food.
• Except for oils, almost all foods contain water, with fruits and
vegetables providing the most.
• The body also produces a small amount of water from normal
metabolism: the catabolism of carbohydrates, protein, and fat
for energy yields carbon and hydrogen atoms that combine
with oxygen to form water and carbon dioxide.
• On average, 250 to 350 mL of metabolic water is produced
daily, depending on total calorie intake.

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 Water Recommendations
• Water is an essential nutrient because the body cannot
produce as much water as it needs.
• Actual requirements vary depending on diet, physical activity,
environmental temperatures, and humidity.
• For men age 19 to older than 70 years, the AI is 3.7 L/day,
which includes 3 L as fluids.
• For women of the same age, the AI is 2.7 L, which includes
approximately 2.2 L from fluids.
• Amounts higher than the AI are recommended for rigorous
activity in hot climates. Because the body cannot store water,
it should be consumed throughout the day.

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• In healthy adults, thirst is usually a reliable indicator of water
need, and fluid intake is assumed to be adequate when the
color of urine produced is pale yellow.
• In some conditions and for some segments of the population,
the sensation of thirst is blunted and may not be a reliable
indicator of need.

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 Inadequate Fluid Intake
• An inadequate intake of water can lead to dehydration,
characterized by impaired mental function, impaired motor control,
increased body temperature during exercise, increased resting heart
rate when standing or lying down, and an increased risk of life-
threatening heat stroke.
• A net water loss of 1% to 2% of body weight causes thirst, fatigue,
weakness, vague discomfort, and loss of appetite. A loss of 7% to
10% leads to dizziness, muscle spasticity, loss of balance, delirium,
exhaustion, and collapse. Left untreated, dehydration ends in death.
• Clinical situations in which water losses are increased—and thus
water needs are elevated—include vomiting, diarrhea, fever,
thermal injuries, uncontrolled diabetes, hemorrhage, certain renal
disorders, and the use of drainage tubes.

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 Excessive Fluid Intake
• A chronic high intake of water has not been shown to cause
adverse effects in healthy people who consume a varied diet as
long as intake approximates output.
• An excessive water intake may cause hyponatremia, but it is rare
in healthy people who consume a typical diet.
• People most at risk include infants; psychiatric patients with
excessive thirst; and athletes in endurance events who drink too
much water, fail to replace lost sodium, or both.
• Symptoms of hyponatremia include lung congestion, muscle
weakness, lethargy, and confusion.
• Hyponatremia can progress to convulsions and prolonged coma.
Death can result.

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 MINERALS
• Although minerals account for only about 4% of the body’s total
weight, they are found in all body fluids and tissues. Calcium,
phosphorus, magnesium, sulfur, sodium, potassium, and chloride are
considered major minerals because they are present in the body in
amounts greater than 5 g (the equivalent of 1 tsp).
• Iron, iodine, zinc, selenium, copper, manganese, fluoride, chromium,
and molybdenum are classified as trace minerals, or trace elements,
because they are present in the body in amounts less than 5 g, NOT
because they are less important than major minerals.
• Unlike vitamins, minerals are not destroyed by light, air, heat, or acids
during food preparation. In fact, when food is completely burned,
minerals are the ash that remains. Minerals are lost only when foods
are soaked in water.

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• Minerals function to provide structure to body tissues and to
regulate body processes such as fluid balance, acid–base
balance, nerve cell transmission, muscle contraction, and
vitamin, enzyme, and hormonal activities (Table 6.1).

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 MAJOR ELECTROLYTES
Sodium:
• By weight, salt (sodium chloride) is approximately 40% sodium; 1 tsp of
salt (5 g) provides approximately 2300 mg of sodium.
• As the major extracellular cation, sodium is largely responsible for
regulating fluid balance.
• It also regulates cell permeability and the movement of fluid, electrolytes,
glucose, insulin, and amino acids.
• Sodium is pivotal in acid–base balance, nerve transmission, and muscular
irritability.
• An AI for sodium is set at 1500 mg/day for young adults.
• For men and women aged 50 to 70 years, the AI is 1300 mg, and after age
70 years, AI decreases to 1200 mg.
• An Upper Limit (UL) for adults is set at 2300 mg/day.

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Potassium:
• Most of the body’s potassium is located in the cells as the
major cation of the intracellular fluid. The remainder is in the
extracellular fluid, where it works to maintain fluid balance,
maintain acid–base balance, transmit nerve impulses, catalyze
metabolic reactions, aid in carbohydrate metabolism and
protein synthesis, and control skeletal muscle contractility.
• Potassium is naturally present in most foods, such as fruits,
vegetables, whole grains, meats, milk, and yogurt. Processed
foods, such as cheeses, processed meats, breads, soups, fast
foods, pastries, and sugary items, have a higher sodium-to-
potassium ratio.

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• The AI for potassium is set at 4.7 g/day for all adults.
• Moderate potassium deficiency, which typically occurs without
hypokalemia, is characterized by increased blood pressure, increased
salt sensitivity, increased risk of kidney stones, and increased bone
turnover.
• An inadequate potassium intake may also increase the risk of
cardiovascular disease, particularly stroke.
• In healthy people with normal kidney function, a high intake of
potassium does not lead to an elevated serum potassium
concentration because the hormone aldosterone promotes urinary
potassium excretion to keep serum levels within normal range.
Therefore, a UL has not been set.
• However, when potassium excretion is impaired (e.g., secondary to
diabetes, chronic kidney insufficiency, end-stage kidney disease,
severe heart failure, or adrenal insufficiency), high potassium intakes
can lead to hyperkalemia and life-threatening cardiac arrhythmias.

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Chloride:
• Chloride is the major anion in the extracellular fluid, where it
helps to maintain fluid and electrolyte balance in conjunction
with sodium.
• Chloride is an essential component of hydrochloric acid in the
stomach and, therefore, plays a role in digestion and acid–
base balance.
• Its concentration in most cells is low.
• The AI for younger adults is 2.3 g/day, the equivalent to 3.8
g/day of salt or 1500 mg sodium.

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 Calcium
• Calcium is the most plentiful mineral in the body, making up
about half of the body’s total mineral content.
• Almost all of the body’s calcium (99%) is found in bones and
teeth, where it combines with phosphorus, magnesium, and
other minerals to provide rigidity and structure. Bones serve as a
large, dynamic reservoir of calcium that readily releases calcium
when serum levels drop; this helps to maintain blood calcium
levels within normal limits when calcium intake is inadequate.
• The remaining 1% of calcium in the body is found in plasma and
other body fluids, where it has important roles in blood clotting,
nerve transmission, muscle contraction and relaxation, cell
membrane permeability, and the activation of certain enzymes.

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• Calcium balance—or, more accurately, calcium balance in the blood—is achieved
through the action of vitamin D and hormones.
• When blood calcium levels fall, the parathyroid gland secretes parathormone
(PTH), which promotes calcium reabsorption in the kidneys and stimulates the
release of calcium from bones.
• Vitamin D has the same effects on the kidneys and bones and additionally
increases the absorption of calcium from the gastrointestinal tract.
• Together, the actions of PTH and vitamin D restore low blood calcium levels to
normal, even though bone calcium content may fall.
• A chronically low calcium intake compromises bone integrity without affecting
blood calcium levels.
• When blood calcium levels are too high, the thyroid gland secretes calcitonin,
which promotes the formation of new bone by taking excess calcium from the
blood.
• A high calcium intake does not lead to hypercalcemia but rather maximizes bone
density.
• Abnormal blood concentrations of calcium occur from alterations in the
secretion of PTH.

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• Calcium bioavailability varies among foods. Oxalates and phytates
present in plants bind with calcium in foods, resulting in less availability
of calcium for absorption. Calcium absorption from spinach is one-
tenth of the absorption rate found with milk. Calcium absorption is
improved in the presence of adequate vitamin D stores in the body.
• Deficiency: deficiency occurs because of chronically insufficient intake,
altered absorption or metabolism, and increased losses of calcium.
Insufficient intake results from a low intake of milk and dairy foods and
restrictive eating.
• Calcium absorption or metabolism can be altered because of medical
conditions or medications. Low production of gastric acid will lead to
diminished calcium absorption. Poor vitamin D status decreases
calcium absorption. Diseases that cause fat malabsorption can affect
calcium, such as cystic fibrosis, inflammatory bowel syndrome, celiac
disease, and short bowel syndrome. Medications such as steroids,
some anticonvulsants, and tetracycline alter calcium absorption.
Alcohol may reduce calcium absorption. Carbonated sodas have been
postulated as contributing to poor bone health.

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• Caffeine and a high protein intake can lead to increased
urinary calcium excretion, but the effects are minimal if
calcium intake is adequate.
• Hypocalcemia affects muscle contraction and nerve
conduction and can result in cardiac arrhythmias, muscle
cramps, and numbness in the extremities and around the
mouth (Tetany).
• Deficiency manifests itself in the form of poor bone mineral
density, and eventually osteopenia can go on to become
osteoporosis.

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• Toxicity: the UL for calcium is 2,500 mg daily for those over 1
year of age. Excess intake can contribute to the development
of calcium oxalate kidney stones in some individuals.
Excessive calcium intake can cause hypercalcemia, which can
lead to soft tissue deposits of calcium, renal damage and
ultimately death. Calcium negatively interacts with iron, zinc,
magnesium, and phosphorus absorption.
• In addition to maintaining bone health, adequate calcium has
been reported to play a role in blood pressure control and
reduction of symptoms of premenstrual syndrome.

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• Absorption factors:
- lactose: increases absorption.
- Sufficient vitamin D.
- Acidity:
Factors that may decrease absorption:
- binders: phytates and oxalates.
- Dietary fat.
- High fiber intake and laxatives.
- Excessively high intakes of P and Mg.
- Drugs: tetracycline, cortisone, and Al containing antacids are
associated with reduced calcium absorption.
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 Phosphorus
• Approximately 85% of the body’s phosphorus is combined with
calcium in bones and teeth. The rest is distributed in every
body cell, where it performs various functions, such as
regulating acid–base balance (phosphoric acid and its salts),
metabolizing energy (adenosine triphosphate), and providing
structure to cell membranes (phospholipids).
• Phosphorus is an important component of RNA and DNA and
is responsible for activating many enzymes and the B vitamins.
• As with calcium, phosphorus absorption is enhanced by
vitamin D and regulated by PTH. The major route of
phosphorus excretion is in the urine.

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 Magnesium
• Approximately 50% of the body’s magnesium content is
deposited in bone with calcium and phosphorus.
• The remaining magnesium is distributed in various soft
tissues, muscles, and body fluids.
• Magnesium is a cofactor for more than 300 enzymes in the
body, including those involved in energy metabolism, protein
synthesis, and cell membrane transport.
• There is increasing interest in the role magnesium may play in
preventing hypertension and managing cardiovascular disease
and diabetes.

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• Low intake of magnesium is associated with risk of metabolic syndrome
(insulin resistance, hypertension, high cholesterol, overweight or obese):
is a cluster of conditions: increases blood pressure, high blood sugar,
increased WC, abnormal chol. or triglycerides) .
• Good sources of dietary magnesium include green leafy vegetables, whole
grains, seeds, and nuts. Animal products also contain magnesium, but in
smaller amounts than in plant foods.

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 Sulfur
• Sulfur does not function independently as a nutrient, but it is
a component of biotin, thiamin, and the amino acids
methionine and cysteine.
• The proteins in skin, hair, and nails are made more rigid by the
presence of sulfur.
• There is neither an RDA nor an AI for sulfur, and no deficiency
symptoms are known.

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TRACE MINERALS

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 Iron
• Approximately two-thirds of the body’s 3 to 5 g of iron is
contained in the heme portion of hemoglobin.
• Iron is also found in transferrin, the transport carrier of iron,
and in enzyme systems that are active in energy metabolism.
• Ferritin, the storage form of iron, is located in the liver, bone
marrow, and spleen.
• Iron in foods exists in two forms: heme iron, found in meat,
fish, and poultry, and nonheme iron, found in plants such as
grains, vegetables, legumes, and nuts. The majority of iron in
the diet is nonheme iron.

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• Normally the overall rate of iron absorption, which includes both heme and
nonheme iron, is only 10% to 15% of total intake.
• In times of need, such as during growth, pregnancy, or iron deficiency, iron is
absorbed more efficiently to boost the overall absorption rate to as high as 50%.
• The bioavailability of heme and nonheme iron differs greatly.
• The rate of heme iron absorption is normally about 15% and is influenced only by
need, not by dietary factors.
• In contrast, nonheme iron absorption is enhanced or inhibited by numerous dietary
factors.
• Nonheme iron absorption is enhanced when it is consumed with heme iron or
vitamin C-rich foods, such as orange juice or tomatoes. For instance, consuming 50
mg of vitamin C with a meal, which is the amount of vitamin C found in one small
orange, can increase nonheme iron absorption three to six times above normal.
• Nonheme iron absorption is impaired when it is consumed at the same time as
coffee, calcium, phytates (found in legumes and grains), or oxalates (found in
spinach, chard). Tea is a potent inhibitor that can reduce nonheme iron absorption in
a meal by 60%. When plant foods are consumed as a single food, only 1% to 7% of
nonheme iron is absorbed.

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• The RDA for iron is set at 8 mg for men and postmenopausal
women and 18 mg for premenopausal women.
• Iron requirements increase during growth and in response to
heavy or chronic blood loss related to menstruation, surgery,
injury, gastrointestinal bleeding, or aspirin abuse.
• Iron recommendations for vegetarians are 1.8 times higher
than those for nonvegetarians because of the lower
bioavailability of iron from a vegetarian diet.

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• Iron deficiency anemia, a microcytic (small blood cells),
hypochromic (pale red blood cells related to the decrease in
hemoglobin pigment)anemia, occurs when total iron stores
become depleted, leading to a decrease in hemoglobin.
• Clinical manifestations include fatigue, decreased work
capacity, impaired cognitive function, and poor pregnancy
outcome, such as premature delivery, low birth weight, and
increased perinatal infant mortality, and maternal death.
• Some people with iron deficiency anemia practice pica, which
impairs iron absorption.

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• The UL for iron is 45 mg per day in healthy adults. This
does not apply to individuals with iron deficiency.
Symptoms of toxicity initially include nausea and
diarrhea and then expand to excess storage of iron,
which results in organ (liver, kidney, and heart) damage.
• Those at risk include men, persons with chronic
excessive alcohol consumption (puts people at risk
because their livers are affected by alcohol and may
malfunction, absorbing too much iron), and individuals
who are genetically at risk for hemochromatosis.

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 Zinc
• The small amount of zinc contained in the body (about 2 g) is
found in almost all cells and is especially concentrated in the eyes,
bones, muscles, and prostate gland.
• Zinc is a component of DNA and RNA and is part of more than 100
enzymes involved in growth, metabolism, sexual maturation and
reproduction, and the senses of taste and smell. Zinc plays
important roles in immune system functioning and wound healing.
• Risk factors for zinc deficiency include poor calorie intake,
alcoholism, and malabsorption syndromes such as celiac disease,
Crohn disease, and short bowel syndrome.
• Vegetarians are also at increased risk because zinc is only half as
well absorbed from plants as it is from animal sources.

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 Iodine
• Iodine is found in the muscles, the thyroid gland, the skin, the skeleton, endocrine
tissues, and the bloodstream.
• It is an essential component of thyroxine (T4) and triiodothyronine (T3), the
thyroid hormones responsible for regulating metabolic rate, body temperature,
reproduction, growth, the synthesis of blood cells, and nerve and muscle function.
• Most foods are naturally low in iodine. The iodine content of vegetables and grains
varies with the soil content.
• Seafood is a natural source of iodine due to iodine in seawater.
• Worldwide, iodine deficiency is a major problem and the leading cause of mental
retardation.
• Iodine deficiency disorders include goiter, hypothyroidism, cretinism, stillbirths,
and delayed psychomotor and cognitive development.
• Goiter may also be caused by goitrogens(cabbage). They suppress the actions of
the thyroid gland.

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 Selenium
• Selenium is a component of a group of enzymes, called
glutathione peroxidases, that function as antioxidants to disarm
free radicals produced during normal oxygen metabolism.
• Selenium, as part of selenoproteins, regulates thyroid hormone
actions.
• Sources of selenium include plants grown in soil with high
selenium content, as well as beef, poultry, seafood, and Brazil
nuts.
• Selenium deficiency is rare. It can occur in areas where soil
content of selenium is poor.
• Selenium deficiency may result in a hypothyroid effect. It can also
make individuals prone to certain rare diseases such as Keshan’s
disease (a form of heart disease), and a form of congenital
hypothyroidism.

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 Copper
• Copper is distributed in muscles, liver, brain, bones, kidneys, and blood.
• Copper is a component of several enzymes involved in hemoglobin
synthesis, collagen formation, wound healing, and maintenance of
nerve fibers.
• Copper also helps cells to use iron and plays a role in energy
metabolism.
• Excess zinc intake has the potential to induce copper deficiency by
impairing its absorption, but copper deficiency is rare.
• Supplements, not food, may cause copper toxicity, as do some genetic
disorders, such as Wilson disease.
• Sources of copper include organ meats, seafood, and nuts. Grain
proteins also contain copper. Fruits and vegetables are low in copper
content.

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 Manganese
• Manganese is involved in the formation of bone. It is a
constituent in metabolism of carbohydrate, protein, and fat.
The DRI for manganese is an AI of 2.3 mg per day for males
and 1.8 mg per day for females.
• Manganese is poorly absorbed from food.
• Symptoms of deficiency of manganese include impaired
growth, reproductive function, and glucose tolerance, and
low serum cholesterol.
• The UL for manganese is 11.0 mg per day for adults.
Occupational exposure to manganese dust has been
reported to lead to symptoms that mimic Parkinson’s
disease.

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 Fluoride
• Fluoride promotes the mineralization of developing tooth
enamel prior to tooth eruption and the remineralization of
surface enamel in erupted teeth. It concentrates in plaque
and saliva to inhibit the process by which cariogenic bacteria
metabolize carbohydrates to produce acids that cause tooth
decay.
• Children under the age of 8 years are susceptible to mottled
tooth enamel if they ingest several times more fluoride than
the recommended amount during the time of tooth enamel
formation. The swallowing of fluoridated toothpaste is to
blame.

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 Chromium
• Chromium enhances the action of the hormone insulin to help
regulate blood glucose levels. A deficiency of chromium is
characterized by high blood glucose and impaired insulin
response.
• Unrefined foods are higher in chromium than processed
foods.
• Found in animal foods, eggs, whole grains.
• No UL recommendation exists for chromium. A potential for
toxicity may exist for individuals with renal or kidney failure
who take chromium supplementation.

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 Molybdenum
• Molybdenum plays a role in red blood cell synthesis and is a
component of several enzymes.
• Dietary deficiencies and toxicities are unknown.

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