MINERALS classification Major mineralsneeded in the body in the largest amounts requirements >100 mg/day calcium, sodium, potassium, phosphorus There are many more minerals and trace elements, however, we will be focusing on the ones that are the most problematic in human nutrition and those which are important for chronic disease prevention. * Calcium Main functions:bone/tooth formationregulation of nerve transmission, blood clotting, contraction of muscleshelps maintain normal blood pressure Stored in:99% of the total calcium in the body is stored in the bones1% of the total calcium in the body is found in the blood * Calcium stored in the bones serves as a reservoir of calcium. Its there to help maintain blood calcium levels when intake of calcium is low. A chronically poor intake of calcium, over a number of years, causes a lot of calcium to removed from the bones to supply the blood (which is used for more immediate needs like muscle contraction, nerve transmission, etc). Eventually, calcium loss from the bones results in reduced bone density and this condition is known as osteoporosis. We will discuss osteoporosis in a bit. Calcium has a low bioavailability so anything that you can do to enhance, and therefore, improve calcium absorption is important.These are factors which enhance calcium’s bioavailability:Vitamin D: fortunately one of the best sources of calcium (milk) also contains Vitamin D. Women taking calcium supplements should also consider taking a calcium supplement that has some Vitamin D to help with absorption.Lactose: again, milk, our best calcium source also contains lactose. (What is lactose?)Gastric acid: is the acid secreted in your stomach for digestion; calcium absorption is enhanced in an acidic environment—since acid is secreted whenever you eat food, its best to take a calcium supplement with food.Need: any time you body needs more calcium, during pregnancy and periods of active growth such as infancy and adolescence, for example, our bodies can absorb more calcium Factors which decrease Calcium absorptionToo much fiber in the diet>35 gms/dayfor most Americans, this is not a problem, since the average fiber intake is ~10-15 gms/dayAgeAs we age, we produce less gastric acidExcess use of laxativesToo much phosphorus in the dietOur main source of phosphorus is soda—and we drink a lot of soda, especially children and teens—which could be putting thier bones at risk, especially when they substitute soda for milkVitamin D deficiencyToo much coffee, tea Osteoporosis a chronic, degenerative diseasecharacterized by: bone lossdecrease in bone density2001: 1.5 million fractures annuallycosts $17 billion/yr ($47 million per day) prevention is key . Bone loss from osteoporosis Normal bone Bone loss occurs primarily in the hips, spine and wrist A DEXA scan is used to measure bone density Osteoporosis is a major public health threat for an estimated 44 million Ameri ...

1. MINERALS
classification
Major mineralsneeded in the body in the largest amounts
requirements >100 mg/day
calcium, sodium, potassium, phosphorus
There are many more minerals and trace elements, however, we
will be focusing on the ones that are the most problematic in
human nutrition and those which are important for chronic
disease prevention.
*
Calcium
Main functions:bone/tooth formationregulation of nerve
transmission, blood clotting, contraction of muscleshelps
maintain normal blood pressure
Stored in:99% of the total calcium in the body is stored in the
bones1% of the total calcium in the body is found in the blood
*

2. Calcium stored in the bones serves as a reservoir of calcium. Its
there to help maintain blood calcium levels when intake of
calcium is low.
A chronically poor intake of calcium, over a number of years,
causes a lot of calcium to removed from the bones to supply the
blood (which is used for more immediate needs like muscle
contraction, nerve transmission, etc).
Eventually, calcium loss from the bones results in reduced bone
density and this condition is known as osteoporosis. We will
discuss osteoporosis in a bit.
Calcium has a low bioavailability so anything that you can do to
enhance, and therefore, improve calcium absorption is
important.These are factors which enhance calcium’s
bioavailability:Vitamin D: fortunately one of the best sources of
calcium (milk) also contains Vitamin D. Women taking calcium
supplements should also consider taking a calcium supplement
that has some Vitamin D to help with absorption.Lactose: again,
milk, our best calcium source also contains lactose. (What is
lactose?)Gastric acid: is the acid secreted in your stomach for
digestion; calcium absorption is enhanced in an acidic
environment—since acid is secreted whenever you eat food, its
best to take a calcium supplement with food.Need: any time you
body needs more calcium, during pregnancy and periods of
active growth such as infancy and adolescence, for example, our
bodies can absorb more calcium
Factors which decrease Calcium absorptionToo much fiber in
the diet>35 gms/dayfor most Americans, this is not a problem,
since the average fiber intake is ~10-15 gms/dayAgeAs we age,
we produce less gastric acidExcess use of laxativesToo much
phosphorus in the dietOur main source of phosphorus is soda—

3. and we drink a lot of soda, especially children and teens—which
could be putting thier bones at risk, especially when they
substitute soda for milkVitamin D deficiencyToo much coffee,
tea
Osteoporosis
a chronic, degenerative diseasecharacterized by: bone
lossdecrease in bone density2001: 1.5 million fractures
annuallycosts $17 billion/yr ($47 million per day) prevention is
key
. Bone loss from
osteoporosis
Normal bone
Bone loss occurs primarily in the
hips, spine and wrist
A DEXA scan is used to measure
bone density
Osteoporosis is a major public health threat for an estimated 44
million Americans
In the U.S. today, 10 million individuals are estimated to

4. already have the disease and almost 34 million more are
estimated to have low bone mass, placing them at increased risk
for osteoporosis.
Of the 10 million Americans estimated to have osteoporosis,
eight million are women and 2 million are men.
34 million Americans, or 55% of the people 50 years of age and
older, have low bone mass, which puts them at increased risk of
developing osteoporosis and related fractures.
Significant risk has been reported in people of all ethnic
backgrounds.
While osteoporosis is often thought of as an older person's
disease, it can strike at any age
80% of those affected by osteoporosis are women.
20% of those affected by osteoporosis are men.
One in two women and one in four men over age 50 will have
an osteoporosis-related fracture in their lifetime.
Osteoporosis is responsible for more than 1.5 million fractures
annually, including: 300,000 hip fractures; and approximately
700,000 vertebral fractures, 250,000 wrist fractures; and
300,000 fractures at other sites.
Osteoporosis Risk Factors Increased ageBeing femaleSmall
boned, thin womenPeople with a history of anorexia
nervosaCaucasian/Asian womenFamily historySedentary
lifestyleSmoking, heavy drinkingLong term use of certain
medications such as prednisone
*
Personal history of fracture after age 50
Current low bone mass

5. History of fracture in a 1° relative
Being female
Being thin and/or having a small frame
Advanced age
A family history of osteoporosis
Estrogen deficiency as a result of menopause, especially early
or surgically induced
Abnormal absence of menstrual periods (amenorrhea)
Anorexia nervosa
Low lifetime calcium intake
Use of certain medications, such as corticosteroids and
anticonvulsants
Low testosterone levels in men
An inactive lifestyle
Current cigarette smoking
Excessive use of alcohol
Being Caucasian or Asian, although African Americans and
Hispanic Americans are at significant risk as well
Remember what a risk factor is?? It is something that increases
the chances of developing a medical condition
The more risk factors one has, the higher the chance of
developing the medical condition. Having one or even 2 risk
factors does not necessarily mean one will definitely develop a
problem, just that the chances are higher.
Preventing Osteoporosis
Consume adequate calcium and vitamin D in your diet--
throughout life
Get regular physical activity, especially weight bearing exercise
Be moderation in alcohol/caffeine consumption
Prevention is key because currently, there is no cure

6. TreatmentHormone replacement therapy (estrogen)Calcium,
vitamin D supplementsDrugs BisphosphonatesAlendronate
(brand name Fosamax®) Risedronate (brand name Actonel®)
Calcitonin (brand name Miacalcin®)Raloxifene
Bisphosphonates are a family of drugs used to prevent and treat
osteoporosis. alendronate (Fosamax ®) etidronate (Didrocal ®)
risedronate (Actonel ®).How do they work? Bisphosphonates
bind permanently to the surfaces of the bones and slow down
the osteoclasts (bone-eroding cells). This allows the osteoblasts
(bone-building cells) to work more effectively.How effective
are they?Bisphosphonates increase bone density and prevent
fractures of the spine (vertebral fractures).
Calcium Needs
Women
age 19-50 1000 mg
> age 51 1200 mg
pregnancy 1000 mg
Men
age 19-50 1000 mg
Current average intake: 500-600 mg per day---only about
half of what needs are
*

7. Compare what is recommended to what our current intake is in
the US:
500-600 mg/day
We only get about half our needs!
Food sources
milk, cheese, yogurt
foods made with milk/cheese (pudding, pizza)
Calcium fortified orange juice
Calcium fortified soy milk
*
Calcium fortified orange juice and calcium fortified soy milk
both have as much calcium in once serving as a glass of milk!
Calcium supplementsWho should take them? people with lactose
intolerance, people who dislike milkany one with a milk allergy
(not the same thing as being lactose intolerant)
Side effects of calcium supplementsconstipation, gas decreases
iron absorptionif you take an iron supplement for iron
deficiency anemia, or to prevent anemia, take your calcium
supplement and iron supplement at different times of the day
Tips for improving bioavailability from calcium supplements

8. calcium citrate is highly bioavailable (eg: Citracal)
take chewables (Tums with Calcium, Viactiv)
split your doses (take only 500 mg at a time)
take with food
don’t take more than 1500 mg/day
avoid oyster shell calcium, dolomite, bone meal, coral calcium
Phosphorus
Main functions:assists many enzymes/vitamins to extract energy
from ATP—adenosine triphosphate
component of cell membranes
bone structure
Requirementssame as calciumexcess phosphorus, esp. combined
with poor calcium intake, may contribute to bone loss Teens, or
anyone, who drink a lot of soda and little or no milk are
increasing the risk of bone loss…a real problem in the US

9. DeficiencyNone— we have problems with excessive intake in
U.S.
Food sourcesSoft drinks, milk, cheese, baked goods, meat, food
additives
Sodium (Na+)
Sodium chloride (NaCl) known as “table salt”
Main functions:fluid/water balanceconduction of nerve
impulsesglucose transport/absorptionacid-base balance
Physiological requirements: 500 mg/dayThis is the amount we
need every day to prevent a deficiency
Average U.S intake: 5000-8000 mg/day
*
The minimum amount of sodium you need each day is 500 mg.
Compare this to the average amount Americans consume each
day!
Recommended intake for good health <2400
mg/day

10. How does this compare with the average intake in the US?
A grain of salt
*
A magnified view of a grain of salt.
Food sources
Table salt: 1 tsp = 2250 mg
Naturally occurring Na
Food serving size Na+ (mg)
milk 1 cup 120
meat (raw) 3 oz 50
fruits ---- <10
vegetables ½ cup 5-50
Sodium is naturally present in almost all foods—so it is
impossible to have a sodium free diet
*
Sodium is naturally present in almost all foods naturally. A cup
of milk right from the cow contains 120 mg!
Sodium Added During Processing

11. Food serving size Na (mg)
ham 3 oz 1200
bologna 2 slices 580
canned soup 1 can 800-1000
cottage cheese 1 cup 920
McDonalds shake medium 300
dill pickle 1 whole 850
soy sauce 1 tbsp 1029
*
We get most of our sodium from salt added during
processing…not from the salt we add at the table to foods.
Remember what your physiological requirements are….if you
eat one can of soup (not the low sodium kind) you are already
consuming twice your needs and 1/3 of what is recommended
for an entire day.
Sodium content of select foods
Taco bell bean burrito (1) 1100 mg
McD. Quarter Pounder w/cheese 1300mg
Pizza Hut Stuffed Crust Pizza (2 slices)
2850 mg
Chicken wings (12) 1750 mg
Kraft Mac and cheese (1 cup,
prepared) 750 mg
Taco Bell Taco (1) 330 mg
American cheese (1 slice) 300 mg
BK Whopper 900 mg

12. *
Processed foods and fast foods are generally high in sodium.
Sodium: major food sources
canned, cured, smoked meatsbologna, salami, pepperoni,
sausage, ham
canned soups
canned vegetables
Bouillon, Ramen noodles
olives, sauerkraut, anchovies
chips, crackers
seasonings (garlic salt, celery salt), MSG (monosodium
glutamate)
some frozen dinners
Hypertension (high blood pressure)
Blood pressurethe measurement of how hard your heart has to
work to pump blood from your heart to the rest of your body
Optimal blood pressure:
systolic <120
diastolic <80
Hypertension
Causes of hypertension:
1. No known cause
this type of hypertension occurs in 90-95% of people
diagnosed with hypertension

13. 2. Kidney disease
kidney disease is the cause of hypertension in only 5-10% of
people with hypertension
The cause of high blood pressure is unknown in the majority of
cases….there are many risk factors, but the exact cause is not
known. For a small percentage of the US population, kidney
disease causes their high blood pressure.
*
SymptomsNone until significant organ damage has
occurredHeadaches, visual problemsHypertension is called the
“silent killer” because there are no symptoms and therefore,
most people do not know they have hypertension
Long term complications of uncontrolled
hypertensionstrokekidney diseaseblindness/impaired visionheart
failure
*
Hypertension is known as “the silent killer” because you can
have high blood pressure for years and years and yet never
know it because there are no outward signs or symptoms.
That is why regular monitoring is important, especially if you
are at high risk. You can have your blood pressure checked free
of charge at most supermarkets and pharmacies.

14. Hypertension
Risk Factorsolder ageas we age, our blood pressure increases
family history
obesity
diabetes/insulin resistanceType 1 or 2smoking, heavy alcohol
intake
African-American descentusually develop high BP at an earlier
age and it can be more severe
heart disease
Hypertension: Prevention
low to moderate sodium consumption
lose weight if overweight
eat a diet high in fruits, vegetables
consume low fat dairy products, whole grains
emphasize poultry, fish, nuts; eat less red meat
get some exercise
*
These are the recommendations to reduce your risk of
developing high blood pressure. If you already have high blood
pressure, these recommendations can also help.

15. The DASH dietThe DASH diet is a plan that has been clinically
proven to help reduce blood pressure
Information regarding the DASH diet is available at the
following
website.http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/
(Or download the pdf file about the dash diet linked on the
syllabus)
Read the article available at the CSPI
website:http://www.cspinet.org/nah/dash.htm
Potassium
Main functions:conduction of nerve impulsescritical in
maintaining the heartbeatfluid and electrolyte balance
Deficiency:90% we eat is absorbed potassium has a high
bioavailabilityLow blood levels may be caused by:excessive
vomiting, prolonged diarrhea, certain diuretics, laxative abuse
*
bioavailability: refers to how much of the nutrient our bodies
can actually absorb from foods.
Potassium
Toxicitycan occur with potassium supplements (KCl)
Food sources
leafy greens (spinach)
oranges, orange juice, broccoli, bananas, tomatoes

16. *
All fruits and vegetables contain potassium…those listed are
especially high in potassium.
2
Assignment 2: Outsourcing Federal Healthcare
Early in their existence, many businesses handle their activities
internally. As businesses mature and grow, they often find
competitive advantage in the specialization provided by outside
firms. This trend is particularly frequent in industries such as
information technology (IT) and healthcare.
The U.S. federal government delivers healthcare through its two
main insurance programs: Medicare and Medicaid. In these
programs, private healthcare providers are reimbursed by
government insurers for health services delivered to insured
citizens.
· Visit the Web sites of Medicare and Medicaid programs for
more information about them.
· Review the article, “Outsourcing: Assessing the Risks and
Benefits for Organizations, Sectors, and Nations” by Harland,
Knight, Lamming, and Walker (2005). The conceptual
framework in this article shows how corporate strategy is
influenced by regulation under the decision node of policy
issues (p. 844).
Based on your analysis of the article and the Web sites, address
the following:
· Identify the main stakeholders in the US federal healthcare
system. In your view, what are their respective goals, wants,
and needs with regard to public health?
· Analyze the current status faced by the federal government in
terms of the strategy being used in its healthcare system.
· Identify strengths and weaknesses of the strategy as well as
opportunities and threats (SWOT analysis) present in the
external environment.
· Propose a new policy to be implemented for optimizing the

17. use of outsourcing in healthcare services to private hospitals
and healthcare practices in order to provide medical services to
the bulk of the US population. This policy should include the
following objectives:
· Lowering costs of the program to reduce federal spending
· Providing highest quality treatment for the insured
· Providing consumer-oriented choice
· Lowering treatment costs for consumers
· Based on your proposal of a new policy, describe the benefits
for at least one stakeholder group you identified in the first
question. Discuss how your outsourcing strategy objectives
satisfy the wants and needs of the specific stakeholder(s).
· Explain the likely outcomes of the outsourcing policy you
recommended. Which stakeholder group benefits the most and
which benefits the least? What are the strategic tradeoffs
implied by your outsourcing recommendation?
Write a 3–4-page paper in Word format. Apply APA standards
to citation of sources. Use the following file naming
convention: LastnameFirstInitial_M2_A2.doc.
By Saturday, March 16, 2013, deliver your assignment to
the M2: Assignment 2 Dropbox.
Harland, C., Knight, L., Lamming, R., & Walker, H. (2005).
Outsourcing: Assessing the risks and benefits for organizations,
sectors, and nations. International Journal of Operations &
Production Management, 25 (9/10), 831–850. (ProQuest
Document ID: 232337858)
http://search.proquest.com.libproxy.edmc.edu/docview/
232337858?accountid=34899
Assignment 2 Grading Criteria
Maximum Points
Identified the main stakeholders in the US federal healthcare
system and described their respective goals, wants, and needs
with regard to the public healthcare system according to a
personal evaluation.
20
Analyzed the current status of the healthcare provided by the

18. US government and proposed a new relevant policy to be
implemented for optimizing the use of outsourcing in healthcare
services to private hospitals and healthcare practices in order to
provide medical services to the bulk of the US population.
28
In using the policy proposed, described the benefits for at least
one stakeholder group identified in the first question.
12
Explained the likely outcomes of the outsourcing policy
recommended, including the impact on different stakeholder
groups as well as possible tradeoffs in implementing it.
12
Wrote in a clear, concise, and organized manner; demonstrated
ethical scholarship in accurate representation and attribution of
sources; and displayed accurate spelling, grammar, and
punctuation.
8
Total:
80
Module 3 Overview
This module introduces you to the critical operational
components of excellence. Efficiency, quality, and resource
management under the umbrella of the corporate strategy
contribute to operational excellence. You will explore the
fundamental drivers and measurements of operational
excellence.
Even the most superior strategy is useless if the organization
does not have the capability to implement it and create strategic
fit. Similarly, the best product in the world is valueless to a
customer if it is not available when it is needed. For corporate
customers, a lack of availability often means an increase in
costs and business risk. To prevent these issues, a company
must develop operational excellence which includes the precise

19. management of production capacity and capacity planning,
design and implementation of inventory controls that balance
cost and availability, and the configuration of logistics
necessary to distribute product or services on schedule.
Effectively managing the sequence of activities in the supply
chain depends on many factors, but perhaps the single most
influential factor in operations management is meeting the
quality standards of the company and its many stakeholders.
Quality problems destroy value in the supply chain by
disrupting the sequence of interdependent activities, threatening
availability, and increasing costs.
In the first assignment of this module, you will discuss the
vertical integration and planning approach adopted by General
Electric (GE). The second assignment is LASA 1, for which you
will review an organization’s analysis report and write a report
on how the organization’s aspects such as marketing,
performance measures, and value chain have helped it to
provide values-based services to its customers.
· Configure an organization’s processes to effectively and
efficiently produce goods and services that enable its value
proposition and maintain competitive differentiation.
· Create an operations strategy that aligns with the mission,
values, and business strategy of the organization.
· Synthesize operating data to explain operating performance
and diagnose performance issues, and selectively apply
quantitative tools for improving operating process performance
through enhancements of quality, speed, efficiency, or
productivity.
· Evaluate the ethical and/or global consequences of an
operating plan.
Name: _____________________________________
Date: _____/_____/_____

20. Section: ____________
FN235 Diet Analysis Project
Vitamins, Minerals & Water
20 points
Using your Diet Analysis Reports, classroom notes, & textbook,
answer the following questions:
1. What are vitamins A (beta-carotene), C, & E classified as?
What do they protect our body’s from? Please list 3 specific
health problems or conditions that these nutrients may protect
us from. 3 points
2. How does your intake compare to your recommendation? (is
it “high >100%” “ <100% low” or “~100% adequate”) 1 point
a. Vitamin E
b. Vitamin C
c. Vitamin A
3. What changes could you make to your diet to more closely
meet your recommendations? Provide a 3 examples of foods
which are good sources for each… 3 points
a. Vitamin E
b. Vitamin C

21. c. Vitamin A
4. How many milligrams of sodium do you consume daily?
How does your sodium intake compare to your
recommendation? 1 point
5. Is it acceptable to be below the sodium DRI? Should you
increase or decrease your intake & why? 1 point
6. What are some “big culprits”/in general, what foods are high
in sodium (list at least 3)? 1 point
7. Is there an imbalance between sodium and potassium in your
diet? Why is it important not to create an imbalance between the
two of these? What condition may it lead to? 1 point
8. How much calcium do you consume daily? Does this meet
your recommendation? 1 point

22. 9. Why is calcium so important? What happens if we do not
get enough calcium (think long-term)? With your calcium
intake, are you at risk of any long-term consequences—explain.
2 points
10. What is the link between Calcium & Vitamin D in bone
health? 1 point
11. What foods could you add to your diet to more closely meet
your recommendations? List good sources for each nutrient
which you will add to your diet if you are low 1 points
a. Calcium
b. Vitamin D
12. How much folate do you consume daily? Does this meet
your recommendation? 1 point

23. 13. Why is folate so important? Who REALLY needs to take a
folic acid supplement, how much & why? 2 points
14. How much water do you consume daily? Does this meet
your recommendation? 1 point