A Critical Consideration of Mineral Metabolism

Glands Govern in Mineral Metabolism

Behavior of Calcium, Phosphorus, and Other Elements in the Body

Is Subject to Functioning of the Endocrines

Say M. Francis Wielage, D.D.S. and Ada M. Wielage, Ph. C. in

A CRITICAL CONSIDERATION OF MINERAL METABOLISM STUDIES AND MINERAL SUPPLEMENTATION

AS RELATED TO DENTISTRY

                This is the first of two articles on the functions of the endocrine glands, the relationships of that function to dental as well as general health, and a review of studies on the subject now available in scientific literature, by Dr. Wielage and his scientist-wife. The second will appear in the March issue of Nutrition and Dental Health.

                There was time when this earth of ours was, no doubt, covered with water. If today we could shrink the earthball so that most of the continents meet, we would notice a space where the Pacific Ocean is located. The volume of earth missing is approximately one-eighth of the total earth mass. As the moon’s mass is approximately one-eighth of the total earth mass, the hypothesis that the moon at one time filled this space has great possibilities.

Through collision, or external attraction by a passing body, this mass was shot or pulled out of the earth. The hollow space gathered some of the excess water and allowed land to appear. This cataclysm may well have taken place, when the earth’s path around the sun was within the path of Mercurius. The earth then changed its rotary location between Venus and Mars. The new location and its effect on gravitation towards the sun allowed the earthball to expand, and continents drifted apart. The mineral kingdom reigned supreme.

Long afterwards, osmotic structures with the aid of catalyzers, allowed the vegetable kingdom to make its appearance. Here the minerals, in organization with the aid of catalyzers, allowed life to manifest itself, the minerals still playing a fundamental part in the process.

Eventually, the animal kingdom made its appearance and though for a long time we paid slight attention to it, the minerals and their importance are getting their true recognition. When colloidal chemistry sprang into prominence, many problems of bio-chemistry appeared near solution.

Though dentistry, for the last hundred years, evolved in the mechanical direction, the last twenty-five years have shown that the scientific aspect of dentistry is rapidly coming to the foreground.

Today, dentistry realizes that the solution of dental ills is to be found in the underlying systemic disturbance, and that oral abnormalities must be considered symptoms of a physical disturbance in general, and a mineral disturbance in particular. Though the blood picture has taken a prominent part in the underlying disturbed physiology, the “mineral picture” will hold in the future an equally important if not a more important place. As oral orthopedic surgeons, dentists of necessity are, and will become, intensely interested in its development.

Such age-old problems as caries and paradentosis have great possibilities of complete solution in the next decade.

In our “New Concept of Dental Medicine.” (1) published in the May issue of the Dental Digest, 1932, we introduced a condensed and enlarged concept of dentistry to the profession. With additional clinical and laboratory data now available, its soundness becomes more and more apparent. Dental literature of today is filled with articles pertaining to mineral metabolism studies. (Of specific interest are recent articles by Grove and Grove (2), Page (3), and Kaushansky (4)).

The Catalyzer-Vitamin-Hormone chart of our “New Concept” not only gives the number of vitamins to be discovered, but an indication is furnished of what can be expected of them, when they are discovered.

The importance of sugar metabolism in relation to calcium and phosphorus metabolism was stressed I the solving of active caries; and in a recent article by Bunting, et al (5), a definite step in that direction has been taken. Clinical data obtained by the Jarvis Study group of Otolaryngologists (11) fall in line with our Keychart in an astounding manner. We will refer to this later.

As the main constituents of tooth structure and bone are the minerals, calcium and phosphorus, it is understandable why particular attention has been paid by the profession to these minerals.

                Unfortunately there has been lacking an authoritative control on laboratory methods and procedures, resulting in a mass of more or less inaccurate determinations with consequent contradictory conclusions.

An extremely timely article appears in the October, 1934 issue of the Journal of Dental Research, by Drs. H. Becks and W.W. Wainwright (6), under the title: “Critical Discussions of Former Salivary Calcium Studies and Their Value in the Establishment of Normal Standards.”

Two years ago a resolution was forwarded to the Research commission and the Committee on Dental Therapeutics of the American Dental association by the members of the Miami Study club of Preventive Dental Medicine in the hope that necessary steps could be taken to remedy this condition of uncertain controls. Becks and Wainwright feel the necessity for “properly controlled methods” and the establishment of “normal standard values as a basis for future work.” To prevent future unreliable data clogging the dental literature, officially controlled laboratory supervision is in order.

Metallic Elements in Body Fluids Important

Bigwood (7), in his article on the concentration of ionic calcium in the blood plasma, states: “In the assemblage of facts which govern the activities of the living cell, physiology assigns to the metallic elements of biologic media a more and more important role. “  Note that “metallic elements” are specifically mentioned, not only calcium and phosphorus. Sodium, potassium and magnesium are of equal importance. The influence of these metallic elements of the body fluids is not only a specific one, but their relative proportion must also be considered.

As Sodium Chloride alone produces a hyperexcitability of the neuro-muscular apparatus, an appropriate quantity of the bivalent antagonistic calcium ions or magnesium ions added to the solution will overcome this condition.

Loeb was able to show in his experiments, that the determined functional quality of the cell, bather in a certain solution, is changed when the concentration of one of the elements is altered. By changing the concentrations of the other chemical bodies in the solution in convenient proportions, the initial functional quality of the cell was restored. He demonstrated that the physiologic characteristics of an organ depended on the balance existing between antagonistic bodies in solution. Monovalent elements, on the one side, bivalent elements, on the other side.

In algebraic formula this is expressed for sodium, potassium, magnesium and calcium as follows:

__Na . + K . _

Ca . . + Mg . .

Which will give the so-called Loeb ionic coefficient.

If the amount of one or more of these elements is changed, thereby modifying the balance, functional properties of the cell will be altered. If these proportions vary in such a manner that the value of the balance is not altered, cell function will not be modified.

Not only is living matter affected by a change in relative concentration of these ions, but the physical properties of certain colloids are altered, activities of ferments are changed. If the relative proportions stay constant and the absolute concentration is changed, these physical properties are not modified.

The promiscuous empirical supplementation of dicalcium phosphate and cod liver oil, can never lead to a scientific solution of dental problems. The raising of serum calcium and serum inorganic phosphorus above normal, must of necessity lead to a demineralization of one or all three of the minerals: sodium, potassium and magnesium, with necessary functional alterations.

Kaushansky (4) mentions discoveries by Luiter, where rabbits fed exclusively on greens showed a decrease in sodium and an accumulation of potassium and calcium in the blood serum. When oats were fed, sodium was increased and potassium and calcium were diminished. The loss of calcium and the increase of sodium was manifested in the animal’s skin, the latter becoming “extremely sensitive to every irritation and was readily inflamed.”

In the 1: 1/5 proportion, sodium and potassium acted as antagonists, the animals did not lose weight, and the general condition was satisfactory. If the ration 1: 1 or 1: ½, a marked reduction in weight followed and the general condition was unsatisfactory.

In our own investigations, where the serum calcium was high and the serum phosphorus low, an adjustment of the calcium phosphorus balance was more readily achieved by demineralizing the individual for calcium, by thyroid therapy. It is of importance to strive to establish a normal calcium phosphorus balance for adults, allowing thereby, a normal balance for sodium, potassium and magnesium. When normal calcium phosphorus level is established, the intake of calcium and phosphorus should balance the output, allowing needed quantities for physiologic functions of the body. In the young, who have to build the skeleton, for which considerable amounts of calcium and phosphorus are required, a depositing quality of the blood for calcium and phosphorus, as advocated by Price (8), is desirable.

Endocrines Control Mineral Balance

Many believe that parathyroid function has primarily to do with calcium metabolism. Aub and co-workers (9) definitely established that the action of the parathyroid has primarily to do with phosphorus metabolism. The demineralizing effect of the parathyroid hormone, which is of the nature of peptization, raises primarily both minerals in the blood serum, but the urinary mineral output tells the story. We find an increase in both calcium and phosphorus but the phosphorus output is excessive, leaving a greater amount of calcium in the serum indirectly. A hypothyroidia gives a raised serum calcium, producing an alkalosis. Hyper-parathyroidia lowers the blood pH. If we understood the parathyroid to be antagonistic to the thyroid, the hypothyroidia produced is responsible for the raised serum calcium directly, and the acid-base balance shift by the hyper-parathyroidia is more or less controlled.

 

Blood Calcium Exists in Two Forms

Calcium exists in the blood under two forms: the diffusable and non-diffusable.

The non-diffusible calcium is calcium combined with protein in colloidal state and the amount combined varies with the modification of the Hydrion concentrations in the medium. 2/5 à 3/5 of the total calcium is non-diffusable calcium. The diffusable calcium being 2/5 à 3/5 of the total calcium is composed of 1/3 à 2/5 of non-ionized calcium-bicarbonate and 1/3 of ionized calcium. The determination of total serum calcium is, therefore, of limited value.

Bigwood (7) gives a method by which the ionic calcium can be scientifically calculated by means of the pH of the blood and the total carbon di-oxide content by the volumetric method of Von Slyke.

In view of the above mentioned algebraic formula

Of Loeb, namely: ___Na + K__ , this calculation of ionic calcium is of importance in biology. The influence

Ca  + Mg

Calcium exercises on cell permeability and excitability depends on its ionic state. It is the active calcium of the body.

 

In our article, “Mineral Supplementation in Relation to Dentistry, and a New Formula Expressing Calcium-Balance,” we suggested the New Formula:

Ca . .X inorganic P2 =10

 

to take the place of the one accepted:

total Ca X inorganic P2=40

 

as the expression of Calcium-Balance.

 

The total calcium does not give the amount of ionic calcium and whereas the Ca . . is the active calcium, the new formula is more accurate.

 

The foregoing shows mineral metabolism studies and the subsequent supplementation to be rather complicated. Moreover, the behavior of the minerals in the body is directly related to endocrine function and vitamins.

 

As the thyroid hormone demineralizer the body for calcium and parathyroid does the same for phosphorus (Aub (9)), a disturbed glandular balance will bring about a change in the Loeb ionic coefficient and thereby a change if function of the whole human organism.

 

The concept of mineral metabolism and supplementation must, therefore, include their relation to: mineral intake, mineral output, blood pH, diet, endocrine balance and disturbance, vitamin insufficiencies, kidney function, focal infection, sunshine, climate, altitude, impacted teeth, sugar metabolism, body temperature, blood pressure and sex.

 

A better understanding of the problem can be obtained by studying the “New Concept of Dental Medicine” (1), especially the Key Chart which is herewith reproduced. It represents the balancing mechanism of the body and the avenue of expression in clinical form. A disturbance from the normal will manifest itself in time in so-called disease symptoms.

 

If the disturbance is in the direction of increased dynamia, it will lead to a state of sympathetic dominance with the following clinical manifestations: dilated pupil; scanty, ropy saliva; increased pulse rate; elevated systolic pressure; over-functioning of the sweat glands; disturbed digestive function; atonic condition of the intestinal tract; elevated temperature; and a red color of the cartilaginous portion of the nasal septum. This of necessity causes a deviation of the acid-base balance, producing a degree of acidoemia and is manifested by a reddish blood serum; contracted blood clot; increased Brownian movement; peptization or demineralization of the storehouse. When this serum is shaken with powdered beefbone, a varied degree of avidity will be observed.

 

One of the most essential features in mineral metabolism is to realize that minerals function only in their ionic state. This ionization depends upon acidity, and the acid-base balance is of the utmost importance. Unfortunately, there is need for an accurate and simple pH determination. The lack of availability does not allow us to overlook its necessity. The photometric method developed Kanner-Chancogne (17) allows an accurate determination into hundredths of a pH in 10 minutes. The whole determination is completed under neutral oil.

 

BIBLIOGRAPHY

  1. Wielage & Wielage, M. Frances and Ada M.; “A New Concept of Dental Medicine,” Dental Digest, May, 1933.
  2. Grove & Grove, Carl T. and Carl J.; “The Biochemical Aspect of Dental Caries,” Dental Cosmos, pp. 1027-1036, Volume 76, No. 10, October, 1934.
  3. Page, Melvin E.; “Conservation of the Edentulous Alveolar Processes,” pp. 52-60, Journal of American Dental Association, Vol. 22, January, 1935.
  4. Kaushansky, L.I.; “The Etiology of So-called Alveolar Pyorrhea. Influence of Diet on Mineral Metabolism,” pp. 69-74, Dental Cosmos, Vol. 77, January, 1935.
  5. Bunting, Russell W.; “Bacteriological, Chemical and Nutritional Studies of Dental Caries by the Michigan Research Group,” Journal of Dental Research, Vol. XIV, No. 2, April, 1934, pp. 97-105.