Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
I don't know Dr. Brunner personally, although I enjoy his
columns. With my apologies to him, I want to deal today with
medical side of essential minerals in the body, and I hope
this will be impetus to him to discuss the matter from his
perspective.
There are a lot of essential minerals and metals that the
body needs. Today we will discuss the major ones.
Sodium is often heard about because it is in charge of
fluid balances. We get most of our sodium from our diet in
the form of sodium chloride, or common table salt. Most of
our foods have sodium added to them particularly snacks such
as pretzels and the like, Chinese food and soups, especially
"cup of soups." The kidneys are in charge of getting rid of
excess sodium, so if you eat too much salt, you will become
very thirsty and drink more fluid. The kidneys will then get
rid of the extra sodium and fluid.
If one has a weak heart, such as congestive heart failure, he
may need to have less fluid in the body, so salt restriction
and diuretics, which are drugs that make one urinate a lot of
fluid and sodium are used. Its difficult to have a low sodium
if one has normal kidneys, but if one has problems with the
body's fluid-set point in the brain, it can happen.
A high sodium is very dangerous, but its also rare, usually
only seen in severe fluid losses such as serious dehydration.
Salt pills are sold over the counter for athletes without a
prescription. Also many females attempt to lose weight by
taking diuretics. Both of these are potentially dangerous.
Potassium is very important. Too much and too little
in the body can be lethal, as it affects the heart. We lose
most of our potassium by vomiting and diarrhea; healthy
people will compensate for this by having their kidneys
absorb potassium from the urine. Elderly people may have a
problem with this. People taking diuretics also lose a lot of
potassium; they must be very careful.
You can make sure you are getting enough potassium by using
fluids that have potassium in them when one needs to
replenish someone with diarrhea and vomiting, such as fruit
juices. Do not give tea or straight water to replenish
losses. Fruits with a lot of potassium include banana,
citrus, avocado (watch it, a lot of fat in avocado), tomato,
and raisins.
Too much potassium in the blood stream can come from many
causes, most commonly from kidneys that do not work. Eating
too much potassium in the diet will normally not affect a
person with healthy kidneys, as the body will put most of it
into the urine.
Calcium is important in the heart, muscle and bone.
People with osteoporosis do not have abnormal calcium.
Rather, they don't get the calcium into the bone. Vitamin D
is necessary for absorption of calcium. In Israel, our skin
makes vitamin D from the sun. In other countries the milk is
fortified with this vitamin.
Too little calcium is rarely seen outside of kidney failure,
too much calcium is often the product of cancer. Too much
dietary calcium is usually sent out of the body through the
kidneys, but it can assist in the formation of kidney stones.
On the other hand, too much vitamin D can be poisonous to the
liver.
Phosphorus and magnesium are needed in every
cell, but it is rare to find problems with these since they
are part of almost all that we eat.
In summary, the average Israeli and European diet is
sufficient to provide us with what we need: healthy people do
not need vitamins or nutritional supplements. Indeed, they
could be dangerous. Again I apologize to you Dr. Brunner. I
hope you will take up the challenge to write your side of
things. Write me in care of the Yated.
