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Nutrition: Electrolytes


He's already talked about hyponatremia
"pathological condition"
good thing I skipped that fraction of a lecture
clearly doesn't know much about it
he's Harvard trained so there's no room for him to learn more
=-]
I'm just supposed to be taking notes here

SODIUM AND SALT INTAKE
AI = 1500 mg or 3.8 g/day (adequate intake)
average intake far more (males approx 8-12, females 6-8) not counting added salt
UL = 5.8g/day based on blood pressure effects on general pop
75% of salt added in processing/manufacturing
high salt in processed meat, fast food, snack food, asian, mexican food
sea salt is over 80% sodium chlorida and almost 15% moisture
he says sea salt contains no important amounts of minerals compared with daily values
present in addition to NaCl:
sulfur, magnesium, potassium, calcium, silicon in amounts over 1 mg per 1/4 tsp

dz assoc w/ high salt intake:
GASTRIC CANCER declining in west in spite of salt intake
high cancer rates in Asia along with high salt intakes
maybe other carcinogens in salt-preserved foods?
OSTEOPOROSIS: experiments show high salt intake increases urinary calcium
KIDNEY STONES: increased urinary calcium encourages calcium oxalate stones in men mainly
BLOOD PRESSURE: give low salt diet to people with high blood pressure, it goes down
person with normal BP, it doesn't go down
works better with drastic salt restriction
about half of hypertensives are salt sensitive, works better on them
SALT SENSITIVITY: assoc w/ obesity, insulin resistance, African American, elderly, female
other lifestyles changes may be more important to BP
salt substitutes contain potassium "lite salt", "no salt", not a bad way to get your potassium

POTASSIUM
many people don't get enough
principle intracellular ion, maintain membrane potential
critical for nerve impulse transmission, muscle contraction, cardiac function
cofactor for a few enzymes
acute deficiency = hypokalemia
usudt excessive losses: diuresis (hydrochlorothiazia, chlorthalidone), prolonged D/V
severe deficiency affects skeletal, smooth and cardiac muscle fx
best sources: fruits and veg, legumes, nuts, seeds, bananas, potato skin, prune, orange, tomato, raisinn, artichoke, spinach, molasses
fruits may be best source because we don't salt them

AI = 4.7 g/day based on preventing kidney stones, HTN and bone loss
AI not met by 90% of US men and 99% of US women
supplements are limited to 100mg due to concern about higher potencies
SE's: gastric upset or hyperkalemia if urinary exceetion is impaired
water softeners are either sodium or potassium chloride, no limiit
salt substitutes contain potassium "lite salt", "no salt", not a bad way to get your potassium
there's no UL for dietary potassium
healthy people readily excrete excess
beware only with prescription level increase

western diet is 3:1 Na:K, primitive diets contained more potassium than sodium
this ratio affects CV Dz and stroke, osteoporosis, kidney stones?
maybe due to not getting enough fruit and veg
may be due to acid forming nature of western diet

read article on primitive human diet
DASH diet successfully lowers BP
works with or without salt restriction
daily servings on dash diet:
grains 7-8, veg 4-5, fruit 4-5, non/low fat dairy 2-3,
meat/poultry/fish 2 or less, nuts/seeds/legumes 3-4
other outcomes: weight loss, stabilize blood lipids and sugar,
maintain bone density, lowers risk of heart dz and stroke
high in potassium, magnesium, calcium

PRESCRIPTION POTASSIUM
coated to ease side effects
2300-3900 mg/day
moderate effect on blood pressure
"smart salt", "slow K" by CIBA 600 mg
SE: gastric irritation and hyperkalemia
POTASSIUM CITRATE in prescription potassium supplement
"Urocit-K"
alkaline compound: citrate
for calcium regulation
increase on bone mass, reduced kidney stones
MEDS can cause hyperkalemia: this is only a partial list!!!
some antihypertensives, angiotensin receptor blockers, ACE inhibitors, spironolactone
digitalis, captopril, anticoagulants: heparin
ACE, NSAIDS, cardiac glycosides

WILLET'S CHAPTER ON BEVERAGES
water, soda, juice, coffee, tea, alcoholic

FLUID REQUIREMENTS
need 1 ml per calorie burned, or
2 liters per 2000 calories
more with increased activity or very hot/dry climate

WATER
cheap and calorie free
variable quality

SODA POP
high calorie
no nutritional value aside from calories
increases risk of obesity, DM, heart dz
articificial sweetners: no well identified short term effects
long term effects unknown

JUICE
phytonutrients
sugar content

COFFEE
pros:
lowers risk of DM, parkinson's, men and non-estrogen using women
lower risk of liver cancer, kidney stones, gall stones
cons:
caffeine
calories added to coffee drinks
small effect on blood chol (if not paper filtered)
small effect on blood pressure
possible effect on bone loss when calcium is low

TEA
(Camelia sinensis)
pros:
lower risk of heart attack and death prob dt improved endothelial fx
no cancer results in humans
lower risk of kidney stones
cons:
caffeine (not much)
reduced iron absorption

ALCOHOL
pros:
lowered death rate all causes with low level consumption
(up to 20g/day)
reduced atherosclorosis
higher HDL
anti-clotting effect
lower CRP
improved insulin sensitivity
red wine, beer, vodka, whatever doesn't make a difference
less type 2 DM and gallstones too
cons:
much higher death rate if intake is high
increased risk of breast cancer esp if low folate level even with low level drinking
more women die of heart disease than breast cancer so alcohol still beneficial
birth defects, developmental deficiencies
progression to alcohol abuse

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