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Calcium\tsupplementation\tabsorption\tis\toptimal\twhen\ttaken\tas\tindividual\tdoses\tof\t500\tmg\tor\tless.\nMany\tformulations\tinclude\tvitamin\tD,\tbecause\tthe\tlikelihood\tof\tneeding\tvitamin\tD\tis\thigh\tif\tcalcium\nsupplementation\tis\tneeded.\tChoosing\ta\tsupplement\tthat\thas\tthe\tUnited\tStates\tPharmacopeia
|
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designation\tincreases\tthe\tlikelihood\tthat\tthe\tsupplement\tquantity\tis\tconsistent\twith\tthe\tlabel,\tand\nthat\tgood\tmanufacturing\tpractices\tare\tused.\nCalcium\tsupplementation\tincreases\tthe\trisk\tof\treaching\tthe\tupper\tlimit\tof\tsafety\t(UL).\tOther\nsources\tof\tcalcium\tinclude\twater\tand\tmedications,\tespecially\tantacids.\tThe\tUL\tfor\teach\tage\tgroup\tis\nlisted\tin
|
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] |
listed\tin\t\nTable\t23.3\n.\nTABLE\t23.3\nUpper\tLimit\tfor\tCalcium\n\tIntake\nAge\nAmount,\tmg\nBirth\tto\t6\tmonths\n1000\n7-12\tmonths\n1500\n1-8\tyears\n2500\n9-18\tyears\n3000\n19-50\tyears\n2500\nOver\t50\tyears\n2000\nPhosphate\nThe\tbody’s\treserve\tof\tphosphorus\tis\tfound\tin\tthe\tbone\tas\thydroxyapatite.\tPhosphate\tsalts\tare
|
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available\tin\tpractically\tall\tfoods\teither\tnaturally\tor\tbecause\tof\tprocessing.\tIn\thealthy\tadults,\tthe\nurinary\tphosphorus\texcretion\tapproximately\n\tequals\tintake.\nThe\timpact\tof\thigher\tdietary\tphosphorus\tor\ta\tlow\tcalcium:\tphosphorus\tratio\ton\tbone\thealth\tis\nunresolved.\tResearchers\thave\tfound\tboth\ta\tnegative\teffect\tand\tno\teffect,\twith\tlimitations\tin\tthe
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ability\tto\tdetermine\tdietary\tphosphorus\tnoted\tas\ta\tcomplicating\tissue\t(\nAnderson\tet\tal,\t2017\n;\t\nCalvo\nand\tTucker,\t2013\n).\nTrace\tminerals\nMany\ttrace\telements\tare\tbeneficial\tfor\tbone\thealth,\tsuch\n\tas\tboron,\tcopper,\tmanganese,\tmagnesium,\nselenium,\tand\tzinc.\tHowever,\tcadmium,\tcobalt,\tand\tlead\tare\tdetrimental.\tThe\trole\tof\tfluoride\tin\tbone
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health\tis\tunclear\t(\nZofkova\tet\tal,\t2017\n).\nVitamins\nVitamin\tA\nVitamin\tA\tconsumption\tconsists\tof\tboth\tretinol\t(animal\tsources)\tand\tcarotenoids\t(plant\tsources).\nSome\tresearch\thas\tlinked\thigh\tdietary\tintake\tof\tretinol\tto\tgreater\trisk\tof\tosteoporosis\tand\n\thip
|
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-0.007644507568329573,
0.01804582215845585,
0.04259898513555527,
0.05913667008280754,
0.03169016167521477
] |
hip\nfracture.\tIn\tcontrast,\tcarotenoids,\tthe\tprecursors\tto\tvitamin\tA\tfound\tonly\tin\tplants,\thas\tshown\nbeneficial\teffects.\tAlthough\tthe\tresearch\tis\tnot\tdefinitive,\tgenerally\tcarotenoids\tare\tthought\tto\tbe\nsafe\tand\tbeneficial\t(\nTanumihardjo,\t2013\n).\nVitamin\tD
|
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] |
safe\tand\tbeneficial\t(\nTanumihardjo,\t2013\n).\nVitamin\tD\nIn\t2008\tthe\tFDA\tamended\tthe\tlabel\thealth\tclaim\tregulations\tconcerning\tcalcium\tand\tosteoporosis\tso\nthat\tthey\tcould\talso\tinclude\tvitamin\tD\tbecause\n\tof\tincreasing\trecognition\tthat\tvitamin\tD\tplays\ta\npivotal\trole\tin\tcalcium\tuptake\tand\ttherefore\tbone\thomeostasis\t(\nFDA,\t2013\n).\tWhile\tthe\tmain\tfunction
|
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] |
FDA,\t2013\n).\tWhile\tthe\tmain\tfunction\nof\tvitamin\tD\tis\tto\tmaintain\tserum\tcalcium\tand\tphosphorus\tlevels\twithin\ta\tconstant\trange,\tvitamin\tD\nis\timportant\tin\tstimulating\tintestinal\tcalcium\ttransport.\tVitamin\tD\talso\tstimulates\tactivity\tof\nosteoclasts\tin\tbone.\tIn\tboth\tthese\tareas\tthe\tnet\tdesired\n\teffect\tis\tto\tincrease\tcalcium\tavailability.
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] |
effect\tis\tto\tincrease\tcalcium\tavailability.\nAn\tindividual’s\tvitamin\tD\tstatus\tdepends\tmostly\ton\tsunlight\texposure,\tand\tsecondarily\ton\tdietary\nintake\tof\tvitamin\tD.\tThe\tsynthesis\tof\tvitamin\tD\tby\tskin\texposed\tto\tsunlight\tvaries\tconsiderably\tas\ta\nresult\tof\tmany\tfactors,\tincluding\tskin\tcolor,\tsunscreen\tuse,\tenvironmental\tlatitude,\tseason\tof\tthe
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] |
year,\ttime\tof\tday,\tand\tage\t(\nHolick,\t2014\n).\tThe\tskin\tof\n\tolder\tindividuals\tis\tless\tefficient\tat\tproducing\nvitamin\tD\tfollowing\texposure\tto\tultraviolet\t(UV)\tlight\tbecause\tlower\tamounts\tof\t\n7-\ndehydrocholesterol\n\tare\tpresent\tin\tthe\tskin\t(\nGallagher,\t2013\n).\tIn\taddition,\tolder\tadults\ttypically
|
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] |
Gallagher,\t2013\n).\tIn\taddition,\tolder\tadults\ttypically\nhave\tlittle\texposure\tto\tthe\toutdoors\tand\ttherefore\tless\tsunlight.\tThose\twho\tlive\tat\tnorthern\tlatitudes\nin\tthe\tUnited\tStates\tand\tCanada\tare\tat\tincreased\trisk\tof\tosteoporosis\n\tbecause\tof\tlimited\tUV\tlight\nduring\twinter\tmonths\t(\nHolick,\t2014\n).
|
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] |
because\tof\tlimited\tUV\tlight\nduring\twinter\tmonths\t(\nHolick,\t2014\n).\nThe\tfew\tfoods\tthat\tnaturally\tcontain\tvitamin\tD\tare\tegg\tyolks;\tfatty\tfish\tsuch\tas\tsalmon,\tmackerel,\ncatfish,\ttuna,\tand\tsardines;\tcod\tliver\toil;\tand\tsome\tmushrooms\t(see\t\nAppendix\t38\n).\tThe\tvitamin\tD
|
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] |
Appendix\t38\n).\tThe\tvitamin\tD\ncontent\tof\tfish\tvaries,\tas\tdoes\tthe\tcontent\tin\tUV-exposed\tmushrooms.\tFluid\tmilk\tin\tthe\tUnited\tStates\nis\tfortified\twith\tvitamin\tD\tat\ta\tstandardized\n\tlevel\tof\t400\tIU\tper\tquart,\twhereas\tother\tfoods,\tincluding\njuices,\tcereals,\tyogurt,\tand\tmargarines,\tmay\tbe\tfortified\tin\tvarying\tamounts.\tThe\tRDAs\tfor\tvitamin\tD
|
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] |
across\tthe\tlife\tcycle\tare\tshown\tinside\tthe\tcover.\tThe\tUL\tis\t100\tµg\t(4000\tIU)\tfor\teveryone\tolder\tthan\n8\tyears,\tand\tlower\tlevels\tfor\tyounger\tchildren\t(see\tinside\tcover).\tFrom\tany\tsource,\tvitamin\tD\tmust\nbe\thydroxylated\tin\tthe\tkidney\n\tbefore\tbecoming\tthe\tphysiologically\tactive\tcalcitriol.
|
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] |
before\tbecoming\tthe\tphysiologically\tactive\tcalcitriol.\nTo\tprevent\trickets,\tthe\tAmerican\tAcademy\tof\tPediatrics\tand\tother\tglobal\thealth\tprofessionals\nrecommend\tthat\tall\tinfants\twho\tare\texclusively\tbreastfed\tbe\tsupplemented\twith\t400\tIU\tof\tvitamin\tD.\nInfants\twho\tare\tboth\tformula\tand\tbreastfed\tshould\talso\tbe\tsupplemented\tuntil\tthey\tare\tconsistently
|
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taking\t1\tliter\t(1\tquart)\tof\tformula\ta\tday.\tExperts\n\tfurther\trecommend\tcontinuing\tthe\tsupplementation\nuntil\t1\tyear\tof\tage,\twhen\tchildren\tbegin\tdrinking\tvitamin\tD–fortified\tmilk\t(\nMunns\tet\tal,\t2016\n;\nWagner\tand\tGreer,\t2008\n).\nThe\tolder\tadult\tis\tat\tincreased\trisk\tfor\tvitamin\tD\tdeficiency\tbecause\tof\tthe\tdecreased\tsynthesis\tof
|
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] |
vitamin\tD\tby\tthe\tskin\tand\tdecreased\texposure\tto\tsunlight,\tincreased\tbody\tfat,\tand\tdecreased\trenal\nfunction\tthat\tdecreases\tthe\n\thydroxylation\tof\tvitamin\tD\tto\tits\tactive\tform\t(\nGallagher,\t2013\n;\nPourshahidi,\t2015\n).\tIn\tgeneral,\tdaily\tvitamin\tD\tintake\tof\t20\tmcg\t(800\tIU)\tis\trecommended\tfor\tseniors\nto\treach\tserum\t\n25-hydroxy\tvitamin\tD\t(calcidiol)
|
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] |
to\treach\tserum\t\n25-hydroxy\tvitamin\tD\t(calcidiol)\n\tlevels\thigher\tthan\t20\tng/mL,\tthus\tpreventing\nvitamin\tD\tinsufficiency\t(\nGallagher,\t2013\n).\tThe\tmost\tcommon\tblood\ttest\tfor\tvitamin\tD\tstatus\tis\tserum\n25-hydroxy\tvitamin\tD\tlevel,\tand\tthe\tnormal\n\trange\tis\tconsidered\tto\tbe\t20\tto\t50\tng/mL\t(\nWisse,\t2016\n).\nVitamin\tK
|
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] |
range\tis\tconsidered\tto\tbe\t20\tto\t50\tng/mL\t(\nWisse,\t2016\n).\nVitamin\tK\nVitamin\tK\tis\tan\tessential\tmicronutrient\tfor\tbone\thealth.\tIts\trole\tin\tposttranslational\tmodification\tof\nseveral\tmatrix\tproteins,\tincluding\t\nosteocalcin\n,\tis\twell\testablished\t(\nHamidi\tet\tal,\t2013\n).\tVitamin\tK
|
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] |
osteocalcin\n,\tis\twell\testablished\t(\nHamidi\tet\tal,\t2013\n).\tVitamin\tK\nmay\talso\tcontribute\tto\tfavorable\tbone\thealth\tthrough\tdecreasing\tbone\tresorption\tand\tincreasing\ncollagen\tcontent\tin\tbone\tcells\n\t(\nHamidi\tet\tal,\t2013\n).\tFollowing\tbone\tresorption,\tosteocalcin\tis
|
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] |
(\nHamidi\tet\tal,\t2013\n).\tFollowing\tbone\tresorption,\tosteocalcin\tis\nreleased\tand\tenters\tthe\tblood.\tIn\tthis\tway,\tosteocalcin\tserves\tas\ta\tserum\tbone\tmarker\tfor\tpredicting\nthe\trisk\tof\ta\tfracture\t(see\t\nAppendix\t37\n).\nMost\tof\tthe\tvitamin\tK\tintake\tin\tthe\tUnited\tStates\tis\tfrom\tgreen\tleafy\tvegetables,\twith\tabout\tone
|
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] |
third\tfrom\tfats\tand\toils.\tAlthough\tmenaquinones,\ta\tform\tof\tvitamin\tK,\tare\tformed\tin\tthe\tgut\n\tby\nbacteria,\tthe\tinfluence\tof\tthis\tsource\ton\tvitamin\tK\tstatus\tappears\tto\tbe\tweak.\tMany\tolder\tadults\thave\ninadequate\tintakes\tof\tvitamin\tK,\tprimarily\tbecause\ttheir\tconsumption\tof\tdark-green\tleafy\tvegetables
|
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] |
is\tso\tlow.\tIt\tis\timportant\tto\tconsider\tthe\tvitamin\tK\tintake\tin\tolder\tpersons\twho\tmay\talso\tbe\ttaking\nblood-thinning\tmedications\t(vitamin\tK\tantagonists).\tRather\tthan\thaving\tthese\tpatients\tavoid\tvitamin\nK\tin\tfoods\tand\tthus\tjeopardize\ttheir\tbone\tstatus,\tit\tis\tbetter\tto\thave\tthe\tvitamin\tK\tdaily\tintake\tbe
|
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] |
consistent\tand\tregulate\tthe\tvitamin\tK\tantagonist\tmedication.\tBecause\tit\tis\tdifficult\tfor\tolder\tadults\tto\nconsume\ta\tconsistent\tamount\tof\tvitamin\tK\tin\ttheir\tdiet\teach\tday,\ta\tsupplemental\tform\tof\tvitamin\tK\tis\nrecommended\tfor\tthose\ton\tblood-thinning\tmedications\t(\nMahtani\tet\tal,\t2014\n).\tIn\tfact,\tit\thas\n\tbeen
|
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] |
Mahtani\tet\tal,\t2014\n).\tIn\tfact,\tit\thas\n\tbeen\nshown\tthat\ttherapeutic\tinternational\tnormalized\tratio\t(INR)\tranges\tfrom\tblood-thinning\tmedication\ncan\tbe\tachieved\twith\tvitamin\tK\tin\tlow-dose\tsupplementation\tand\twhen\tfluctuations\tare\tfew\t(\nMahtani\net\tal,\t2014\n).\nOther\tdietary\tcomponents
|
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] |
Mahtani\net\tal,\t2014\n).\nOther\tdietary\tcomponents\nSeveral\tother\tdietary\tfactors\thave\tbeen\tassociated\twith\tbone\thealth,\tbut\ttheir\trelative\tquantitative\nimportance\tis\tnot\tclear.\nAlcohol\nAlthough\tpreviously\n\tmentioned\tas\ta\trisk\tfactor,\tlow\tto\tmoderate\tconsumption\tof\twine\tand\tbeer\tmay
|
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] |
be\tbeneficial\tto\tbone\thealth.\tHigh\talcohol\tintake\tis\tassociated\twith\tlower\tbone\tdensity,\thigher\nprevalence\tof\tosteoporosis,\tand\tincreased\trisk\tof\tfracture,\talthough\tassociated\tpoor\tlifestyle\tfactors\nand\tcomorbid\tconditions\tincrease\tthe\tdifficulty\tof\tinterpreting\tresults\t(\nGaddini\tet\tal,\t2016\n).\nCaffeine\nThe\trelationship
|
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] |
Gaddini\tet\tal,\t2016\n).\nCaffeine\nThe\trelationship\n\tof\tconsumption\tof\tcaffeine\tto\tosteoporosis\thas\tnot\tbeen\tclearly\testablished.\nWhereas\tcoffee\tintake\twas\tassociated\twith\ta\tmodestly\tincreased\trisk\tof\tbone\tfracture\tin\twomen,\tthe\nopposite\twas\ttrue\tfor\tmen,\twhere\thigher\tcoffee\tintake\twas\tassociated\twith\ta\tdecreased\trisk\tin\ta
|
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meta-analysis\tof\tnine\tcohort\tand\tsix\tcase-control\tstudies\t(\nLee\tet\tal,\t2014\n).\tHowever,\ta\tsystematic\nreview\tconcluded\tthat\tup\n\tto\t400\tmg/day\tof\tcaffeine\tin\thealthy\tadults\tis\tnot\tassociated\twith\tadverse\nhealth\teffects,\tincluding\tbone\t(\nWikoff\tet\tal,\t2017\n).\tInterpretation\tof\tthe\tcaffeine\tcontent\tof\tcoffee\tor
|
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).\tInterpretation\tof\tthe\tcaffeine\tcontent\tof\tcoffee\tor\nother\tbeverages\tis\tdifficult\tbecause\tof\tvariation\tdue\tto\tbrewing,\tportion\tsize,\tand\tother\tbeverage\nadditions.\nDietary\tfiber\nFiber\tincludes\ta\tvariety\tof\tdifferent\tcompounds,\tand\tso\tintake\tof\t“fiber”\tas\ta\tcategory\n\tcan\tproduce
|
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can\tproduce\ndifferent\teffects\ton\tbone.\tPrebiotics\tare\ta\tform\tof\tfiber\tthat\thas\tbeneficial\teffects\ton\tcalcium\nabsorption\tand\tmay\thave\tbeneficial\teffects\ton\tbone\thealth\tin\thumans\t(\nWallace\tet\tal,\t2017\n).\tThe\nbioavailability\tof\tcalcium\tin\tplant\tfoods\thigh\tin\toxalates\tor\tphytates\tmay\tbe\tlow.\tThe\toverall\timpact
|
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] |
on\tBMD,\tosteoporosis,\tand\tfracture\trisk\thas\tnot\tbeen\twell\tstudied.\nSoy\tand\tisoflavones\nEpidemiologic\tstudies\thave\treported\tthe\tprevalence\tof\thip\tfracture\tto\tbe\tlower\tin\tolder\tAsian\twomen\nwho\thave\ta\tdiet\thigh\tin\tsoy\tand\tisoflavones\tcompared\twith\tolder\tCaucasian\twomen.\tHuman\tstudies
|
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have\tbeen\tinconclusive\tconcerning\tthe\trole\tof\tisoflavones\ton\tbone\thealth,\tpossibly\tbecause\tof\ndiffering\tstudy\tdesigns,\tdoses,\tlengths\tof\tstudy,\tdifferences\tin\tparticipants,\tand\tother\tdietary\tor\nexercise\tcomponents\n\t(\nZheng\tet\tal,\t2016\n).\tSoy\tprotein\thas\tnot\tbeen\tshown\tto\tbe\tmore\tbeneficial\tto\nbone\thealth\tthan\tother\tprotein\tsources\t(
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bone\thealth\tthan\tother\tprotein\tsources\t(\nShams-White\tet\tal,\t2018\n).\nHigh\tacid\tor\talkaline\tdiets
|
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Higher\tacid\tdiets\tinclude\tthose\thigh\tin\tprotein,\tdairy,\tand\tgrains.\tIt\tis\ttheorized\tthat\tthese\thigher\nacid\tdiets\tmight\tincrease\tcalcium\texcretion\tand\thave\ta\tdetrimental\teffect\ton\tbone.\tThe\ttheory\talso\nsupports\ta\tconverse\n\tbeneficial\teffect\tof\tan\talkaline\tdiet\t(high\tin\tfruits\tand\tvegetables)\ton\tbone.
|
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Several\tmeta-analyses,\texperimental\tstudies,\tobservational\tstudies,\tand\treviews\thave\tnot\tsupported\neither\tthe\tnegative\teffect\tof\thigher\tacid\tdiets\ton\tbone\tor\tthe\tpositive\teffects\tof\tan\talkaline\tdiet\ton\nbone.\tHigher\tprotein\tintake\tmay,\tin\tfact,\thave\ta\tpositive\teffect\ton\tbone\t(\nCuenca-Sánchez\tet\tal,\t2015\n;\nHanley\tand\tWhiting,\t2013\n;
|
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] |
Cuenca-Sánchez\tet\tal,\t2015\n;\nHanley\tand\tWhiting,\t2013\n;\t\nRemer\tet\tal,\t2014\n).\nSodium\nIn\ta\trecent\tmeta-analysis\tstudy,\ta\thigh-sodium\tdiet\twas\tfound\tto\tincrease\tosteoporosis\trisk\t(\nFatahi\tet\nal,\t2018\n).\tThis\tassociation\tmay\tbe\tattributable\tto\tincreased\tcalcium\texcretion\t(\nFatahi\tet\tal,\t2018\n).
|
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0.008849204517900944
] |
Fatahi\tet\tal,\t2018\n).\nAlthough\tthe\tcalciuric\teffect\tof\tsodium\thas\tbeen\tspeculated,\tthere\tseem\tto\tbe\tno\tadverse\teffects\nwith\tadequate\tcalcium\tand\tvitamin\tD\tintake\t(\nIlich\tet\tal,\t2010\n).\n\tOn\tthe\topposite\tend\tof\tthe\tspectrum,\nbecause\tsodium\tis\tfound\tabundantly\tin\tbone,\t\nhyponatremia\n,\tor\tlow\tserum\tsodium,\tmay\tincrease\tan
|
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] |
hyponatremia\n,\tor\tlow\tserum\tsodium,\tmay\tincrease\tan\nolder\tadult’s\tosteoporosis\trisk\t(\nHannon\tand\tVerbalis,\t2014\n).\nVegetarian\tdiets\nResearch\thas\tshown\tlower\tBMD\tamong\tvegetarians\tcompared\twith\tomnivores;\thowever,\tthe\npotential\timpact\ton\tosteoporosis\trisk\tis\trelatively\tsmall\t(\nHo-Pham\tet\tal,\t2009\n).\tVegans\tand\tsome
|
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] |
Ho-Pham\tet\tal,\t2009\n).\tVegans\tand\tsome\nvegetarians\tmay\tconsume\tless\tprotein,\tvitamin\tD,\tvitamin\tB\n12\n,\tand\tcalcium\tcompared\twith\nomnivores,\tthus\tincreasing\tosteoporosis\trisk;\thowever,\tvegan\tand\tvegetarian\tdiets\talso\ttypically\ninclude\thigher\tlevels\tof\tother\tnutrients\tthat\tmay\thave\tpositive\teffects\ton\tbone\t(\nTucker,\t2014\n).\tA
|
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] |
Tucker,\t2014\n).\tA\nstudy\tdone\tin\tchildren\tconcluded\tthat\ta\twell-planned\tvegetarian\tdiet\tthat\tincluded\tdairy\tand\tegg\nintake\tdid\tnot\tlead\n\tto\tsignificantly\tlower\tbone\tmass\tand\tfound\tsome\tevidence\tthat\tthe\tlacto-ovo-\nvegetarian\tdiet\twas\tprotective\tagainst\tbone\tabnormalities\t(\nAmbroszkiewicz\tet\tal,\t2018\n)\nPrevention\tof\tosteoporosis\tand\tfractures
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Ambroszkiewicz\tet\tal,\t2018\n)\nPrevention\tof\tosteoporosis\tand\tfractures\nThe\tincreasing\tlongevity\tof\tthe\tpopulation\temphasizes\tthe\tneed\tfor\tprevention\tof\tosteoporosis.\nUniversal\tguidelines\tapply\tto\teveryone.\tConsuming\tadequate\tamounts\tof\tcalcium\tand\tvitamin\tD,
|
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] |
lifelong\tmuscle\tstrengthening\tand\tweight-bearing\texercise,\tavoidance\tof\ttobacco,\tmoderate\tor\tno\nintake\tof\talcohol,\tand\tsteps\tto\tavoid\tfalls\tare\tall\tpart\tof\tthe\tholistic\tapproach\tto\ta\tlifestyle\tthat\npromotes\tbone\thealth\t(\nNorth\tAmerican\tMenopause\tSociety\t[NAMS],\t2010\n).\nExercise
|
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] |
North\tAmerican\tMenopause\tSociety\t[NAMS],\t2010\n).\nExercise\nTo\tpreserve\tbone\thealth\tthrough\tadulthood,\tthe\tAmerican\tCollege\tof\tSports\tMedicine\trecommends\nweight-bearing\taerobic\n\tactivity\twith\thigh\tbone-loading\tforce\t(such\tas\tintensive\twalking,\tjogging,\tor
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ascending/descending\tstairs)\tthree\tto\tfive\ttimes\tper\tweek,\tresistance\ttraining\ttwo\tto\tthree\ttimes\tper\nweek,\tand\tbalance\texercises\t(\nChodzko-Zajko\tet\tal,\t2009\n;\t\nGarber\tet\tal,\t2011\n).\tRegular\twalking\tand\nswimming\tappear\tto\thave\tminor\tbenefits\ton\tBMD\tin\tolder\tindividuals\t(\nBeck\tet\tal,\t2017\n).\nDiet\nThe\tNOF\trecommends\tuniversal
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Beck\tet\tal,\t2017\n).\nDiet\nThe\tNOF\trecommends\tuniversal\n\tguidelines\tfor\tall\tadults\tfor\tthe\tprevention\tof\tosteoporosis\tthat\nincludes\tadequate\tcalcium\tand\tvitamin\tD,\tand\ta\tbalanced\tdiet\tof\tlow-fat\tdairy,\tfish,\tfruits,\tand\nvegetables.\tAlthough\tthe\tNOF\trecommends\tthe\tsame\tamount\tof\tcalcium\tintake\tas\tthe\tIOM,\tthe\tNOF
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] |
recommends\thigher\tamounts\tof\tvitamin\tD\tthan\tthe\tIOM\tfor\tthose\t50\tyears\tand\tolder\t(800\tto\t1000\nIU/day).\tIf\tthese\tintake\tgoals\tare\tnot\treached\n\tby\tfood,\tsupplements\tshould\tbe\tconsidered.\tIn\naddition,\tachieving\tand\tmaintaining\ta\thealthy\tweight\tand\tconsuming\ta\tlower\tsodium\tdiet\tis\nrecommended\tfor\toptimal\tbone\thealth\tfor\twomen.
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recommended\tfor\toptimal\tbone\thealth\tfor\twomen.\nTreatment\tof\tosteoporosis\nMedical\tnutrition\ttherapy\nCalcium\t(1000\tto\t1200\tmg/day)\tand\tvitamin\tD\n3\n\t(800\tIU/day)\tare\ttypically\trecommended\tfor\tpatients\nbeing\ttreated\twith\tone\tof\tthe\tbone\tdrugs,\teither\tantiresorptive\n\tor\tanabolic;\tideally\tpatients\tshould
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or\tanabolic;\tideally\tpatients\tshould\nachieve\tthese\tnutrients\tlevels\tfrom\tdietary\tsources,\tbut\tif\tnecessary,\tsupplemental\tforms\tcan\tbe\tused\n(\nGallagher,\t2013\n;\t\nRizzoli\tet\tal,\t2014\n).\tThese\tamounts\tare\tconsidered\tboth\tsafe\tand\tsufficient\tfor\tbone\nformation.\tBecause\tof\tthe\trange\tof\tnutrients\tinvolved\tin\tbone\thealth,\ta\thealthy\tdiet\temphasizing\tthe
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] |
recommendations,\tneed\tfor\tsupplements,\tand\tstrategies\tthat\tenhance\tquality\tof\tlife\t(\nDorner\tet\tal,\n2018\n).\nExercise\nFor\tthose\twith\tosteoporosis,\trecommendations\n\tinclude\tdaily\tbalance\texercises,\tweight-bearing\naerobic\texercise\t5\tor\tmore\tdays\ta\tweek,\tresistance\ttraining\t2\tor\tmore\tdays\ta\tweek,\tand\tlimiting
|
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] |
twisting\tor\tother\tactivities\tleading\tto\tpoor\talignment\tof\tthe\tspine\t(\nGiangregorio\tet\tal,\t2015\n).\tIt\tis\nimportant\tto\tnote\tthat\teach\tclient’s\tsituation\twith\tosteoporosis\tis\tunique\tand,\ttherefore,\tshould\tbe\nevaluated\tby\ta\thealth\tprofessional\tto\tdetermine\tappropriate\n\texercises\tbased\ton\tthe\tclient’s\tspecific\nmedical\thistory\t(\nGiangregorio\tet\tal,\t2015
|
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medical\thistory\t(\nGiangregorio\tet\tal,\t2015\n).
|
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FDA-approved\tdrugs\tfor\tprevention\tand\ttreatment\tof\tosteoporosis\nMost\tmedications\tapproved\tfor\tthe\tprevention\tof\tosteoporosis\twhen\tBMD\tis\tlow\tor\tthere\tis\ta\thigh\nrisk\tof\tfracture\tare\talso\tapproved\tfor\tthe\ttreatment\tof\tosteoporosis.\tThese\tinclude\tbisphosphonates\n(alendronate,\trisedronate,\tibandronate,\tzoledronic
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(alendronate,\trisedronate,\tibandronate,\tzoledronic\n\tacid),\tpeptide\thormones\t(teriparatide\tand\ncalcitonin\n),\testrogen\t(in\tthe\tform\tof\tmenopausal\thormone\ttherapy),\testrogen\tagonists\tor\tselective\nestrogen\treceptor\tmodulators\t(SERMs),\tand\ta\tbiologic\tagent\t(denosumab).\tHowever,\tbecause\tof
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] |
potential\tside\teffects,\tnonestrogen\ttreatment\tis\trecommended,\tespecially\tif\tmenopausal\tsymptom\nrelief\tis\tnot\ta\tgoal.\nThe\t\nbisphosphonates\n\tact\tas\tantiresorbers\ton\tosteoclasts\n\tto\treduce\ttheir\tbone-degradative\nactivities.\tThey\tact\tby\tinhibiting\tosteoclast-mediated\tbone\tresorption.\tPossible\tside\teffects\tinclude
|
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] |
gastrointestinal\tproblems\tand\trare\tcases\tof\tjaw\tnecrosis.\tTeriparatide\tis\ta\tform\tof\tPTH\tthat\tworks\tby\nincreasing\tosteoblast\tnumber\tand\tfunction.\tCalcitonin\tis\tused\tto\tinhibit\tosteoclastic\tbone\tresorption\nby\tblocking\tthe\tstimulatory\teffects\tof\tPTH\ton\tthese\n\tcells.\tCalcitonin\tcan\tbe\tadministered\tby\tnasal
|
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cells.\tCalcitonin\tcan\tbe\tadministered\tby\tnasal\nspray.\tIt\timproves\tBMD,\tespecially\tof\tthe\tlumbar\tspine,\tand\tit\tmay\treduce\tthe\trecurrence\tof\nfractures\tin\tpatients\twith\tosteoporosis.\t\nEstrogen\tagonists\n\tor\tantagonists\tused\tto\tbe\treferred\tto\tas\nselective\testrogen\treceptor\tmodulators\t(SERMS)\n\tare\table\tto\tstimulate\t\nestrogen\treceptors\n(ER)
|
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] |
are\table\tto\tstimulate\t\nestrogen\treceptors\n(ER)\n\tin\tbone\ttissue\tand\tyet\thave\tvery\tlittle\teffect\ton\tthe\tERs\tof\tthe\n\tbreast\tor\tuterus.\tTwo\texamples\nof\tthese\tdrugs\tare\ttamoxifen\tand\traloxifene.\tThe\tmost\tcommon\tside\teffect\tis\thot\tflashes.\tThe\tbiologic\nagent\tdenosumab\tworks\tby\tpreventing\tthe\tformation\tof\tosteoclasts.\tPossible\tside\teffects\tinclude
|
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] |
joint\tand\tmuscle\tpain.\nFor\tthose\twith\tosteoporosis\t(men\tand\twomen),\toften\ta\tbisphosphonate\tor\tdenosumab\t(women)\tis\nprescribed.\tBecause\tlong-term\teffects\tare\tnot\tclear,\n\ttreatment\tis\tsuggested\tfor\t5\tyears\trather\tthan\nlifelong.\tPatient\tpreferences,\trisk\tof\tfalling,\tother\tcomorbidities,\tand\tthe\tcosts\tand\tbenefits\tof
|
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medication\tshould\tbe\tdiscussed\tbetween\tclient\tand\tphysician\tto\tdevelop\tindividualized\tcare\t(\nQaseem\net\tal,\t2017\n).\nIntegrative\tApproaches\nThe\tmost\tcommon\tintegrative\tinterventions\tfor\tbone\thealth\tinclude\tan\tanti-inflamatory\tdiet,\ncalcium\tand\tbone\n\tsupportive\tmicronutrients\tsuch\tas\tboron,\tmagnesium\tand\tvitamin\tK\tand\nnutritive\therbs\tsuch\tas\tnettle\t(
|
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] |
nutritive\therbs\tsuch\tas\tnettle\t(\nUrtica\tdioica\n).\tInflammation\tis\ta\trisk\tfactor\tin\tmany\tchronic\ndiseases,\tincluding\tosteoporosis.\tDiet\thas\tbeen\tshown\tto\tbe\ta\tcontributing\tfactor\tin\tinflammation\nand\tmay\taccelerate\tbone\tloss,\tespecially\tin\twomen\t(\nVeronese\tet\tal,\t2017\n)\t(See\t\nChapter\t7\n\tand\nAppendix\t22\n).\tDietary\tsupplements\tcontaining
|
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] |
)\t(See\t\nChapter\t7\n\tand\nAppendix\t22\n).\tDietary\tsupplements\tcontaining\n\tcalcium\tand\tother\tbone\tsupport\tnutrients\t(covered\nin\tthis\tchapter)\tare\ta\tcommon\tintegrative\tintervention.\tFor\tmore\tinformation\tabout\tsafely\nrecommending\tdietary\tsupplements,\tsee\t\nChapter\t11\n.\tNettle\tis\tan\tanti-inflammatory\therb\tand\tis\ta
|
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] |
Chapter\t11\n.\tNettle\tis\tan\tanti-inflammatory\therb\tand\tis\ta\nrich\tsource\tof\tcalcium,\tabout\t1400\tmg\tper\t100\tgrams\tdried\therb\tor\t430\tmg\tcooked\tfresh\therb\n(\nSuliburska,\t2012\n)\t(\nBauman,\t2018\n).\tBecause\tthis\tplant\tcontains\ttiny\tstinging\n\thairs\tunder\tthe\nleaves,\tthey\tmust\tbe\tthoroughly\tmacerated,\tdried\tor\tcooked\tbefore\teating.\tNettles\tare\tcommonly
|
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effects\tare\tdue\tto\tconsuming\tfresh\tnettles\twith\tthe\tstinging\thairs\tin\ttact.\tNettles\tare\tnot\nrecommended\tin\tpregnancy\tor\tlactation\t(\nNatural\tMedicines\tDatabase,\t2019\n).\nCLINICAL\tCASE\tSTUDY\nGrace,\ta\t70-year-old\twhite\twoman\tof\tNorthern\tEuropean\tancestry,\tdeveloped\tlactose\tintolerance
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during\ther\tearly\t50s\twhen\tshe\thad\ta\tserious\tgastrointestinal\tinfection.\tShe\tcurrently\tis\tretired,\nlives\talone,\n\tand\tstays\tindoors\tmost\tof\teach\tday\twatching\ttelevision.\tApproximately\t3\tyears\tago\tat\nage\t67,\tshe\thad\tdual-energy\tx-ray\tabsorptiometry\t(DEXA)\tmeasurements\tthat\tshowed\tthat\tshe
|
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had\tlow\tbone\tmineral\tdensity\t(BMD)\tvalues\tof\ther\tproximal\tfemur\tand\tlumbar\tvertebrae\t(both\nvalues\twere\tclassified\tas\tosteoporotic).\tHer\theight\tand\tweight\tat\tthe\ttime\twere\t5’5”\tand\t120\npounds.\tHer\tFRAX\tassessment\twas\ta\t9.7%\n\tof\tfracture\tin\tthe\tnext\t10\tyears.\tHer\tphysician
|
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of\tfracture\tin\tthe\tnext\t10\tyears.\tHer\tphysician\nrecommended\tthat\tshe\tstart\ttaking\tsupplements\tof\tcalcium\t(1000\tmg/day)\tand\tvitamin\tD\t(800\nunits/day)\tbecause\tof\ther\tlactose\tintolerance\tand\ther\tlack\tof\tconsumption\tof\tall\tdairy\tproducts.\nBecause\tof\tthe\tfragility\tof\ther\tbones,\ther\texercise\tshould\tfocus\ton\tposture,\tbalance,\tgait,
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] |
measurements\tsuch\tas\tserum\tcalcium\tand\tphosphate\twere\tnormal.\tAfter\tdiscussion\tof\ther\thigh\nrisk\tof\tan\tosteoporotic\tfracture,\ther\tphysician\tdecided\tto\tplace\tGrace\ton\ta\tbisphosphonate\tdrug\tin\naddition\tto\tcalcium\tand\tvitamin\tD.\nAfter\t1\tyear\ton\tthe\tnew\ttherapy\tand\tcontinuation\tof\tthe\n\tcalcium\tand\tvitamin\tD,\ther\tBMD\tvalues
|
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] |
calcium\tand\tvitamin\tD,\ther\tBMD\tvalues\n(her\tthird\tset\tof\tDEXA\tmeasurements)\tactually\tincreased\ta\tfew\tpercentage\tpoints,\teven\tthough\nthey\tremained\twithin\tthe\tclassification\tof\tosteoporosis.\tShe\tand\ther\tphysician\tdecided\tto\tcontinue\nthis\tfor\tanother\t4\tyears\tbefore\treevaluating\ther\tcondition.\nNutrition\tdiagnostic\tstatement\n•
|
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] |
Nutrition\tdiagnostic\tstatement\n•\t\nInadequate\tcalcium\tand\tvitamin\tD\tintake\trelated\tto\tavoidance\tof\tdairy\n\tproducts\tas\nevidenced\tby\tdiet\thistory\trevealing\tless\tthan\t20%\tof\testimated\trequirements.
|
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24\nNutrition\tfor\toral\tand\tdental\nhealth\nJanice\tL.\tRaymond,\tMS,\tRDN,\tCSG\nKEY\tTERMS\nanticariogenic\ncalculus\ncandidiasis\ncariogenic\ncariogenicity\ncariostatic\ncoronal\tcaries\ndemineralization\ndental\tcaries\ndental\terosion\ndentin\nearly\tchildhood\tcaries\t(ECC)\nedentulism\nenamel\nfermentable\tcarbohydrate\nfluoroapatite\nfluorosis\ngingiva\ngingival\tsulcus
|
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fluoroapatite\nfluorosis\ngingiva\ngingival\tsulcus\nhydroxyapatite\nlingual\n\tcaries\nperiodontal\tdisease\nplaque\nremineralization\nroot\tcaries\nstomatitis\nStreptococcus\tmutans\nxerostomia\nxylitol\nDiet\tand\tnutrition\tplay\tkey\troles\tin\ttooth\tdevelopment,\tintegrity\tof\tthe\t\ngingiva\n\t(gums)\tand\tmucosa,
|
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gingiva\n\t(gums)\tand\tmucosa,\nbone\tstrength,\tand\tthe\tprevention\tand\tmanagement\tof\tdiseases\tof\tthe\toral\tcavity.\tDiet\thas\ta\tlocal\neffect\ton\ttooth\tintegrity;\tthe\ttype,\tform,\tand\tfrequency\tof\tfoods\tand\tbeverages\n\tconsumed\thave\ta\ndirect\teffect\ton\tthe\toral\tpH\tand\tmicrobial\tactivity,\twhich\tmay\tpromote\tdental\tdecay.\tNutrition
|
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0.029389381408691406,
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0.07106691598892212,
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] |
systemically\taffects\tthe\tdevelopment,\tmaintenance,\tand\trepair\tof\tteeth\tand\toral\ttissues.\nNutrition\tand\tdiet\taffect\tthe\toral\tcavity,\tbut\tthe\treverse\tis\talso\ttrue:\tthat\tis,\tthe\tstatus\tof\tthe\toral\ncavity\tmay\taffect\tone’s\tability\tto\tconsume\tan\tadequate\tdiet\tand\tachieve\tnutritional\tbalance.\n\tIndeed,
|
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] |
Indeed,\nthere\tis\ta\tlifelong\tsynergy\tbetween\tnutrition\tand\tthe\tintegrity\tof\tthe\toral\tcavity\tin\thealth\tand\tdisease\nrelated\tto\tthe\tknown\troles\tof\tdiet\tand\tnutrients\tin\tthe\tgrowth,\tdevelopment,\tand\tmaintenance\tof\tthe\noral\tcavity\tstructure,\tbones,\tand\ttissues\t(\nTouger-Decker\tand\tMobley,\t2013\n).\nNutrition\tfor\ttooth\tdevelopment
|
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Touger-Decker\tand\tMobley,\t2013\n).\nNutrition\tfor\ttooth\tdevelopment\nPrimary\ttooth\tdevelopment\tbegins\tat\t2\tto\t3\tmonths’\tgestation.\tMineralization\n\tbegins\tat
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] |
approximately\t4\tmonths’\tgestation\tand\tcontinues\tthrough\tthe\tpreteen\tyears.\tTherefore\tmaternal\nnutrition\tmust\tsupply\tthe\tpreeruptive\tteeth\twith\tthe\tappropriate\tbuilding\tmaterials.\tInadequate\nmaternal\tnutrition\tconsequently\taffects\ttooth\tdevelopment.\nTeeth\tare\tformed\tby\tthe\tmineralization\tof\ta\tprotein\tmatrix.\tIn\t\ndentin\n,\tprotein\tis\tpresent\tas
|
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] |
dentin\n,\tprotein\tis\tpresent\tas\ncollagen,\twhich\tdepends\ton\tvitamin\tC\tfor\tnormal\n\tsynthesis.\tVitamin\tD\tis\tessential\tto\tthe\tprocess\tby\nwhich\tcalcium\tand\tphosphorus\tare\tdeposited\tin\tcrystals\tof\t\nhydroxyapatite\n,\ta\tnaturally\toccurring\nform\tof\tcalcium\tand\tphosphorus\tthat\tis\tthe\tmineral\tcomponent\tof\t\nenamel\n\tand\tdentin.\tFluoride
|
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] |
enamel\n\tand\tdentin.\tFluoride\nadded\tto\tthe\thydroxyapatite\tprovides\tunique\tcaries-resistant\tproperties\tto\tteeth\tin\tprenatal\tand\npostnatal\tdevelopmental\tperiods.\nDiet\tand\tnutrition\tare\timportant\n\tin\tall\tphases\tof\ttooth\tdevelopment,\teruption,\tand\tmaintenance\n(\nFig.\t24.1\n).\tPosteruption\tdiet\tand\tnutrient\tintake\tcontinue\tto\taffect\ttooth\tdevelopment\tand
|
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] |
mineralization,\tenamel\tdevelopment\tand\tstrength,\tand\teruption\tpatterns\tof\tthe\tremaining\tteeth.\tThe\nlocal\teffects\tof\tdiet,\tparticularly\t\nfermentable\tcarbohydrates\n\tand\teating\tfrequency,\taffect\tthe\nproduction\tof\torganic\tacids\tby\toral\tbacteria\tand\n\tthe\trate\tof\ttooth\tdecay\tas\tdescribed\tlater\tin\tthis\nchapter.\nFIG.\t24.1\nAnatomy\tof\ta\ttooth.\nDental\tcaries
|
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] |
chapter.\nFIG.\t24.1\nAnatomy\tof\ta\ttooth.\nDental\tcaries\nDental\tcaries\t(described\tbelow)\tremains\tthe\tmost\tcommon\tchronic\tdisease\tin\tboth\tchildren\tand\nadults\tdespite\tthe\tfact\tthat\tit\tis\tpreventable\t(National\tInstitute\tof\tDental\tand\tCraniofacial\tResearch\nwebsite).\tUnfortunately,\tdifferences\tare\tevident\tin\tcaries\tprevalence;\tapproximately\t20%\tto\t25%\tof
|
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U.S.\tchildren\thave\t80%\tof\tthe\tdental\tcaries.\tTrends\n\tin\tdental\tcaries\thave\tdemonstrated\tthat\tchildren\nwho\tcome\tfrom\thomes\tin\twhich\tparents\thave\ta\tcollege\teducation\thave\tfewer\tcaries\tthan\tchildren\nfrom\thomes\tin\twhich\tparents\thave\tless\tthan\ta\tcollege\teducation\t(\nCenters\tfor\tDisease\tControl\tand\nPrevention\t[CDC],\t2017
|
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Centers\tfor\tDisease\tControl\tand\nPrevention\t[CDC],\t2017\n).\tThese\tdifferences,\tor\thealth\tdisparities,\tmay\thappen\tas\ta\tresult\tof\tlack\tof\naccess\tto\tcare,\tcost\tof\tcare\tnot\treimbursed\tby\tthird-party\n\tpayers\t(e.g.,\tinsurance,\tMedicaid),\tlack\tof\nknowledge\tof\tpreventive\tdental\tcare,\tor\ta\tcombination\tof\tfactors.\tThe\tCDC\tcites\tthe\tpercent\tof\tU.S.
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] |
children\taged\t5\tto\t19\twith\tuntreated\tdental\tcaries\tbetween\t2011\tand\t2014\twas\t18.6%.\tThe\tpercent\nof\tU.S.\tadults\taged\t20\tto\t44\tduring\tthat\tsame\ttime\tframe\twas\t31.6%.\nPathophysiology\nDental\tcaries\n\tis\tan\toral\tinfectious\tdisease\tin\twhich\torganic\tacid\tmetabolites\n\tlead\tto\tgradual\ndemineralization
|
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0.020354773849248886,
0.14257757365703583,
0.0497066006064415,
0.05414827913045883,
0.012679214589297771
] |
lead\tto\tgradual\ndemineralization\n\tof\ttooth\tenamel,\tfollowed\tby\trapid\tproteolytic\tdestruction\tof\tthe\ttooth\tstructure.\nCaries\tcan\toccur\ton\tany\ttooth\tsurface.\tThe\tcause\tof\tdental\tcaries\tinvolves\tmany\tfactors.\tFour\tfactors\nmust\tbe\tpresent\tsimultaneously:\t(1)\ta\tsusceptible\thost\tor\ttooth\tsurface;\t(2)\tmicroorganisms\tsuch\tas\nStreptococcus\n\tor
|
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] |
Streptococcus\n\tor\t\nLactobacillus\n\tin\tthe\tdental\tplaque\tor\toral\tcavity;\t(3)\tfermentable\n\tcarbohydrates\tin\nthe\tdiet,\twhich\tserve\tas\tthe\tsubstrate\tfor\tbacteria;\tand\t(4)\ttime\t(duration)\tin\tthe\tmouth\tfor\tbacteria\nto\tmetabolize\tthe\tfermentable\tcarbohydrates,\tproduce\tacids,\tand\tcause\ta\tdrop\tin\tsalivary\tpH\tto\tless
|
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] |
than\t5.5.\tOnce\tthe\tpH\tis\tacidic,\twhich\tcan\toccur\twithin\tminutes,\toral\tbacteria\tcan\tinitiate\tthe\ndemineralization\tprocess.\t\nFig.\t24.2\n\tshows\tthe\tformation\tof\tdental\tcaries.
|
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] |
FIG.\t24.2\nFormation\tof\tdental\tcaries.\nSusceptible\ttooth\nThe\tdevelopment\tof\tdental\tcaries\trequires\tthe\tpresence\tof\ta\ttooth\tthat\tis\tvulnerable\tto\tattack.\tThe\ncomposition\tof\tenamel\tand\tdentin,\tthe\tlocation\tof\tteeth,\tthe\tquality\tand\tquantity\tof\tsaliva,\tand\tthe
|
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presence\tand\textent\tof\tpits\tand\tfissures\tin\tthe\ttooth\tcrown\tare\tsome\tof\tthe\tfactors\tthat\tgovern\nsusceptibility.\tAlkaline\tsaliva\thas\n\ta\tprotective\teffect\tand\tacidic\tsaliva\tincreases\tsusceptibility\tto\ndecay.\nThe\toral\tmicrobiome\nThe\tmicrobiome\tplays\tan\timportant\trole\tin\tour\thealth\tand\twell-being.\tThe\toral\tcavity\trepresents\tone
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of\tthe\tmost\tdiverse\tmicrobial\tcommunities\tin\tthe\thuman\tbody\tmade\tup\tof\tat\tleast\t700\tspecies\n(\nDuran-Pinedo\tand\tFrias-Lopez,\t2015\n).\tMicroorganisms\tfrom\tthe\toral\tcavity\tare\tthe\tetiologic\tagents\nfor\ta\tnumber\n\tof\tinfectious\tdiseases,\tincluding\tdental\tcaries,\tperiodontal\tdisease,\talveolar\tosteitis
|
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(also\tknown\tas\tdry\tsocket\tthat\toccurs\tafter\ta\ttooth\tis\textracted),\tand\ttonsillitis.\tSeveral\tstudies\thave\nlinked\toral\tdiseases\tto\tsystemic\tand\tchronic\tdiseases\tincluding\tcardiovascular\tdisease,\tpreterm\nbirth,\tdiabetes,\tpneumonia,\tand\teven\tcancer\t(\nWhitmore\tand\tLamont,\t2014\n).\tThe\tbig\tquestion\tin\tthis\nrelationship
|
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Whitmore\tand\tLamont,\t2014\n).\tThe\tbig\tquestion\tin\tthis\nrelationship\n\tis\twhether\tthe\tchanges\tin\tthe\toral\tmicrobiota\tare\tthe\tcause\tor\tthe\tconsequence\tof\tthe\npathologic\tprocess.\nA\tnumber\tof\tacid-producing\tspecies\tof\tbacteria\thave\tbeen\tassociated\twith\tdental\tcaries.\nStreptococcus\tmutans\n\tis\tthe\tmost\tprevalent,\tfollowed\tby\t\nLactobacillus\tcasein\n\tand
|
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] |
is\tthe\tmost\tprevalent,\tfollowed\tby\t\nLactobacillus\tcasein\n\tand\t\nStreptococcus\nsanguis\n.\t\nBifidobacterium\n,\t\nPropionibacterium\n,\tand\t\nScardovia\n\thave\talso\tbeen\tassociated\twith\tcaries.\nIn\tjuxtaposition,\n\tsome\tbacteria\thelp\tmaintain\thomeostasis\tthrough\tammonia\tproduction\tfrom\narginine\tand\turea.\tFor\texample,\t\nStreptococcus\tsalivarius
|
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] |
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