CALCIUM

tofuCalcium is the most abundant mineral in the body, with most of it in the bones and teeth. In addition to its role in the structure of bone and teeth, calcium has important roles in:
– Bone formation and remodeling (osteoclasts dissolve bone and osteoblasts synthesize new bone).
– Cell signaling (contraction and relaxation of blood vessels and muscles, nerve impulses, hormone secretion).
– Calcium is required for 7 vitamin K-dependent clotting factors.

Blood calcium levels are tightly regulated to a narrow range so blood levels are not a good measure of calcium status. Vitamin D is needed for proper calcium absorption. Parathyroid hormone acts on the kidney when blood calcium is low to increase active 1,25-OH D3 (calcitriol), which then promotes increased absorption of calcium and release of stored calcium from bone. 

 

SYMPTOMS OF DEFICIENCY

Acute calcium deficiency would likely be the result of low parathyroid hormone that can be due to magnesium deficiency, kidney failure, or vitamin D deficiency. Symptoms may include muscle or nervous irritability, muscle spasms and cramps, or in severe cases, tetany.

Chronic calcium deficiency results in bone loss which causes rickets in children and osteoporosis or osteomalacia in both adults and children

As dietary protein increases, there is an increase in urinary excretion of calcium.  Higher sodium intake has also been associated with increased urinary excretion of calcium.  Kidney stones are typically calcium oxalate or calcium phosphate, and tend to occur in those with higher urinary excretion of calcium. Interestingly, higher dietary intakes of calcium actually lower urinary excretion of calcium making the standard recommendation for those who suffer from kidney stones to reduce calcium intake to be misguided.  The recommendation should be to reduce protein and sodium intake and drink more water. 

Adequate calcium seems to be protective against colorectal cancers, hypertension (especially pregnancy induced), and may reduce insulin resistance, being protective against type-2 diabetes.

 

FOOD SOURCES

Most people get their calcium from fortified cereals or dairy.  It is however quite possible to get adequate calcium with a dairy free diet if you know what to eat. 
                                                  mg calcium
Firm tofu (1/2 cup)                             861
Collard greens (1 cup)                       357
Turnip greens (1 cup)                        197
Kale (1 cup)                                       187
Greens (1 cup)                                  100-300
Beans & legumes                              100-200
Sardines (7 filets)                               327
Seeds and nuts                                  70-100
Orange juice (1 cup -fortified)            500
Medium orange                                   65
Soy milk (1 cup)                                  300
Molasses (1 TBS)                               178
Milk/ yogurt (8 ounces)                        300-415
Cheese (1 ounce)                               140-160

 

SAFETY AND TOXICITY

Toxicity has never been seen with foods although there is possibly increased prostate cancer in those with a very high dairy intake. Mild toxicity related to excessive intake of calcium supplements, or as part of antacids that are high in calcium, can result in loss of appetite, nausea, vomiting, constipation, abdominal pain, dry mouth, thirst, frequent urination.  If calcium intake exceeds 2-4 grams daily on an ongoing basis, this can decrease the uptake of magnesium, zinc, iron, manganese, and other minerals, which can result in decreased reflexes, muscle weakness, ataxia, and anorexia. 

 

TOLERABLE UPPER LIMITS

                                      MG/DAY

Infants                          Unknown (since they are in rapid bone growth – intake may be high but safe if just from breast milk or formula)

Children and adults             2500 

The RDA for infants is listed as 210-170 mg, 500-1,300 mg children and 1300 mg for teens and adults.  If your diet is low in calcium, I suspect you can avoid toxicity by keeping supplementation below 2000 mg a day and I would recommend only 1000 mg as supplements and add calcium rich foods. Remember to take a vitamin D supplement or you will not be absorbing much of the calcium from the diet or supplements. 

 

Read about calcium and insulin resistance here…

Read about other sources of calcium here…

Read my blog on Vitamin D and calcium here…

Read my blog on calcium and heart disease here…

 

Dr. Paul

 

 

 

 

 

 

ASPARAGINE

meatAsparagine is an amino acid that we typically all can make from either aspartate or glutamine that we get in our diets.  I was not aware of deficiency states for this until a couple of my own patients tested low for this amino acid on the Spectracell Micronutrient Test (MNT). Read more at www.spectracell.com
Asparagine seems to have a role in:
 – Proper sequences of amino acids and proteins (amino acids are the building blocks of proteins).
 – It is the safe storage form of aspartate, needed to make DNA, RNA, and ATP. 
 – It provides amino groups for the production of other amino acids when they are needed.

The major health concerns regarding asparagine seem to come when there is a problem with the enzyme asparagine synthetase (ASNS). The enzyme ASNS converts aspartate to asparagine and and glutamine to glutamate. Health problems are either due to the lack of asparagine (not enough in the diet or not enough made due to the lack of ASNS function) or due to the accumulation of aspartate and glutamine when the enzyme is missing or not working properly.

Asparagine in protein is an attachment site for carbohydrates involved in the formation of collagen, enzymes, and in cell to cell recognition.

Aspartate is involved in cellular energy in the citric acid cycle, and in the urea cycle it helps in the removal of excess ammonia.

 

SYMPTOMS OF DEFICIENCY

There is limited published data on asparagine deficiency symptoms. In a study “Deficiency of asparagine synthetase causes congenital microcephaly and a progressive form of encephalopathy” (you can read that here… ) four families with this genetic defect were found and their babies had congenital microcephaly (small heads), intellectual disability, progressive cerebral atrophy, and intractable seizures. 

In over 10,000 patients tested by MNT, 23% were found to have deficient asparagine function with the main symptoms reported being those of fatigue and immune stress (autoimmune issues like rheumatoid arthritis and allergies). 

This is one of those deficiencies that you or your physician would not discover unless specialized testing like MNT was done or the genetics were determined through an extensive or specific genetic analysis. 

 

FOOD SOURCES

Asparagine is considered a dispensable amino acid since it is present in all proteins, and our body can make more from aspartate and glutamine. There is no RDA, though cooking, storage, and acidity can destroy asparagine. 

 

SAFETY AND TOXICITY

No toxicity has been reported. 

It appears safe to supplement up to 6 grams daily in adults. If supplementing children, I would make the following estimations of need:
Infants                         – up to 1 gm daily
Children                       – up to 2 gms daily
Teens/adults               – up to 6 gms daily

Since there is very little literature on supplementing this amino acid, I would use symptoms and MNT to assess the effects of your supplementation after 3-6 months at a particular level of supplementing. 

Molecular basis for the activation of a catalytic asparagine residue in a self-cleaving bacterial autotransporter

Asparagine synthetase: regulation by cell stress and involvement in tumor biology

 

 

Dr. Paul

 

 

 

 

 

 

 

VITAMIN K

kale and broccoliVitamin K is one of the fat-soluble vitamins along with A, D, and E.  Vitamin K1 (phylloquinone) is a required coenzyme for carboxylation of glutamic acid and is critical for calcium binding that is required for the activation of seven vitamin K dependent clotting factors, which include factors II (prothrombin), VII, IX, X, and protein Z, protein S, and C that regulate the coagulation cascade. These vitamin K dependent factors are synthesized in the liver, hence the bleeding issues that can occur with liver disorders. 

Vitamin K2 (menaquinon) is made by gut bacteria in the gastrointestinal track and has a role in moving calcium into bone and away from deposition in blood vessel walls, thus reducing arteriosclerosis and building strong bones.  There are two forms of K2:
  – MK-4 (menaquinone-4) found in butter, egg yolks, and animal based foods.
  – MK-7 (menaquinone-7) found in fermented foods and stays in the body longer. 

The role of K2 in calcium metabolism works in concert with vitamin D needed for calcium absorption from the intestines and given the close interplay between calcium and magnesium, these two are often best given together. 

Gas6 is a K-dependent protein found throughout the nervous system, heart, lungs, stomach, kidney, and cartilage. It seems to be involved in cell signaling and cellular growth.  There may be a significant role in the developing and aging nervous system.

 

SYMPTOMS OF DEFICIENCY

Most symptoms of vitamin K deficiency involve easy bleeding or bruising, nose bleeds, and rarely, bleeding into the GI track with bloody or black stools, blood in the urine, or heavy menses for women.  Infants and newborns can have a bleeding disorder called hemorrhagic disease of the newborn (HDN) that can be life threatening and hence the recommendation that all newborns get a shot of phylloquinone (vitamin K1).

The other symptoms of vitamin K deficiency seem to relate to the long term calcium build-up in the blood vessels (arteriosclerosis) and poor bone mineralization from inadequate deposition of calcium with resulting osteoporosis, and increased risk of fractures. 

The anti-coagulants Coumadin and Warfarin deplete vitamin K and patients on these should not take extra vitamin K unless directed to do so by their physician. 

 

FOOD SOURCES
Kale 1 cup                   547 micrograms
Broccoli                       420 micrograms
Parsley                        324 micrograms
Swiss chard                299 micrograms
Spinach raw                120 micrograms
cooking oils                 2-26 micrograms

 

SAFETY AND TOXICITY

Vitamin K1 and K2 are safe with no upper limits having been established.  Vitamin K3 (menadione) can interfere with glutathione and can induce liver toxicity, jaundice, and hemolytic anemia. 

The major toxicity (bleeding disorders) can occur when those taking anticoagulants (Warfarin and Coumadin) take vitamin K supplements. 

No upper limits have been established for vitamin K.
Adequate Intake has been set at:
                                                micrograms/day
Infants                                      2.0
Children                                   30-60 
Teens and adults                     90 

RDA for vitamin K is 1 microgram per Kg (per 2.2 lbs.), with 80 micrograms a day for adults. Therapeutic doses have been safely used in studies from 100-500 micrograms.  

Clearly, eating greens or broccoli will provide plenty and even therapeutic doses of vitamin K.

Read my blog on Vitamin K2, Vitamin D, Calcium, and Magnesium here… 

Read my blog on why you need Vitamin K2 and how it interacts with calcium and vitamin D here…

 

Read my blog on why infants should get vitamin K at birth here…

 

 

Dr. Paul

 

 

 

 

 

 

Vitamin E

almondsVitamin E is one of the 4 fat-soluble vitamins along with A, D, and K.  Vitamin E comes in many forms with 4 tocopherols (alpha-tocopherol being the main biologically active one in humans), and 4 cotrienols that seem to have little activity in humans. 

The main function of alpha-tocopherol is as an anti-oxidant, intercepting free radicals and protecting fats and low density lipoproteins (LDL’s) from oxidation. When alpha-tocopherol neutralizes a free radical, it’s anti-oxidant capacity is regenerated by vitamin C. Vitamin E seems to directly control inflammation, red and white blood cell production, connective tissue growth, cell division, and can convert arachadonic acid free radicals to less harmful derivatives  and reducing inflammatory cytokines.  Most chronic diseases have an inflammatory component, hence the importance of adequate vitamin E. 

 

SYMPTOMS OF DEFICIENCY

Severe deficiency can present with neurological symptoms like impaired balance and coordination and muscle weakness.  Most symptoms are chronic in nature and related to the damage by free radicals and oxidative stress:
– Heart disease, arteriosclerosis and strokes
– Cancer 
– Cataracts
– Reduced immune function
– Dementia and Alzheimer’s
– Complications of diabetes
– Possible role in fibrocystic breast disease, menopause symptoms, tardive dyskinesia, Parkinson’s and arthritis. 

 

FOOD SOURCES

                               alpha-tocopherol
Almonds  (1 oz)           12.8 mg           
Hazelnuts (1oz)            6.1  mg
Peanuts (1oz)               3.2  mg
Sunflower oil (Tbs)       6.6  mg
Safflower oil (Tbs)        4.6  mg
Canola oil (Tbs)            2.9  mg
Other oils (Tbs)            1-2 mg
Avocado                       3.3 mg 
Spinach (1/2 cup raw) 1.7 mg

 

SAFETY AND TOXICITY

Few side effects have been noted in adults. The major concern is an increased likelihood of hemorrhage at doses exceeding 1000 IU daily.  

Tolerable Upper Limits
Infants                          unknown (100 IU daily)
Children                       200-600 IU daily
Teens/adults                1000 IU daily

 

The Role of Vitamin E in Human Health and Some Diseases

 

The Vitamin E Fact Sheet
 

Dr. Paul

 

 

 

 

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