MINERALS

Chapter 8: CALCIUM and IRON

 Question: What two major functions do
minerals provide?

• A) Growth and Development & Provide Energy

• B) Provide Energy & Regulate Metabolism
• C) Regulate Metabolism & Growth and Development
 Question:

Which is NOT a major mineral?

A. Sodium
B. Potassium
C. Sulfur
D. Calcium
E. Iron
Essential Minerals
 REMEMBER, DIET FIRST!

• However, athletic activity may raise some mineral requirements

 Additional minerals may be needed for the synthesis of new tissues

associated with physical training

 Loss of minerals often observed following intense exercise via sweat, urine,
and feces

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MACROMINERALS
 Definition of Macrominerals
• Called the “major minerals”
• Any mineral required in the diet in relatively large amounts

• Classified as macrominerals if:

 The RDA or AI is greater than 100 mg per day or if the body contains more
than 5 grams
 Macrominerals

• Calcium
• Phosphorus
• Magnesium
• Potassium
• Sodium
• Chloride
• Sulfur
CALCIUM
 DRI

• Children 1-3 years = 700 mg

• Youths 4-8 years = 1,000 mg
• Youths and adolescents 9-18 years = 1,300 mg
• Adults 19-50 years = 1,000 mg
• Adults 51-70 years
 1,000 mg for men
 1,200 mg for women
• Osteoporosis concern
• Adults over 71 = 1,200 mg
Food Calcium (mg) Calories
Skim milk (8 oz) 306 90
Yogurt, low-fat, fruit (8 oz) 345 232
Swiss cheese (1.5 oz) 336 162
Salmon, canned (3 oz) 181 118
Sardines, canned (3 oz) 325 177
Spinach, cooked (0.5 cup) 146 30
Collards, cooked (0.5 cup) 178 31
Beans, navy (0.5 cup) 61 148
Soy milk, fortified (8 oz) 368 98
Orange juice, fortified (8 oz) 300-350 110
Cereal, breakfast, fortified (1 oz) 256-1,053 88-106
 Nutrients Influencing Absorption and
Excretion

• Vitamin D
 Facilitates absorption
• Phytates and oxalates – interfere w/ absorption
 Phytates – found in legumes
 Oxalates – found in spinach
 May diminish calcium absorption from those foods
• Dietary fiber and phosphorous
 Decrease absorption (effects are small)
• Sodium & PROTEIN
 Excess intake increases calcium excretion

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Changes 300mg absorbed 700 excr
Calcium Deficiency Relative to Physical Performance
• Low serum calcium level in tissues can cause a number of problems
 For athletes
• Impaired muscular contraction could hinder performance
• Muscle cramping
– Due to an imbalance of calcium in the muscle and surrounding
body fluids
• Note: serious deficiencies are rare in athletes
 Hormones may extract calcium from bone as needed

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 Bone Health

• Supplementation w/ calcium + vitamin D, may be necessary in persons

not achieving the RDI
• Calcium & vitamin D
– Can protect or improve bone mineral density
– Can reduce fracture risk in postmenopausal women
– Supplementation for bone health work more effectively when they
are combined**

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 Question
Which of the following may impair Calcium absorption?
A. Phytates
B. Oxalates
C. Fiber
D. Phosphorus
E. All of these
 Osteoporosis
• Definition: thinning and weakening of the bones related
to loss of calcium stores
 Primarily age and gender related
 Prevalent in white post-menopausal women

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Osteoporosis is known as the “silent killer”

• Causes no pain

• Following a serious bone fracture:

 Nearly 1/3 or more of women and men die due to accompanying
illnesses within a year
Trabecular bone – spongy and more susceptible to
calcium loss
• The softening of
bones leads to
fractures

• Three most commonly

affected regions in the
body
 Spine
 End of radius in
the forearm
 Neck of the femur
at the hip joint
 Lifestyle Factors- modifiable

• Physical inactivity and inadequate dietary intake of calcium

• Cigarette smoking
• Excessive consumption of coffee and alcohol
• Stress
• Various medications

• All of these factors may influence peak bone mass (the highest bone mass in young
adulthood)

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Calcium
• Take a tablet with 200 mg with small
meals and snacks 3x a day
– Rather than one tablet with 600
Supplementation: mg
• More calcium absorbed

Doses when intake is spread

throughout the day
 Question:
TRUE OR FALSE
It is possible to have Osteoporosis and not know it.

A. TRUE
B. FALSE
OLD Female
LEA
MODEL Athlete
Triad
Main
problem
with low
Ca+
intake
stress
fractures

FHA/ Low Bone Mineral Density/

Newer Model
Simplified
 Osteoporosis in Sports

• Female athlete triad

 Low Energy Availability (LEA)/(Disordered eating)
 FHA/(Amenorrhea)
 Low BMD/ (Osteoporosis)

• Particularly seen in female endurance athletes and those involved in weight control sports
(gymnastics, figure skating)

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Low Energy Availability/Disordered Eating

Energy availability =

dietary energy intake - the energy expended in exercise

(EA=EI-EEE)
 Disordered Eating

• Female athletes, involved in endurance and weight-control sports, susceptible

to the female athlete triad, with one of the end results being premature
osteoporosis

• Disordered eating
– Energy intake less than energy expenditure

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 Functional hypothalamic amenorrhea (FHA)

Functional Hypothalamic Amenorrhea (FHA):

Amenorrhea caused by low energy availability
 Decrease body fat levels
 Reduced production of estrogen

3 types of FHA:
• stress-related amenorrhea
• weight loss-related amenorrhea
• exercise-related amenorrhea
 Low BMD/Osteoporosis
Low Bone Mineral Density (BMD):
Z-score between -1 and -2 & secondary clinical risk factors for fracture

• DEXA scores reported as "T-scores" & "Z-scores."

• T-score = comparison of person's bone density w/ healthy 30-year-old same sex.
• Z-score =comparison of person's bone density w/ average person of same age, sex.(misleading in older population)
• Lower scores (more negative) = lower bone density:
• T-score of -2.5 or lower qualifies as osteoporosis.
• T-score of -1.0 to -2.5 signifies osteopenia, below-normal bone density w/out full osteoporosis.
• Z-scores not used to formally diagnose osteoporosis. Low Z-scores can sometimes be a clue to look for a cause of
osteoporosis.
T-scores and osteoporosis
Relationships within the triad
• Energy availability < 30 kcal/kg FFM/day results in impaired bone formation and reproductive function
(Loucks AB et al 2011)

• Increased duration of missed menstrual cycles increases likelihood of decreased BMD (ACSM 2007)

• Stress fracture risk 2-4 times greater in amenorrheic vs. eumenorrheic athletes or BMD below -1
(Bennell KG et al, 1999)
 The Female Athlete Triad
• Why does this happen?
• Disordered eating
• Attempts to lose body weight/restrictive eating
• Improve appearance
• Improve competitive ability
• Amenorrhea
• Sign of disturbed hormonal status associated w/ disordered eating in
postpubertal females
• Osteoporosis
• Decreased estrogen  loss of bone density speeds up
 Question

The 3 parts of the female triad include:

A. Moody behavior, fatigue and low iron levels

B. Low energy availability, reduced iron, reduced calcium levels
C. Low energy availability, amenorrhea, reduced iron levels
D. Low energy availability, functional hypothalamic amenorrhea, low bone
mineral density
 Treatment

• Energy availability of 30-45 kcal/kg FFM should be a priority in

management of amenorrheic athletes (ACSM 2007; Loucks et al 2011;
Arends 2012)

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 Micronutrient Recommendations for Female
Ahtlete Triad

• Calcium: 1500mg/day 2016 Sports, Cardiovascular, and Wellness

Nutrition (SCAN)

• Vitamin D: 1500-2000 IU/d2016 Sports, Cardiovascular, and Wellness

Nutrition (SCAN)

• Vitamin K 60-90 mcg/day (ACSM 2007)

 Concern w/ OCP treatment
• Improved BMD is more closely associated with increased body weight
than with OCP/HRT use (Nattiv et al 2007; Ducher G et al 2011; Arends
2012)

• Restoration of menses with OCP will not normalize metabolic factors that
impair bone formation, health and performance (Ducher G et al 2011;
Arends et al 2012)

• Use of OCP prevents determination of a healthy body weight as indicator

of return of menses
 Secondary Amenorrhea

• Definition: cessation of menses for prolonged periods (>90 days)

– Sign of disturbed hormonal status
– Associated with disordered eating
– Anorexia nervosa
• Also called athletic amenorrhea
– When observed in athletic females
– Associated with osteoporosis

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43 What eating problems are associated with
sports?
• OSFED- Other Specified Feeding and Eating Disorders
• Anorexia Athletica
• Weight loss as an ergogenic aid
– Wrestling
– Gymnastics
– Cheerleading
– Bodybuilding
– Lightweight football and rowing
– Distance running
 Question

The TRIAD can only occur in female athletes

A. True
B. False
 2014 IOC coined “RED-S”

RELATIVE ENERGY DEFFICIENCY in SPORT

- Emphasizes just not found in females

- implies low energy availability =

- dietary energy intake <energy expenditure.

- Normal body functioning impaired: BMR, menstrual function, bone

health, immunity, protein synthesis, & cardiovascular health.
 RED-S impact on performance

 decreased endurance
 increased risk of injury
 poor response to training
 impaired cognitive function
 decreased coordination & concentration
 irritability, depression
 decreased glycogen stores
 decreased muscle strength
 Male Triad
• Low Energy Availabilty
• Low Bone Mineral Density
• Low Testosterone levels

• sports that emphasize leaness are 25 times more likely to develop

• overtraining can cause male athletes to produce up to 40 percent less
testosterone.
https://training-conditioning.com/new
s/experts-examine-male-athlete-triad/

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 "The mindset should be, ‘I
am fueling myself.’

MALE TRIA It should not be about

D? controlling calories or eating
only ‘the right kinds of
foods.’
 Start at a young age
• Dynamic exercise (weight bearing)
• Calcium-rich diet
• Low-fat dairy products
Calcium • Inexpensive, high-calcium, high-protein, high-
Prudent nutrient density

Recommendations Postmenopausal women and older men

• Calcium and vitamin D supplements may be
recommended

Obtain a bone density test if at risk

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TRACE MINERALS
 Definition
• Also known as “trace elements” or “microminerals”
• Minerals needed in quantities less than 100 mg per day

• Main trace minerals:

– Iron, copper, zinc, chromium, selenium, boron, and vanadium
IRON
 IRON

• Oxygen carrying component of blood

• Part of many enzymes

• 2/3 of body’s FE stores present in hemoglobin of RBC

• In muscle: present as myoglobin; stored as ferritin

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 RDA

• For adult men <50 yrs: 8 mg

• For adult women <50 yrs: 18 mg
– 15 mg for women age 14-18
– Pregnant women: 27 mg
– Postmenopausal women: 8 mg
• Current DV: 18 mg
• UL range: 40-45 mg/day
 • Heme iron
– Formed only in animal foods (meat, chicken, fish)
– 35-55% of iron found in meat is heme iron
• Higher percentage in beef compared to

Food
chicken or fish
– Greater bioavailability
• 10-35% of it absorbed from intestines
Sources: • Liver
– Compared to 2-10% for nonheme iron

Heme Iron •
•
Heart
Lean meats
• Oysters
• Clams
• Dark Poultry Meat
 Food Sources: Nonheme Iron
• Nonheme Iron
– Found in both plant and animal foods
– 20-70% of iron in animal foods is nonheme iron
– 100% in plant foods is nonheme iron

• Dried fruits (apricots, prunes, raisins)

• Vegetables (broccoli and peas)
• Legumes
• Whole-grain products
About 40% of
the iron in meat,
fish, and poultry
is bound into
Heme accounts for
heme; the other about 10% of the
60% is nonheme average daily iron
iron. intake, but it is well
absorbed (about
Key: 25%).
Heme
Nonheme Nonheme iron
accounts for the
All of the iron in remaining 90%, but it
foods derived is less well absorbed
from plants is (about 17%).
nonheme iron.
Stepped Art -
Heme and nonheme iron in
foods
 Deficiency in athletes
• Essential for endurance athletes to have adequate iron in the diet
• Iron is so critical to the oxygen energy system
• Anemia & PICA
–
• Normal hemoglobin levels:
– Males = 14-16 grams per deciliter of blood
– Females = 12-14 grams per deciliter of blood
• Classification of anemia:
– Males: less than 13 grams
– Females: less than 11 grams (in some cases, 12)

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 Inadequate dietary intake

Exercise (particularly running)

Causes of Ruptured RBC from foot strikes

deficiency
Menstrual losses

Bleeding caused by use of aspirin or other anti-

in athletes inflammatory drugs
Iron loss through sweat

Strenuous endurance training: elevated hepcidin

(decreases absorption)

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 Question

The most of absorbable form of iron is_______ and can be found in

__________.

A. Heme, animals and plants

B. Heme, animals only
C. Non-heme, animals and plants
D. Non-heme, animals only
 Seen during prolonged running
• Hematuria: the presence of hemoglobin or myoglobin in
urine

Iron Loss • May be caused by repeated foot contact with the ground
• Ruptures RBCs and releases hemoglobin (hemolysis)
• Released hemoglobin may be excreted by kidneys

During Iron loss through sweat loss

Exercise • Serum iron may actually increase during an exercise session

and be partially excreted in sweat
• Athletes in training may lose more FE than non-athletes

Intense, prolonged exercise may cause

inflammation and bleeding in gi tract
 Stages of Deficiency- occurs slowly
1st: ferritin levels (protein storage form) drop
2nd: blood levels of Fe drop
(Hgb levels are still normal)
As situation worsens: ANEMIA develops

3rd: Fe- deficiency anemia: difficulty making Hgb (both Fe & Hgb levels reduced)

(it is possible to be deficient in iron without producing an anemia)

 Common S/S Fe- deficiency Anemia –
training table p 310

• Fatigue, weakness
• Paleness
• SOB
• Brittle, spoon-shaped nails
• Irritability
• Poor appetite
• Difficulty concentrating
• Feeling cold
• Headache
• Hair loss
 Heavy train loads:

Athletes at • Wrestlers, gymnasts, distance

runners (marathoners – greater
risk risk of anemia)

Female athletes- inadequate

diet, excessive menstruation
 Definition: form of anemia associated with
endurance training
Not a true anemia
• Hemoglobin is toward lower end of normal range but other
indices of iron status are normal

Sports
Anemia
Not known whether it is a beneficial
physiological response or a condition that
will hinder performance
 Short-Term

Short-Term • Develops during early phases of training OR when

magnitude of training increases drastically; Hgb
returns to NL after 1st month of training (chronic

& Long- effects of training)

Long-Term
Term • Seen in highly trained endurance athletes
• Theories:

Sports • Production of RBC by bone marrow is decreased

because RBCs become so efficient in releasing
oxygen to tissues

Anemia • Increase in blood volume can compensate for

moderate reduction in hemoglobin
concentration

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 Iron

• Iron supplementation
– Offers no benefits to individuals with normal hemoglobin and iron
status
• Endurance athletes may benefit
– Want to increase their RBC and hemoglobin levels
– Iron one of the few minerals recommended as a supplement by
ACSM and AND
 “Live high, train low”
• GOAL: enhance aerobic endurance performance
• Ascending to high altitude (2,000 m)
 Decreases atmospheric pressure
• Decreases oxygen pressure in the blood
• Kidneys produce natural EPO (vs. illegal blood doping)
 Stimulates bone marrow to produce more RBC
• RBC & hemoglobin concentrations become elevated
• Athlete may not train as intensely at altitude
 Due to decreased oxygen pressures
 Need to return to lower altitudes to train
In Summary…
Athletes in training may lose more iron
than nonathletes
 Foods Rich in Key Minerals
Starches Fruits, Vegetables, Meat, Milk and Fats and
and citrus and dark green fish, dairy Oils
Grains others and others poultry products

Phosphoru Magnesium Calcium Iron Calcium Trace

s Phosphorus Zinc Magnesium amounts
Magnesium Magnesium Chromiu Zinc
Iron Iron m
Zinc Zinc Selenium
Chromium Selenium
Selenium
 Should physically active individuals take
mineral supplements?
• In general, NO!
 Possible to obtain adequate mineral nutrition from diet if you adhere to
guidelines
 Many minerals harmful when taken in excess
• Recognized that certain athletes may benefit from supplements
 Deficiencies to the point of impairing physical performance are rare
• Exception: low levels of serum iron
• If there is concern, consult sport nutritionist or nutritionally-oriented physician

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