Mineral Metabolism

Wedad Sarawi, BSc, MSc, PhD

Office: Bldg.8, 2nd floor, Room 30
E-mail: wsarawi@[Link]

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 Outline
• Definition of minerals

• Classification of minerals

• Mineral hemostasis

• Functions of minerals

• Sign and symptoms of mineral deficiency and toxicity

 Introduction
• Minerals are inorganic substances (elements) required in small
amounts by the body.
• They function in a number of processes including formation of bones
and teeth, fluid balance, nerve conduction, muscle contraction,
signaling, and catalysis.
• Many of the essential minerals are widely distributed in foods, and
most people eating a mixed diet are likely to receive adequate
intakes.
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 Introduction
Minerals Homeostasis
• In considering the homeostasis (balance) of any substance, both the
external and internal balance of the substance must be kept in mind.
1. External balance
• Input (intake or absorption)
• Output (excretion)
2. Internal balance
• Distribution between different compartments
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 Introduction

• Mineral deficiencies usually are rare as they are widely

distributed in food.

• However there are many deficiency cases noted of iron, iodine

and calcium deficiencies.

• It may take many months to develop mineral toxicity based on

body stores.
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Classification of Minerals
Minerals are classified based on:

•Its daily requirement

•Functional need to body

Minerals are classified based on its daily requirement
Minerals

Major minerals Trace minerals

They are used and stored in large quantities in the They are as vital as the major minerals, but in
body, more than 100 mg/day. trace amounts less than 100 mg/day

Iron (Fe), Copper (Cu), Cobalt (Co),

Sodium (Na), Potassium (K), Chloride
Chromium (Cr), Fluoride (F), Iodine (I),
(Cl), Calcium (Ca), Phosphorus (P),
Manganese (Mn), Molybdenum (Mo),
Magnesium (Mg), Sulfur (S)
Selenium (Se), Zinc (Zn)
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Nutritionally Important Minerals
Minerals classified based on functional need to body
:
Minerals involved in: Example .
Structural functions Ca, P, Mg, F in bones; S in Keratin Fe
in Heme
Nerve and muscle functions Ca, Na, K, Mg
Membrane functions Na, K
Vitamins Co in Vitamin B12
Enzymes as cofactors. Co, Cu, I, Mg, ,Mn, Na, K
Hormones I in Thyroid hormones.
Acid-base and water balance Na, K and Cl

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Neuro Muscular Activity
Minerals Bone Involvement
Classification Based
Calcium on Functional Needs Calcium
Sodium Phosphorous
Potassium Magnesium
Chloride Fluorine
Antioxidant Activity

Selenium
Copper
Zinc
Manganese
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Macrominerals

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 Calcium (Ca)
• Calcium is the most abundant macromineral.

• Mineral Function: major component of bones and teeth with ~98%

being found in bones. Also, essential in blood coagulation, nerve and
muscle function and milk production.

• Symptoms of Deficiency: retarded growth, tetany, deformed bones in

(rickets), and osteoporosis in elderly.

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Calcium Deficiency

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 Calcium in bones

• Ca along with P, and Mg forms the inorganic matrix of the

bone as Hydroxyapatite crystals  strength to the skeleton.
 Calcium (Ca)
• Symptoms of Toxicity: kidney stones, cardiac arrest (prolonged
systole), constipation. Can result from overproduction of parathyroid
hormone (PTH).

• Sources: dairy products, leafy green vegetables, soy, tofu and fish.

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Calcium absorption

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 Calcium distribution

• 99% of Ca2+ is in bones (1.2kg)

• 0.8% of Calcium is in soft tissues (ICF)
• 0.1% in Blood ( ECF)
• The free calcium is the physiologically active form and is tightly
regulated.
Three hormones involved in Ca regulation
• Parathyroid hormone (PTH), 1,25-dihydroxy Vitamin D3, Calcitonin
Three organs involved in Ca regulation:
• Bone, kidney, intestine
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 Ca in blood

Hypercalcemia: blood calcium level > 11mg/dl

• Muscle weakness and myopathy, fatigue, fractures
• Formation of stones
• Pancreatitis
• Mental changes; depression, confusion and memory loss
Hypocalcemia: blood calcium < 9mg/dl
• Neuromuscular excitability which causes muscle cramps
• Paraesthesia
• Tetany
• Agitation and seizures
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 Calcium
regulation
in blood

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 Bone remodeling
• Osteoblasts are responsible for bone formation, while Osteoclasts are for bone
resorption.
• Bones undergo mineralization during osteoblastic activity, and demineralization
during osteoclastic activity.
• Osteoclasts secrete acid, causing the release of calcium and phosphate into the
bloodstream. There is constant exchange of calcium between bone and blood.
 Calcium Dietary Requirements

• Adult: 800 mg/day

• Pregnancy, lactation and post-menopause: 1500 mg/day
• Growing Children: (1-18 yrs): 1200 mg/day
• Infants: (< 1 year): 300-500 mg/day
 1,25-dihydroxy Vitamin D3
(Calcitriol)
Actions:
• Stimulation of calcium and phosphate absorption from the intestine
• Increased efficiency of PTH action on bone
• Stimulates calcium reabsorption by the kidney
Vitamin D factories:
• Skin
• liver
• Kidney
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 Phosphorus (P)

• Mineral Function: similar to Ca, it is essential for the formation of

bones, teeth, and body fluids. Required for acid-base balance, protein
activation via phosphorylation (Phospholipids, nucleic acids,
Phosphoproteins). Required for metabolism, cell respiration and normal
reproduction.

• Symptoms of Deficiency: (Rare) muscle weakness, poor reproduction,

anorexia, rickets, osteomalacia. 27
 Phosphorus (P)

• Symptoms of Toxicity: excess P combine with Ca and form crystals

that deposit in soft tissue (metastatic calcification).

• Sources: dairy products, meat, eggs and green leafy vegetables.

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 Regulation of P in blood

• PTH stimulates the excretion of P by inhibiting tubular

renal reabsorption of P, Thus there is inverse relationship
of PTH activity and serum P levels.
• Hyperparathyroidism decreases serum inorganic P levels.
• Excretion of P and Ca is reciprocally regulated. When
Phosphorous is excreted Ca is retained and vice a versa.
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 Magnesium (Mg)

• Mineral Function: essential for >300 enzymatic processes, with Ca and

P form matrix of bones and enamel of teeth, neuro-muscular function,
and maintenance of intracellular levels of K and Ca. A regulator of ion
channels; an important intracellular signaling molecule.

• Symptoms of Deficiency: cardiac arrhythmias and hyperexcitability of

skeletal muscles and nerves.
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 Magnesium (Mg)

• Symptoms of Toxicity: hypotension, urine retention, irregular

heartbeat and muscle weakness (due to depressed nerve conduction).

• Sources: dark chocolate, nuts, spinach, pumpkin seeds, and avocado.

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 Mg in blood

Hypomagnesemia
• Starvation, malnutrition and malabsorption
• Chronic alcoholism and liver cirrhosis
• Uncontrolled Diabetes mellitus (Osmotic diuresis)
• Hyperthyroidism
• Rickets

Hypermagnesemia
• Hypothyroidism
• Advanced Renal Failure (Less excretion)
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 Sodium (Na)

• Mineral Function: Na+ is the chief Cation of extracellular fluid (ECF)

essential for maintaining water balance, osmotic equilibrium, acid–base
balance, cell membrane potential that are essential for the functioning of
neurons and myocytes.

• Symptoms of Deficiency: loss of appetite, nausea and vomiting.

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 Sodium (Na)

• Symptoms of Toxicity: high blood pressure; hypernatremia stimulates thirst

centres in the brain which secretes antidiuretic hormone from the pituitary
gland leading to water retention. This results in an increase in plasma
volume and, consequently, an increase in BP.

• Sources: salt, ready meals, meat, cheese, and nuts.

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 Na in blood
Hypernatremia

• Parenteral IV infusion with Saline. High intake of Salt without corresponding in take of water.

• Hyperaldosteronism: Aldosterone increases renal reabsorption of Na and decrease its excretion.

• Cushing's Syndrome high cortisol released from adrenal increases reabsorption of Na

Hyponatremia

• Diarrhea and excessive sweating

• Nephrotic Syndrome

• Addison's disease (adrenal insufficiency) low aldosterone decreases reabsorption of Na

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 Chloride (Cl)

Cl plays an important roles in several physiologic processes and are provided

as salt (NaCl).

• Mineral Function: Cl- is essential for production of gastric HCl for

digestion process.

• Cl and Na ions goes simultaneously. Conditions increasing Na also

increases Cl and vice versa.

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 Potassium (K)

• Mineral Function:. intracellular cation (K+) essential for neural

transmission, neuromuscular and cardiac muscle activity, vascular
tone, acid base balance and it is a main component of body fluid.

• Symptoms of Deficiency: severe: cardiac arrhythmias, muscle weakness,

glucose intolerance; moderate: high BP, high risk of kidney stones, stroke.

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 Potassium

• Symptoms of Toxicity: cardiac arrhythmias, skeletal muscle weakness

and cardiac arrest.

• Sources: fruits and vegetables (bananas, oranges, avocado, potatoes)

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 K in blood
Excretion of Na+ and K+ are reciprocally regulated. If Na+ is excreted K+ is retained vice a versa.

Hyperkalemia

• GFR falls below 30 ml/min due to primary renal dysfunction or acute volume depletion 
dehydration, bleeding or congestive heart failure .

• Violent Muscular Activity

• Addison's Disease (adrenal insufficiency) low aldosterone Decreases K excretion

Hypokalemia

• Insulin Therapy

• Cushing’s Syndrome (high cortisol)

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 Sulfur
• Mineral Function: present in methionine and cysteine amino acids which
possess –SH groups. The SH groups are responsible for forming S-S bonds in the
structures. Sulfated compounds in the human body include immunoglobulins,
keratin of nail/hair, and Glutathione Peroxidase

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 Sulfur

• Symptoms of Deficiency: reduce protein synthesis, brittle hair and

nails, itchy skin/ scalp, exacerbated acne, depression, and memory
loss.

• Symptoms of Toxicity: (Rare) burning sensation, indigestion,

vomiting, diarrhea, and bed wetting.

• Sources: found in proteins – egg, fish, meat, and liver

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Microminerals

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 Iron (Fe)
• Dietary iron is available as ferrous (Fe2+) in heme (animal sources) and
ferric (Fe3+) in non-heme sources (plants).

• Mineral Function: Iron is an essential component of many proteins;

hemoglobin and myoglobin. Also used for oxygen transport and storage,
anemia prevention, and act as a cofactor for many enzymes (e.g., catalase).

• About 70% of Fe is present in hemoglobin (RBC) and 5% in myoglobin

(muscles) the remaining 25 % in other cells.
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FYI

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 Iron (Fe)
• Ferric iron (Fe+3) is the unabsorbable form of iron.
• Ferric form is transformed to Ferrous form of iron at GIT in presence of Vit C
(Ascorbic acid).
• Ascorbic acid transform non absorbable Ferric form to absorbable Ferrous form.
• Vitamin C is the most potent enhancer iron absorption.

Fe +3
Fe+2
Vitamin C
Glutathione-SH
 Iron (Fe)
• Iron is called one way element (absorption & excretion occurs in the small
intestine).
• RDA 10 mg , only 10% is absorbed 1mg/day

• Iron is normally stored in liver, spleen and bone marrow.

• Iron is temporarily stored in the form of Ferritin until it get utilized.

 Iron (Fe)
• Symptoms of Deficiency: iron deficiency anemia (tiredness, impaired work
performance, failure to thrive in infants).

• Symptoms of Toxicity: acute toxicity causes GI problems (constipation,

diarrhea, cramps, hematemesis); chronic toxicity increased risk for bacterial
infections, arthropathy, cardiomyopathy, and endocrine dysfunctions.

• Sources: meat (liver, heart kidney), dates, nuts, and green leafy vegetables,

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Iron Deficiency Anemia

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 Zinc (Zn)
• Mineral Function: Sexual maturation and fertility, cofactor for enzymes
in DNA, RNA and protein synthesis, immune system, wound healing, as
a cofactor for >100 enzymes (e.g., alcohol dehydrogenase, carbonic
anhydrase and superoxide dismutase), taste protein in saliva gustin. Also is
required for the storage and secretion of insulin from the pancreas.

• Symptoms of Deficiency: growth retardation, dermatitis, alopecia, loss of

appetite, delayed sexual maturation, diarrhea, and immune deficiencies.
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 Zinc

• Acrodermatitis enteropathica (AE) is an inherited form of zinc deficiency

(hypozincemia) caused by a defect in the absorption of zinc.

• Symptoms of Toxicity: acute toxicity causes nausea and vomiting; chronic toxicity
causes copper deficiency and gastric ulcer.

• Sources: meat, fish, eggs, and dairy products.

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 Copper (Cu)
• Mineral Function: essential for metalloenzymes (Super oxide Dismutase, Monoamine
Oxidase), red blood cell formation (key component of ceruloplasmin, ferroxidase
enzyme, involved in the oxidation of Fe+2 to Fe+3) and maintains myelin sheaths of
nerve fibers. Also, it is necessary for the synthesis of phospholipids, collagen elastin
and melanin.

• Symptoms of Deficiency: Iron deficiency anemia, neutropenia, bone fractures, weakness,

fatigue, hypopigmentation of skin and hair, and weight loss.

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 Copper (Cu)
• Symptoms of Toxicity: acute toxicity causes vomiting, diarrhea, hemolytic
anemia, blue-green discoloration of saliva; chronic toxicity causes hepatitis,
cirrhosis, jaundice, golden brown/yellow/green ring round the cornea known as
Kayser Fleischer Ring.

• Sources: meat, shellfish, nuts, and whole grains.

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Copper Toxicity – Kayser Fleischer Ring.

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 Diseases associated with Cu metabolism

Menkes’ disease:
• Genetic defects in intestinal absorption of Cu which leads to severe deficiency and
low serum ceruloplasmin level  child may die at very early age.
Wilson’s disease:
• Genetic defects in copper excretion, leading to accumulation of copper in liver,
brain, kidney, cornea, other tissues. Defect in incorporation of copper into
ceruloplasmin. Liver cirrhosis Mental disturbances Kayser Fleischer ring
• Treatments: Penicillamine and liver transplantation

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 Fluoride
• Mineral Function: Fluoride in body is mainly present in bones and teeth.
It is added to water in many parts of the world to reduce the incidence of
dental caries and decay as it replaces the hydroxyl group of
hydroxyapatite, forming fluorapatite that is more resistant to the enamel-
dissolving acid produced by mouth bacteria.

• Symptoms of Deficiency: directly affects the health of teeth and bones,

plaque formation, inflammation and decay of the tooth.
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 Fluoride
• Symptoms of Toxicity: fluorosis which causes GIT upset (gastroenteritis,
loss of appetite, weight loss) and mottling of teeth enamel, stratification
and discoloration of teeth (Brown/Yellow Patches on Teeth). Extreme
toxicity causes skeletal fluorosis (Osteoporosis and Osteosclerosis with
brittle bones).

• Sources: drinking water, fluoride toothpaste, tea.

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Dental and Skeletal Fluorosis

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 Cobalt
• Mineral Function: Cobalt forms an integral parts of Cyanocobalamin (vit B12)
which has a role in normal functioning of the brain and nervous system. Cobalt is
required to maintain normal bone marrow function and blood formation.

• Symptoms of deficiency: causes deficiency of vit B12  macrocytic anemia.

• Symptoms of Toxicity: overproduction of RBCs causing polycythemia.

• Sources: mostly present in animal food sources (meat and fish).

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 Chromium (Cr) Manganese (Mn)
• Mineral Function: potentiates the action Mineral Function: Manganese acts as a cofactor

of insulin and plays important role in for RNA Polymerase, Superoxide Dismutase,. Also,

carbohydrate, lipid and protein it’s essential for bone formation and nervous
system.
metabolism.
Symptoms of Deficiency: (Rare) growth
• Symptoms of Deficiency: impaired glucose
retardation, skeletal deformities, diminished activity
tolerance
of β cells in the pancreas.
• Symptoms of Toxicity: organ damage. Symptoms of Toxicity: (Rare) psychotic and
• Sources: grape juice, yeast, lean meat, and parkinsonism like symptoms.
broccoli. Sources: tea, grains, beans, nuts, liver and kidney.
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Ultra trace Microminerals

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 Iodine (I)
• Mineral Function: Iodine is utilized in the synthesis of the thyroid hormones
triiodothyronine (T3-[more active form]) and thyroxine (T4) that are required for
development, growth, and metabolism.

• Symptoms of Deficiency: goiter (enlargement of the thyroid in response to excessive

stimulation by TSH), fatigue, weight gain, decreased thermogenesis, and decreased
metabolic rate.

• Symptoms of Toxicity: rapid heart rate, excessive sweating, protruding eyes, weight loss.
• Sources: Fish (such as cod and tuna), seaweed, shrimp, and dairy products.

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Iodine Deficiency – Goiter

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 Selenium (Se)
• Mineral Function: Se is present in many proteins (selenoproteins) known for its antioxidant
activity. Selenoproteins include (glutathione peroxidase, thioredoxin reductase, ribonucleotide
reductase, deiodinases), and implicated in the maintenance of redox status.

• Symptoms of Deficiency: Keshan's Disease (cardiac enlargement, arrhythmia,

cardiomyopathy-Multifocal Myocardial Necrosis), impaired immune function.

• Symptoms of Toxicity: Selenosis – garlic breath, brittle hair and nails, hair loss, and skin
lesions.

• Sources: meat (liver and kidney), dairy products, and grains

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Thank You