Effects of mineral waters on acid-base status in healthy adults: results of a randomized trial.

BACKGROUND: The 'Western diet' typically consumed in industrialized countries is characterized by high amounts of processed cereal grains and animal products while being low in vegetables, tubers, and fruits. This dietary behavior leads to imbalances of acid-base status in favor of the acids and may cause low-grade metabolic acidosis (LGMA) that is associated with negative effects on health in the long run, including urolithiasis, bone loss, and even cardiometabolic diseases. Therefore, it has become of great interest to find dietary strategies that can be used to neutralize the acid load associated with Western diets. OBJECTIVE: The aim of this study was to investigate whether the diet-dependent net acid load can be reduced by the daily consumption of mineral waters with different bicarbonate content and different potential renal acid load (PRAL). METHODS: A single-centered, randomized trial including 129 healthy men and women aged from 18 to 75 years was conducted. Participants consumed 1,500-2,000 mL of one of four mineral waters with different bicarbonate content and different PRAL values daily for 4 weeks: low bicarbonate, high PRAL (LBHP, HCO3 -: 403.0 mg/L, PRAL: 10.7); medium-high bicarbonate, medium PRAL (MBMP, HCO3 - : 1816.0 mg/L, PRAL: -10.8); high bicarbonate, low PRAL (HBLP, HCO3 -: 2451.0 mg/L, PRAL: -19.3); medium-high bicarbonate, low PRAL (MBLP, HCO3 -: 1846.0 mg/L, PRAL: -22.1). Throughout the study, participants were asked to maintain their usual dietary habits. The primary outcome was the net acid excretion (NAE) measured in the 24-h urine output. RESULTS: Consumption of the three mineral waters: MBMP, HBLP, and MBLP led to a significant decrease in NAE values. Within the MBMP group, the NAE could be reduced by 48% (P = 0.001), while consumption of HBLP led to a reduction of 68% (P < 0.001) and MBLP to a reduction of 53% (P = 0.001). Moreover, a slight increase in serum bicarbonate could also be observed in the groups that drank HBLP (P = 0.057) and MBLP (P = 0.001). CONCLUSION: Daily consumption of at least 1,500-2,000 mL of mineral water rich in bicarbonate (>1800.0 mg/L) with medium or low PRAL (<-11 mEq/L) can effectively reduce the NAE level by reducing the dietary acid load under free-living conditions in healthy adults.

Micronutrient Status of Recreational Runners with Vegetarian or Non-Vegetarian Dietary Patterns.

Vegetarian diets have gained popularity in sports. However, few data exist on the status of micronutrients and related biomarkers for vegetarian and vegan athletes. The aim of this cross-sectional study was to compare the micronutrient status of omnivorous (OMN, n = 27), lacto-ovo-vegetarian (LOV, n = 26), and vegan (VEG, n = 28) recreational runners. Biomarkers of vitamin B12, folate, vitamin D, and iron were assessed. Additionally, serum levels of calcium, magnesium, and zinc were examined. Lifestyle factors and supplement intake were recorded via questionnaires. About 80% of each group showed vitamin B12 adequacy with higher levels in supplement users. Mean red blood cell folate exceeded the reference range (>340 nmol/L) in all three groups (OMN: 2213 ± 444, LOV: 2236 ± 596, and VEG: 2354 ± 639 nmol/L; not significant, n.s.). Furthermore, vitamin D levels were comparable (OMN: 90.6 ± 32.1, LOV: 76.8 ± 33.7, and VEG: 86.2 ± 39.5 nmol/L; n.s.), and we found low prevalence (<20%) of vitamin D inadequacy in all three groups. Less than 30% of each group had depleted iron stores, however, iron deficiency anemia was not found in any subject. Our findings suggest that a well-planned, health-conscious lacto-ovo-vegetarian and vegan diet, including supplements, can meet the athlete's requirements of vitamin B12, vitamin D and iron.

The Revised D-A-CH-Reference Values for the Intake of Vitamin B12 : Prevention of Deficiency and Beyond.

SCOPE: The nutrition societies of Germany, Austria, and Switzerland are the joint editors of the "D-A-CH reference values for nutrient intake", which are revised regularly. METHODS AND RESULTS: By reviewing vitamin-B12 -related biomarker studies, the reference values for vitamin B12 were revised in 2018. For adults, the estimated intake is based on the adequate serum concentrations of holotranscobalamin and methylmalonic acid. The estimated values for children and adolescents are extrapolated from the adult reference value by considering differences in body mass, an allometric exponent, and growth factors. For infants below 4 months of age, an estimated value is set based on the vitamin B12 intake via breast milk. The reference values for pregnant and lactating women consider the requirements for the fetus and for loss via breast milk. The estimated values for vitamin B12 intake for infants, children, and adolescents range from 0.5 to 4.0 µg d-1 . For adults, the estimated values are set at 4.0 µg d-1 , and for pregnant and lactating women, they are set at 4.5 and 5.5 µg d-1 , respectively. CONCLUSION: Based on the data of several vitamin B12 status biomarkers studies, the reference value for vitamin B12 intake for adults is raised from 3.0 to 4.0 µg d-1 .

Alternative Ernährungsformen: Allgemeine Aspekte und vegetarische Kostformen.

Alternative diets (AD) differ from the current common mixed diet; AD are recommended as a permanent diet. These diets are based on ethical, philosophical and health promoting principles and lead to very different recommendations for food selection. Even within a particular AD there is usually a broad spectrum of versions, so that a general evaluation is only possible to a limited extent. This is also true for single AD. Vegetarian diets and partly paleo-diets have been investigated to a reasonable extent. Plant based diets are appropriate as permanent diets and offer health benefits as compared with currently practiced diets (risk reduction of cancers by 10-18% and of heart diseases by 30%; favorable effect on blood pressure and lipid profile; no risk reduction on cancer and total mortality). Vegan diets have to be critically assessed: they are linked to an increased risk of deficits for single nutrients (vitamin B12, iodine and as the case may be. calcium and long chain omega-3 fatty acids), if suitable supplements or fortified foods are not consumed.

Higher prevalence of vitamin D deficiency in German pregnant women compared to non-pregnant women.

PURPOSE: Adequate vitamin D status is crucial for normal development of the fetus and for maternal health. As data on vitamin D status (25-hydroxyvitamin D, 25(OH)D) in German women of different states of pregnancy were not available, this study compared the vitamin D status of German women in all trimesters of pregnancy with that of non-pregnant women. METHODS: The study sample of 858 women (18-45 years) was recruited from April 2013 to March 2015 as a part of the cross-sectional Germany-wide VitaMinFemin study. Serum 25(OH)D levels were determined using chemiluminescence immunoassay. RESULTS: A total of 78.1% of the pregnant women and 53.9% of the non-pregnant women had a vitamin D status <50.0 nmol/L (p < 0.001). In pregnant women, the multivariate binary analysis showed that winter [odds ratio (OR) 13.5], longitude of residence between 6.3°E and 8.9°E (OR 2.0) or 9.0°E and 10.9°E (OR 2.3) and third trimester (OR 2.3) were associated with a higher risk of vitamin D status <25.0 nmol/L, whereas increasing age per one year (OR 0.9) with a lower risk. Compared with non-pregnant women, pregnant women were 3.7 times more likely to have a vitamin D status <25.0 nmol/L. CONCLUSION: A low vitamin D status is prevalent among German pregnant women and should be improved to supply mother and fetus adequately.

Dietary therapy in heart failure with preserved ejection fraction and/or left ventricular diastolic dysfunction in patients with metabolic syndrome.

BACKGROUND: Heart failure is an ongoing epidemic of left ventricular (LV) dilatation and/or dysfunction due to the increasing prevalence of predisposing risk factors such as age, physical inactivity, (abdominal) obesity, and type-2-diabetes. Approximately half of these patients have diastolic heart failure (HFpEF). The prognosis of HFpEF is comparable to that of systolic heart failure, but without any known effective treatment. DIASTOLIC DYSFUNCTION: A biomathematically corrected diagnostic approach is presented that quantifies diastolic dysfunction via the predominant age dependency of LV diastolic function and unmasks (metabolic) risk factors, that are independent of age and, therefore, potential targets for therapy. Patients with HFpEF have reduced cardiac energy reserve that is frequently caused by insulin resistance. Consequently, HFpEF and/or LV diastolic dysfunction may be regarded as a cardiac manifestation of the metabolic syndrome (MetS). DIETARY THERAPY: Accordingly, a causal therapy for metabolically induced dysfunction aims at normalizing insulin sensitivity by improving postprandial glucose and lipid metabolism. The respective treatments include 1) weight loss induced by dietary energy restriction that is often not sustained long-term and 2) independent of weight loss, focus on carbohydrate modification in exchange for an increase in protein and fat, ideally combined with an aerobic exercise program. Hence, beneficial effects of different macronutrient compositions in the dietary therapy of the underlying MetS are discussed together with the most recently available publications and meta-analyses. CONCLUSION: Modulation/restriction of carbohydrate intake normalizes postprandial hyperglycemic and insulinemic peaks and has been shown to improve all manifestations of the MetS and also to reduce cardiovascular risk.

The Ongoing Sodium Controversy - Between PURE and NutriCode 1.

The impact of sodium intake on cardiovascular health has long been a subject of controversial debates. On the one hand, the World Health Organization (WHO) and the American Heart Association (AHA) have argued for a target of 1500-2000 mg of sodium per day (4-5 g sodium chloride daily). On the other hand, this recommendation has been accompanied by a growing body of criticism. Recently, the results of the PURE and the NutriCode study have flared up the "salt controversy". Actually, the results of the PURE study seem to strengthen the position of those who have called into question the AHA and WHO guidelines for daily sodium intake whereas those who recommend a considerable salt reduction believe that the NutriCode study confirm their conviction. In this paper, the results of the PURE and NutriCode study will be discussed and evaluated with regard to practical consequences.

[Nutrition and bone health: What ist the evidence?]. / Ernährung und Knochengesundheit.

Nutrients are of particular importance for bone health: they act as structural elements of bones, modulate the activity of osteoblasts and osteoclasts, and influence bone remodeling through various mediators. A bone protective diet can be characterised as a diet rich in fruits and vegetables, dairy products, seeds and nuts, whole grain and soy products and moderate amounts of fish, eggs and lean meat. This diet provides sufficient amounts of protein, calcium, magnesium and vitamins (e. g. K, C, folic acid, B6 and B12), which are important for bone development. For specific nutrients, the following bone-protective recommendations can be given: 1.0-1.3 g protein/kg body weight and day; 1000-1200 mg/day calcium, preferably as part of the normal diet. In case of insufficient calcium intake or on antiresorptive medication a supplementation of 200-500 mg or 500-1000 mg calcium/day, respectively, should be given. Furthermore, for prevention of bone fractures a cut off level of ≥ 75 nmol calcidiol/l is suggested.

[The calcium debate--strong bones at the expense of cardiovascular health?]. / Calcium: Knochenschutz auf Kosten der Gefässe?

Ensuring an adequate intake of calcium--by means of supplements, if necessary--is a well-established approach in prevention and therapy of osteoporosis. However, in the meantime concerns have been voiced doubting the safety of calcium supplements. The discussion commenced when a new evaluation of the Auckland calcium intervention study revealed a higher rate of myocardial infarction after administration of calcium, compared to placebo. Two meta-analyses on the cardiovascular risk of calcium supplements supported these findings. Nevertheless, these results are still discussed contentiously. Doubts were increased by the fact that neither a reevaluation of the WHI calcium vitamin D study, nor a current meta-analysis could identify calcium as a cardiovascular risk factor. Against this background the present article analyses the controversial data with respect to the well-known "Hill-criteria" of causality, including consistency of data, magnitude of association, dose-response relationship and biological plausibility.

L-Arginine and vascular health. / Bedeutung von L-Arginin für die Gefäßgesundheit.

Endothelial dysfunction, characterized by a disturbed vascular NO metabolism, represents a key point in atherogenesis. Modern antiatherogenic therapies improve NO availability within the endothelium. As L-arginine acts as the substrate of endothelial nitric oxide synthase (eNOS), arginine supplementation can enhance NO formation. Actually, L-arginine at appropriate dosage (6­8 g/day) improves endothelial function and lowers blood pressure. However, beneficial effects can only be expected in individuals with pronounced endothelial dysfunction and/or individuals with an absolute (patients with hemodialysis) or relative (patients with elevated ADMA levels) arginine deficiency. Whether L-arginine delays progression of atherosclerotic lesions and lowers cardiovascular morbidity and mortality is unknown.

Breastfeeding woman are at higher risk of vitamin D deficiency than non-breastfeeding women - insights from the German VitaMinFemin study.

BACKGROUND: Despite increased awareness of the adverse health effects of vitamin D deficiency, only a few studies have evaluated the vitamin D status (25-hydroxyvitamin D [25(OHD)]) of breastfeeding women and up to now, no information exits for German breastfeeding women. Therefore, the aim of study was to determine the vitamin D status of breastfeeding women compared to non-pregnant and non-breastfeeding (NPNB) women. METHODS: This cross-sectional study investigated 124 breastfeeding women and 124 age and season matched NPNB women from the German "Vitamin and mineral status among German women" study. The study participants were recruited from April 2013 to March 2015 and did not take vitamin D supplements. Serum 25(OH)D was analyzed by chemiluminescent immunoassay. RESULTS: Vitamin D deficiency (<25.0 nmol/L) was prevalent in 26.6% of the breastfeeding women. The majority of women (49.2%) showed 25(OH)D concentration between 25.0 and 49.9 nmol/L. In multiple binary logistic regression analysis, breastfeeding women had a 4.0-fold higher odds ratio (OR) (95% confidence interval [CI] 1.8, 8.7) for vitamin D deficiency than NPNB women. For breastfeeding women, the risk of vitamin D deficiency was higher in the winter and spring months (OR: 2.6, 95% CI 1.1, 6.3) and increased with lower longitude per one unit (OR 0.7, 95% CI 0.6, 0.9). CONCLUSION: Breastfeeding women in Germany had a higher risk of deficient vitamin D levels than NPNB women. In further studies, the optimal vitamin D status for breastfeeding women should be investigated and also the required vitamin D doses to ensure this vitamin D status. TRIAL REGISTRATION: German Clinical Trial Register (identification number: DRKS00004789).

Nutritional biology: a neglected basic discipline of nutritional science.

On the basis of a scientific-philosophical analysis, this paper tries to show that the approaches in current nutritional science-including its subdisciplines which focus on molecular aspects-are predominantly application-oriented. This becomes particularly evident through a number of conceptual problems characterized by the triad of 'dearth of theoretical foundation,' 'particularist research questions,' and 'reductionist understanding of nutrition.' The thesis presented here is that an interpretive framework based on nutritional biology is able to shed constructive light on the fundamental problems of nutritional science. In this context, the establishment of 'nutritional biology' as a basic discipline in research and education would be a first step toward recognizing the phenomenon of 'nutrition' as an oecic process as a special case of an organism-environment interaction. Modern nutritional science should be substantively grounded on ecological-and therefore systems biology as well as organismic-principles. The aim of nutritional biology, then, should be to develop near-universal 'law statements' in nutritional science-a task which presents a major challenge for the current science system.

Vitamin D Status and Mortality: Meta-Analysis of Individual Participant Data Confirms Strong Association.

Scientists and physicians have suggested that poor vitamin D intake can result in increased cardio-vascular mortality. Also total mortality appears to be increased with poor vitamin D status. A research team of the German Cancer Research Center in Heidelberg (DKFZ) headed by Ben Schöttker was able to demonstrate this association in a meta-analysis of 8 European and US-based cohort studies. In addition, serum 25(OH)D concentration (calcidiol) was shown to constitute a prognostic parameter in patients with a history of cancer.

[Safety of folic acid]. / Sicherheit von Folsäure. Fakten und Fiktionen.

Improving dietary folate intake is a central public health goal. However, critical voices have become louder warning of too high intake of folic acid. Safety concerns of a high folic acid exposure are usually limited to synthetic folic acid contained in drugs and food supplements. Against this background, the present article focuses on two matters: (a) How do the absorption and metabolism of synthetic folic acid differ from that of other folates? (b) How has the longterm safety of folic acid to be judged, especially regarding the risk of colorectal cancer, autism, asthma, impaired immune defence, masking vitamin B12 deficiency and interactions with the methotrexate metabolism?