UNIT -6

Presented By : Asha Prabeesh

Msc DFSM,PGDND
Minerals: Essential Nutrients
Minerals are vital for our body's healthy operation.

They're inorganic substances that perform various critical

functions, from building strong bones to enabling nerve
signals. Unlike vitamins, which are organic, minerals are pure
elements.

The body requires different amounts of each mineral, leading

to their classification into two main groups.
Mineral Classification: Major vs. Trace

We classify minerals based on the daily amounts our bodies need:

● Major Minerals (Macrominerals): These are required in larger

quantities. Think of them as the 'bulk' minerals our body utilizes
constantly for fundamental processes. The daily intake for these is
generally more than 100 milligrams (mg).

● Trace Elements (Microminerals): While needed in smaller

amounts, these are no less important. They often act as catalysts for
various reactions and play specialized roles. The daily intake for
these is typically less than 100 milligrams (mg).
Mineral Classification List
Here is a breakdown of common essential minerals by their classification

A. Major Minerals (Macrominerals) B. Trace Elements (Microminerals)

● Calcium (Ca) ● Iron (Fe)

● Phosphorus (P) ● Zinc (Zn)
● Sodium (Na) ● Iodine (I)
● Potassium (K)
● Selenium (Se)
● Magnesium (Mg)
● Chloride (Cl) ● Copper (Cu)
● Sulfur (S) ● Manganese (Mn)
● Chromium (Cr)
● Fluoride (F)
● Molybdenum (Mo)
● Cobalt (Co) - often as part of Vitamin
B12
● Boron (B)
● Vanadium (V)
 CALCIUM

Calcium (Ca) is the most abundant mineral in the human body, classified as a Major Mineral
(Macromineral).

● Quantity Needed: Required in amounts greater than 100 mg per day.

● Distribution:
○ 99% is stored in bones and teeth, providing structure and acting as a reservoir.
○ The remaining 1% is vital for numerous other critical bodily functions.

● Overall Importance: Essential not just for strong bones, but for a wide range of metabolic
and physiological processes vital for overall health.
Functions of Calcium:
1. Bone Formation: Essential for the formation and maintenance of strong bones, providing structural integrity
to the skeleton.
2. Tooth Formation: Crucial for the development and strength of teeth, contributing to dental health.
3. Muscle Contraction: Plays a vital role in initiating and facilitating muscle movement and contraction,
including the function of skeletal, smooth, and cardiac muscles.
4. Nerve Transmission: Aids in the transmission of nerve signals (neurotransmitters) between nerve cells,
ensuring proper communication throughout the nervous system.
5. Blood Clotting: Necessary for proper blood clot formation, acting as a crucial cofactor in the coagulation
cascade.
6. Cell Signaling: Acts as a secondary messenger in various cellular communication pathways, mediating
responses to hormones and other signals.
7. Heart Health: Regulates heartbeat and cardiac muscle function, contributing to a stable and healthy
cardiovascular system.
8. Enzyme Function: Serves as a cofactor for many enzymatic reactions, enabling a wide range of metabolic
processes.
9. Hormone Release: Involved in the release of certain hormones (e.g., insulin) and neurotransmitters from
cells.
10. Intracellular Transport: Helps transport molecules across cell membranes, contributing to cellular nutrient
Dietary Sources:
● Milk and milk products (yogurt, cheese, paneer)
● Leafy green vegetables (spinach, broccoli, mustard greens, kale)
● Fortified tofu and soy beverages
● Canned fish with bones (salmon, sardines)
● Legumes, nuts, sunflower seeds, soybeans
● Okra, trout, acorn squash

CALCIUM -RDA (ICMR 2020):

Adult Men - 1000mg/day

Adult Women - 1000 mg/day
Pregnant Women - 1000 mg/day
Lactating Women -1200 mg/day
Infants -300 mg/day
Children -500mg/day
Calcium-Deficiency Disorders
1. Osteoporosis
● Definition: A condition where the bone mass of the skeleton is
diminished, leading to weakening of the bone and increased
susceptibility to fractures. The bone tissue itself is structurally normal,
but there's simply less of it.
● Causes:
○ Lack of calcium (long-term insufficient intake)
○ Poor absorption of calcium
○ Immobility (lack of weight-bearing exercise)
○ Decreased level of estrogen in postmenopausal women (a major
risk factor)
○ Corticosteroid use (e.g., long-term corticosteroid injection or oral
therapy)
2. Osteomalacia
● Definition: A condition characterized by the softening of bone due to
defective bone mineralization. While the quantity of bone tissue might
be present, it lacks proper hardness because of insufficient calcium
and phosphorus deposition.

● Key Difference from Osteoporosis: In osteomalacia, the bone is soft

due to inadequate mineralization. In osteoporosis, the bone is normally
mineralized but its density (mass) is reduced.
3. Tetany
Definition: A state of increased neuromuscular excitability. It occurs when calcium in
the blood drops below the normal level (hypocalcemia). This change leads to
increased excitability of nerve cells, resulting in uncontrolled contraction of the
muscle tissue.

Mechanism: Low extracellular calcium ions destabilize the nerve cell membrane, leading
to spontaneous depolarization and repetitive firing, which manifests as muscle spasms
and cramps.

Types of Tetany:

○ Acute Tetany: Often associated with rapid drops in blood calcium, leading to
severe symptoms like muscle cramps, spasms (e.g., carpopedal spasm), and
laryngeal stridor.

○ Chronic Tetany: May result from long-term, less severe hypocalcemia,

presenting with more subtle symptoms like tingling, numbness, and
generalized muscle aches.
 Calcium Definition What Happens / Key Common Causes Notes / Types
Deficiency Characteristics
Diseases

Osteoporosis Where bone Bones become weak and brittle; Lack of calcium (long-term), poor Often called
mass of the increased fracture risk. Quantity of absorption, immobility, decreased "weakening of bone."
skeleton is bone is reduced. estrogen (postmenopausal Bone structure is
diminished. women), Corticosteroid injection. normal, but there's
less of it.

Osteomalacia Softening of Defective bone mineralization; bones Lack of calcium, poor absorption Differs from
bone. lack proper hardness despite potentially (often due to Vitamin D deficiency osteoporosis; bone is
normal bone tissue quantity. affecting Ca/P absorption). soft, not necessarily
diminished in quantity.

Tetany Increased Occurs when calcium in the blood drops Low blood calcium (hypocalcemia). Types: Acute Tetany,
neuromuscular below the normal level. Results in Chronic Tetany.
excitability due increased excitability of nerve cells and
to uncontrolled contraction of muscle
hypocalcemia. tissue.

Calcium Toxicity (Hypercalcemia): Excess calcium can lead to kidney stones, impaired kidney
function, constipation, and in severe cases, confusion or irregular heart rhythms.
 PHOSPHORUS (P)
Functions:

○ Bone & Teeth Structure: Crucial for normal structure of bones and teeth.
○ Energy Metabolism: Involved in changing food enzymes into energy.
○ Cellular Role: Found in every cell; part of acid-base balance system.
○ Calcium Absorption: Helps in calcium absorption (but excess can hinder).
○ Nervous Health & Healing: Promotes nervous health and hastens healing
processes.

Dietary Sources:

○ Animal Products: Meat, fish, poultry, eggs, milk and milk products.
○ Plant-Based: Seeds, nuts, whole grain cereals, pulses, beans.
○ Specific Examples: Yellowfin tuna, tofu, scallops, pumpkin seeds, quinoa.

RDA (ICMR 2020):

○ Adult Men & Women: 800 mg/day

○ Pregnant & Lactating Women: Increased requirements
Phosphorus Deficiency (Hypophosphatemia)
● Related Issues: While severe dietary phosphorus deficiency is
rare due to its widespread presence in food, conditions leading
to low blood phosphorus can cause:

○ Muscle weakness and pain

○ Bone pain and fragility
○ Confusion and neurological symptoms
○ Rickets (in children) or osteomalacia (in adults) if severe
and prolonged, as it impacts bone mineralization.

Phosphorus Toxicity (Hyperphosphatemia):

High levels, often due to kidney issues, can cause soft tissue
calcification (e.g., in blood vessels), bone problems, and itching.
 SODIUM (Na)
Sodium is an essential mineral required in significant amounts by the body to support several vital physiological
processes.

Functions:

● Fluid Balance: Essential for maintaining the balance of fluids both inside and outside cells. This is crucial for
cell function and overall hydration.
● Blood Pressure Regulation: Plays a key role in regulating blood pressure, impacting cardiovascular health.
● Nerve and Muscle Function: Helps in the transmission of nerve signals throughout the nervous system and
is vital for proper muscle contraction, including the heartbeat.

Dietary Sources: Sodium is widely available in the diet, primarily through:

● Common table salt (Sodium chloride)

● Processed foods (which often contain large amounts of added sodium)
● Condiments like soy sauce
● Smaller, naturally occurring amounts are found in milk, breads, vegetables, and unprocessed meats.
● Specific examples include dill pickles, clams, cheese, and dry-roasted sunflower seeds.
Recommended Dietary Allowance (RDA) - ICMR 2020:
● Adult Men & Women: 2000 mg/day
● Important Note from ICMR 2020: It emphasizes limiting visible salt intake due to associated health
risks, particularly high blood pressure, when consumed in excess.

Deficiency (Hyponatremia):
Sodium deficiency, known as Hyponatremia, occurs when the concentration of sodium in the blood falls to an
abnormally low level.

● Causes: While extremely low dietary sodium intake can contribute, hyponatremia is more commonly
caused by:
○ Excessive water intake, which dilutes the existing sodium.
○ Significant loss of fluids containing sodium, such as from severe vomiting, diarrhea, or excessive
sweating.
○ Certain medical conditions (e.g., kidney failure, heart failure) or medications (e.g., some diuretics).
○ Symptoms: Symptoms can range from mild to severe and include nausea, vomiting, headache,
confusion, fatigue, and muscle cramps. In more severe cases, it can lead to seizures and even coma.
Sodium Toxicity (Hypernatremia):
Too much sodium, especially with inadequate water, leads to dehydration, extreme thirst, confusion,
and can cause high blood pressure (hypertension) long-term.

Causes:
● Dehydration (most common cause): insufficient water intake, excessive fluid loss (e.g., severe
vomiting, diarrhea, profuse sweating, fever) without adequate rehydration.
● Excessive intake of salt without sufficient water.
● Certain medical conditions (e.g., diabetes insipidus) or medications.

Symptoms & Health Risks:

● Extreme thirst, dry mouth, reduced urination.
● Confusion, lethargy, irritability, muscle twitching.
● Seizures, coma, and brain damage in severe cases due to brain cell shrinkage.
 MAGNESIUM
● Functions:
○ Found in bones and in every cell of the human body.
○ Needed for making protein, muscle contraction, and nerve transmission.
○ Important for immune system health.
○ Helps metabolize Vitamin E and Calcium.
○ Aids in building and strengthening bones and teeth.
● Dietary Sources:
○ Nuts and seeds (pumpkin seeds, almonds, cashews)
○ Legumes (lima beans, lentils, kidney beans, soybeans)
○ Leafy green vegetables (spinach, kale, collard greens)
○ Seafood (tuna)
○ Chocolate, artichokes
○ Whole grain cereals (brown rice)
○ Dairy products
● RDA (ICMR 2020):
○ Adult Men : 400 mg/day
○ Adult Men : 420 mg/day
Magnesium Deficiency : Hypomagnesemia
Low blood magnesium levels.

Symptoms: Muscle cramps/spasms, fatigue, weakness, numbness/tingling, abnormal heart rhythms.

Causes: Often due to underlying medical conditions (e.g., GI disorders, kidney issues, alcoholism) or
certain medications, rather than just low dietary intake.

Magnesium Toxicity : Hypermagnesemia

High blood magnesium levels.

Symptoms: Nausea, vomiting, muscle weakness, low blood pressure, drowsiness. Severe cases can lead
to respiratory depression or cardiac arrest.

Causes: Usually from overuse of magnesium supplements/medications, especially in individuals with

impaired kidney function.
B. Trace Elements (Microminerals)
● Iron (Fe)
● Iodine (I)
● Fluoride (F)
● Zinc (Zn)
● Selenium (Se)
● Copper (Cu)
● Manganese (Mn)
● Chromium (Cr)
● Molybdenum (Mo)
● Cobalt (Co) - often as part of Vitamin B12
● Boron (B)
● Vanadium (V)
 IRON (Fe)
Iron (Fe) is an indispensable trace element, meaning the body needs it in smaller quantities, but its role in
vital physiological processes is enormous. It is one of the most critical minerals for sustaining life and
overall health, primarily due to its central role in oxygen transport.

Functions:
● Oxygen Transport & Storage: Essential component of hemoglobin (in red blood cells), which
transports oxygen from the lungs to all body tissues. It's also part of myoglobin (in muscle cells),
vital for oxygen storage in muscles.
● Energy Production: Participates in various enzyme systems involved in cellular energy production
(cellular respiration).
● Growth & Development: Important for normal growth and development, particularly in children.
● Immune Function: Plays a crucial role in maintaining a healthy immune system, supporting the
body's defense against infections.
● Healing & DNA Synthesis: Important for tissue healing and repair, as well as the synthesis of
DNA.
Dietary Sources:
Iron is found in a variety of foods, with two main types: heme iron (from animal sources, more easily
absorbed) and non-heme iron (from plant sources, absorption can be enhanced by Vitamin C).

● Heme Iron Sources: Red meat, organ meats (liver), poultry, fish.
● Non-Heme Iron Sources: Legumes (beans, lentils), dark leafy greens (spinach), fortified cereals,
eggs.
RDA (ICMR 2020):
● Adult Men: 19 mg/day
● Adult Women (19-50 years): 29 mg/day (due to menstrual blood loss)
● Pregnant Women: 27 mg/day
● Lactating Women: 19 mg/day

Deficiency Diseases: Iron Deficiency Anemia:

The most common nutritional deficiency worldwide. It occurs when the body lacks sufficient iron to produce
adequate amounts of hemoglobin, leading to a reduced capacity of red blood cells to carry oxygen.

● Causes:
○ Insufficient Dietary Iron Intake: Not consuming enough iron-rich foods.
○ Blood Loss: Heavy menstrual bleeding, gastrointestinal bleeding (e.g., ulcers, hemorrhoids, certain
medications like NSAIDs), frequent blood donations, or internal bleeding.
○ Impaired Absorption: Conditions like celiac disease, inflammatory bowel disease, or certain stomach
surgeries can reduce iron absorption.
○ Increased Requirements: Periods of rapid growth (infancy, adolescence), pregnancy (due to
increased blood volume and fetal demands).
Symptoms:
○ Common: Extreme fatigue, weakness, pale skin, shortness of breath, dizziness or lightheadedness,
cold hands and feet.
○ Other: Brittle nails, inflammation or soreness of the tongue, unusual cravings for non-nutritive
substances (pica, e.g., ice, dirt), headache, rapid heartbeat.

Complications (if untreated): Heart problems (enlarged heart, heart failure due to increased pumping
effort), developmental delays in children, and pregnancy complications (premature birth, low birth weight).

Iron Toxicity
Acute Iron Poisoning:
Sudden, massive overdose (often accidental in children).

Risks: Severe GI issues, multi-organ damage (liver, heart), shock, potentially fatal.

Chronic Iron Overload (Hemochromatosis):

Body stores too much iron over time (often genetic).

Risks: Gradual iron accumulation damaging organs (liver, heart, pancreas), leading to conditions like cirrhosis, heart
failure, and diabetes.
 IODINE (I)
Iodine is an essential trace element that plays a critical role in human health, primarily
due to its indispensable involvement in thyroid hormone synthesis. Although required in
minute quantities, its deficiency can lead to severe health consequences globally.

Functions:
● Thyroid Hormone Synthesis: Iodine is the primary constituent of thyroid
hormones, thyroxine (T4) and triiodothyronine (T3).
● Metabolism Regulation: Thyroid hormones regulate numerous metabolic
processes, including energy production, growth, and development.
● Brain Development: Crucial for normal brain development in the fetus and young
children.
● Nervous System Function: Supports proper nerve and muscle function.
● Body Temperature Regulation: Helps maintain normal body temperature.
Dietary Sources:
● Iodized Salt: The most common and effective source in many countries.
● Seafood: Fish (cod, tuna), seaweed (kelp, nori, kombu), shellfish. The iodine content
varies based on where they live.
● Dairy Products: Milk, yogurt, cheese (content varies with iodine in animal feed).
● Eggs: Contain a moderate amount of iodine.
● Grains: The iodine content varies depending on the soil iodine content.

RDA (ICMR 2020):

● Adult Men & Women: 140 µg/day
● Pregnant Women: 220 µg/day
● Lactating Women: 280 µg/day
Deficiency Diseases:
Iodine deficiency is a major public health problem worldwide.

● Goiter: The most visible sign of iodine deficiency, characterized by an

enlargement of the thyroid gland in the neck as it tries to capture more iodine
from the blood.
● Hypothyroidism: An underactive thyroid gland, leading to insufficient
production of thyroid hormones. Symptoms include fatigue, weight gain, cold
intolerance, constipation, dry skin, hair loss, and impaired cognitive function.
● Cretinism: Severe and irreversible mental and physical retardation in infants
and young children, caused by severe maternal iodine deficiency during
pregnancy. It results in profound developmental delays, short stature, and
neurological impairment.
● Other Issues: Increased risk of stillbirths, miscarriages, and congenital
anomalies. Reduced intellectual capacity and learning disabilities in children.
Toxicity (Excess Iodine):
While essential, excessive iodine intake can also be harmful, though toxicity from food sources alone is
rare in healthy individuals. It's more common from high-dose supplements or medications.

● Symptoms: Can lead to symptoms similar to deficiency, such as goiter and hypothyroidism, as
chronic high intake can inhibit thyroid hormone synthesis.
● Other Symptoms: Hyperthyroidism (less common but possible, especially in individuals with
pre-existing thyroid conditions),
Toxicity (Excess Iodine):
While essential, excessive iodine intake can also be harmful, though toxicity from food sources alone is
rare in healthy individuals. It's more common from high-dose supplements or medications.

● Symptoms: Can lead to symptoms similar to deficiency, such as goiter and hypothyroidism, as
chronic high intake can inhibit thyroid hormone synthesis.
● Other Symptoms: Hyperthyroidism (less common but possible, especially in individuals with
pre-existing thyroid conditions),
 FLUORINE (Fluoride)
Fluorine exists primarily as fluoride ions in the body and plays a unique role in human
health, predominantly recognized for its beneficial effects on dental health and, to a lesser
extent, bone strength.

Functions:
● Tooth Formation & Strength: Fluoride incorporates into the enamel structure of
teeth, forming fluorapatite. This makes tooth enamel harder, more resistant to acid
erosion, and significantly more resistant to dental caries (tooth decay). It also
promotes remineralization of early enamel lesions.
● Bone Health: Contributes to bone mineralization and maintenance. While essential
for healthy bones, excessive intake can have adverse effects.
Dietary Sources:
● Fluoridated Water: The most significant dietary source of fluoride in many regions.
● Tea: Black and green teas naturally contain fluoride.
● Seafood: Fish and shellfish contain moderate amounts of fluoride.
● Certain Foods: Smaller amounts can be found in some processed foods and beverages where
fluoridated water is used in processing.
● Toothpaste/Mouthwash: While not dietary, fluoridated dental products are a major source of topical
fluoride exposure.

RDA (ICMR 2020):

ICMR 2020 provides Adequate Intake (AI) rather than a strict RDA for Fluoride, as it's not considered an essential
nutrient in the same way, but highly beneficial for dental health.

● Adult Men & Women: 3 mg/day (This recommendation is typically for overall intake, including water.)
Fluoride: Deficiency Disease
Dental Caries (Tooth Decay): Not enough fluoride leads to weaker enamel, making teeth more
susceptible to cavities.

Toxicity (Fluorosis)
Excess fluoride primarily affects teeth and bones.

A. Dental Fluorosis:
Occurs in childhood, affecting tooth enamel appearance.

Stages : Ranges from faint white flecks to severe brown stains and pitting.

B. Skeletal Fluorosis:
Chronic excess fluoride affecting bones.

Progression : Starts with pain/stiffness, then needs one stick, progresses to two sticks/crutches, potentially
leading to crawling/bedridden state, and in severe cases, complications can lead to death.
Skeletal Fluorosis: Stages
These are descriptive, not formal, stages of severe skeletal fluorosis:

● Initial: Fluoride builds in bones, often mild joint pain/stiffness.

● "One Stick Stage": Significant joint pain and stiffness, requires one walking stick.
● "Two Stick Stage": Severe joint limitation, requires two sticks or crutches.
● "Crawling/Bedridden Stage": Most severe, unable to walk, resorting to crawling or becoming
bedridden.
● Death: Extreme outcome due to complications from severe immobility or organ impairment.

C. Acute Fluoride Poisoning

Rare but serious, resulting from a single, very large dose of fluoride (e.g., accidental ingestion of concentrated
fluoride products).

Symptoms: Rapid onset of nausea, vomiting, abdominal pain, diarrhea, muscle weakness, convulsions, and can
be fatal due to cardiac arrest or respiratory failure.
Trace Elements: Functions, Sources, and Deficiency
Mineral Functions (Short) Dietary Sources (Short) Deficiency Symptoms (Short)

Zinc (Zn) Immunity, wound healing, Meat, seafood (oysters), Growth retardation, impaired
growth, taste/smell. legumes, nuts. immunity, skin issues.

Selenium Antioxidant, thyroid Brazil nuts, seafood, Keshan disease (heart),

(Se) function. meats, grains. Kashin-Beck (joints), weak
immunity.

Copper Iron metabolism, energy, Organ meats, shellfish, Anemia, bone issues, nerve
(Cu) collagen formation. nuts, seeds. problems (rare).

Manganese Bone formation, Whole grains, nuts, Impaired growth, bone

(Mn) metabolism, antioxidant. legumes, leafy greens, demineralization (rare).
tea.

Chromium Enhances insulin action, Whole grains, meats, Impaired glucose tolerance (insulin
(Cr) glucose metabolism. broccoli, nuts. resistance).
Trace Elements: Functions, Sources, and Deficiency
Mineral Functions (Short) Dietary Sources Deficiency Symptoms (Short)
(Short)

Molybdenum Enzyme cofactor Legumes, grains, nuts, Very rare; neurological issues,
(Mo) (metabolism). milk, leafy greens. sulfur amino acid intolerance.

Cobalt (Co) Component of Animal products (meat, Vitamin B12 deficiency (anemia,
Vitamin B12. dairy, eggs - via B12). nerve damage).

Boron (B) Bone health, brain Fruits, vegetables, nuts, Not well-established; potential
function. legumes. bone/brain impact.

Vanadium (V) Unclear; may have Shellfish, mushrooms, Not well-established as

insulin-like effects. parsley, black pepper. essential; no clear symptoms.
IMPORTANT QUESTIONS

● What is the requirement of calcium in normal diet.Mention the food sources ,factors affecting absorption and
deficiency manifestation of calcium
● Functions and deficiency of calcium
● Hyponatremia & Hypernatremia
● Hypokalemia & Hyperkalemia
● Functions and sources of phosphorus
● Explain the sources ,functions and deficiency diseases of Iodine
● Functions, sources and deficiency diseases of Iron
● List down the sources of potassium
● List down Fluorine deficiency problems