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1
Q

Goals for nutritional tx plan:

A
  • decrease sx / pain / discomfort
  • prevent chronic disease
  • increase function (cellular / interpersonal / social)
  • JOY in eating: intuitive. intelligent.
  • integration & respect with/of our bodies
2
Q

What do we learn about our tastes from kids?

A
  • they are malleable, responding to exposure

* preferences shift as we seek novelty and variety

3
Q

Obstacles to implementing successful nutrition plans:

A
  • judgement / guilt / shame
  • unrealistic ideals
  • authoritative physician attitude
  • orthorexia
  • inflexibility
  • reductionist / mechanistic / dualistic thinking
4
Q

Name 2 benefits of increased adiponectin output:

A
  • improved insulin sensitivity

* decreased systemic inflammation

5
Q

In a female with high cortisol/DHEA ratio, DHEA replacement can improve:

A

anxiety scores

6
Q

EPA/DHA can improve neuro function via:

A

membrane fluidity and integrity

7
Q

5-HTP and amino acids are important for:

A

neurotransmitter precursor availability

8
Q

Sleep hygiene and melatonin help regulate:

A

the sleep / wake cycle

9
Q

What might you use to support psycho-emotional wellness:

A
  • mindfulness / awareness practice
  • aesthetic enjoyment
  • social networks and belonging
  • personal purpose / mission / goals
10
Q

Where do we make ATP?

A
  • Krebs cycle
  • Ox phos
  • Beta oxidation
11
Q

Name 2 sources of ROS:

A
  • mitochondria-dependent reactions

* phase 1 detox - CYP450

12
Q

What are some effects of excess ROS?

A
  • insulin resistance / endocrine disorder
  • neurodegenerative disease
  • heart disease
  • allergy and autoimmunity
  • GI disorder
  • cancer
13
Q

Name 2 carotenoids:

A
  • beta-carotene

* lycopene

14
Q

Polyphenols:

anthocyanin and isoflavones are examples of:

A

flavonoids

15
Q

Polyphenols: EGCG stands for ________ and is an example of:

A

ellagic acid

a phenolic acid

16
Q

Resveratrol is categorized as a:

A

stillbene (polyphenols)

17
Q

Phase I - CYP450: generates reactive __________ from __________, (minimal/moderate) support needed to facilitate.

A

intermediates
xenobiotics
minimal

18
Q

Phase II - conjugation: an elaborate __________ system, requires more support with increasing ___________ load.

A

antioxidant

xenobiotic

19
Q

Name 2 non-hepatic biotransformations:

A
  • Intestinal CYP3A4 enzymes - many drugs, carcinogens

* antiporter “phase 3” - MDR1 gene products

20
Q

Describe the detox mechanisms of Turmeric:

A
  • induces glutathione transferase, NADPH, and quinone transferase
  • modulates/inhibits CYP450 1A1 (procarcinogenic)
21
Q

Describe the detox mechanisms of Zinc:

A
  • induces metallothioneins
  • transport/storage of Zn and Cu
  • transport of toxic metals (Hg, Cd) for hepatic/renal glutathione conjugation + excretion
  • useful in therapeutic fasting
22
Q

What are some examples of pro-inflammatory states?

A
  • stress
  • reduced sleep
  • dysbiosis
  • oxidative stress
  • endocrine disruption
    • may lead to immune sensitization –
23
Q

Prostaglandin and leukotriene synthesis is dependent on ________________ of the cell membrane.
Increase n-__ composition facilitates anti-inflammatory PGs and LTs and reduces production of ______________.

A

fatty acid composition
n-3 (omega-3)
pro-inflammatory mediators

24
Q

Anti-COX, -LOX, etc culinary spices:

A

Turmeric - inhibits NF-kB, COX2, LOX, anti-apoptotic proteins
Ginger - inhibits COX 1 / 2, 5-LOX, gene induction

25
Q

T/F: The immune system educated the microbiota.

A

False - microbiota educate the immune system!

26
Q

Gut _______ barrier prevents immune ____________ by ectopic macromolecules.

A

mucosal

sensitization

27
Q

Healthy mucosa and microbiota are essential for:

A

digestion and nutrient absorption

28
Q

Catecholamine concentration (particularly NE) is sensed by intestinal bacteria, and co-regulates ________ behaviors: (3)

A

Virulence -

  • growth rates
  • adhesion/colonization
  • exotoxin production
29
Q

You can feed commensal bacteria with: (3)

A
  • fruit and veg
  • fiber
  • prebiotic / FOS supplement
30
Q

You can supplement commensal bacteria with: (2)

A
  • fermented foods

* probiotics

31
Q

Starve gut pathogens by _______________ or kill with ________________.

A

Simple carbohydrate restriction

botanical and Rx antimicrobial tx

32
Q

Structural integrity comes down to 4 considerations:

A
  • musculoskeletal tissues
  • integumentary barrier
  • membrane permeability and fluidity
  • ECM homeostasis (MMP)
33
Q

MMP stands for:

A

matrix metalloproteinase - process bioactive molecules, degrade ECM proteins

34
Q

What tx might you offer to improve structural integrity?

A
  • DHA intake - alters mitochondrial membrane phospholipid FA concentrations, maintains barrier function
  • α-tocopherol, Vit C, selenium - inhibits MMP3, synergistic effects
35
Q

Metabolic syndrome review:

A
  • insulin resistance w/ increased output
  • elevated fasting glucose
  • depressed HDL
  • elevated TGs
  • HTN (>140/90)
  • abdominal adiposity (>9 WHR)
36
Q

Fasting insulin values that demonstrate insulin resistance:

A

> 25 mIU/L OR

> 174 pmol/L

37
Q

Causes of elevated fasting insulin:

A
  • acromegaly
  • Cushings syndrome
  • insulinoma
  • iatrogenic (corticosteroids, OCPs, levodopa)
38
Q

What is a shortcoming of the WHO and ATP criteria for metabolic syndrome dx?
Proposed solution?

A

they do not account for ethnic variation in defining obesity / central adiposity
– ratio of waist to height: >1:2 correlated with great risk

39
Q

How many US adults are “idiopathically” hypertensive?

A

> 30% over 20 y.o.

>3% of children/adolescents

40
Q

What are some supposed effects of hyperinsulinemia on the cardiovascular system?

A
  • atherogenesis
  • increased plasminogen activator inhibitor -> increased risk of coronary thrombosis, accelerated atherosclerosis
  • dyslipidemia -> atherogenesis
41
Q

Reactive (____________) and spontaneous (___________) hypoglycemia can either present with a predominantly Autonomic or ___________ picture, or both.

A

r - post-prandial
s - fasting state
autonomic or neuroglycopenic

42
Q

Autonomic ssx of hypoglycemia:

A
  • anxiety
  • palpitations
  • tachycardia
  • tremor
  • pallor
43
Q

Cholinergic ssx of hypoglycemia:

A
  • hunger
  • diaphoresis
  • paresthesias
44
Q

Neuroglycopenic ssx of hypoglycemia:

A
  • headaches
  • cognitive impairment
  • fatigue
  • altered behavior / affect
  • motor dysregulation
    severe -
  • seizure
  • coma
45
Q

Other ssx of hypoglycemia that are less defined:

A
  • irritability
  • depression
  • sleep cycle dysregulation
  • abdominal pain
  • myalgia / arthralgia
  • dizziness / vertigo
46
Q

What is Whipple’s triad?

A
  • ssx of hypoglycemia
  • low plasma glucose
  • sx resolution with increased glucose
47
Q

Describe the pathophysiology (pathway) of hypoglycemia:

A

high refined carb intake (rapid absorption) -> hyperglycemia -> exaggerated insulin response -> hypOglycemia -> exaggerated food-seeking response -> hyperglycemia -> …

48
Q

Conditions that contribute to hypoglycemia:

A
  • hypothyroidism
  • hypoadrenalism
  • hepatic disease / dysfunction
49
Q

Dietary tx of hypoglycemia:

A
Avoid: 
* refined carbs
* caffeine
* alcohol
* concentrated sugars
Include: 
* high-protein foods
* complex carbs
* elimination diet
50
Q

Supplemental tx of hypoglycemia:

A
  • chromium picolinate 200-1000 µg

* magnesium 400-800mg

51
Q

Diabetes tx plan:

A

Goal - improve insulin sensitivity

  • wt loss (less adipose, more adiponectin)
  • avoid refined carbs / sugar
  • chromium 200-1000 µg
  • toxicant avoidance (PCBs in dairy, fish, animal fat)
  • aryl hydrocarbon receptor (AhR) modulators
    • protective: I3C, curcumin
    • avoid: PCBs, PCDDs, PCDFs
  • anti-inflammatory protocols
  • CoQ10 100-400mg (dec ROS)
52
Q

How might you minimize inflammation in your DM pt?

A
  • weight loss (dec TNF⍺, IL-1b, RBP4)
  • anti-inflammatory diet
  • fatty acid therapy (3-6g EPADHA, 2-4g GLA)
  • curcumin 1-2g
  • ALA 600mg (inhibits NF-kB)
  • therapeutic fasting (induces autophagy/mitophagy)
53
Q

How might you support your DM pt on the neuro/psych level?

A
  • B12 1mg/day - requisite for metformin users

* mindful eating / awareness practice

54
Q

How might you support your DM pt with digestion/absorption/microflora?

A
  • dec refined carbs (inc commensals, dec pathogenic)
  • inc soluble fiber (legumes, whole grains, non-starch veg)
  • SIBO assessment / tx
  • probiotic (food / supplement)
55
Q

Recommendations for structural integrity in DM?

A
  • chromium picolinate
  • protein intake 20-30% of calories
  • exercise
56
Q

Cautions in treating DM:

A
  • ensure regular blood glucose monitoring
  • monitor serum K+ and renal function
  • maintain contact with other providers in care team - prevent hypoglycemia, hypotension, hypocholesterolemia
57
Q

Describe pathogenesis of asthma:

A

allergen exposure -> mucosal peptide generation -> induces Th2 -> excess inflammatory cytokine / adhesion molecule production/activation (eos, basos, monos) -> IgE overproduction -> mast cell degranulation -> bronchospasm

58
Q

Nutritional considerations in asthma:

A
  • allergy elimination diet (gold standard) - consider grains, dairy, eggs, chocolate, fish, soy, legumes
  • food additive avoidance - sulfites, tartrazine, sodium benzoate, MSG, aspartame
  • breastfeed >4 months
  • vegan diet
  • reduced-energy diet (for wt loss)
  • low trans-fat diet
  • antioxidant therapy
  • pyridoxine
59
Q

What are some sources of dietary sulfites?

A
  • dried fruits
  • wine
  • fruit juice
  • molasses
  • pickled foods
  • dried potatoes
  • wine vinegar
60
Q

T/F: Molybdenum may be considered to treat sulfite-sensitive asthmatics, as it is a necessary cofactor for sulfite kinase, and should be co-administered with Zn.

A

False - sulfite oxidase / take with Copper

61
Q

Low vitamin B__ is often observed in asthmatics. _________ can be supplemented to bind histamine, and prevent mast cell ________________. Co-administer __.

A

B6
pyridoxine
degranulation
Mg

62
Q

Supplementation considerations for asthma:

A
  • B6
  • pyridoxine 50-200mg
  • Mg 200-800mg
  • fish oil 2-4g (EPA-DHA)
  • vit D3 1-2000 IU
63
Q

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, lethal interstitial lung dz characterized by destruction of ________ cells and hyperplasia of ___________ cells, and subsequent ____________ deposition.

A
type 1 alveolar cell destruction (gas xchg)
type 2 alveolar cell hyperplasia (surfactant)
collagen deposition (fibrosis)
64
Q

Characteristic histological pattern of IPF:

A

UIP - usual interstitial pneumonia

65
Q

Risk factors for IPF:

A
  • FHx of pulmonary fibrosis
  • smoking
  • GERD
  • DM II
  • occupational inhalant exposure (dust, smoke, gases, etc)
66
Q

IPF nutritional txs:

A
  • anti-inflammatory diet
  • high fruit intake (limited evidence)
  • elimination diet
  • NAC
67
Q

________ function may be central to reversing pulmonary arterial HTN. Name 3 ways:

A

Mitochondrial

  • targeted drug therapy
  • high dose antioxidants
  • improve membrane integrity to normalize potential
68
Q

PAH nutritional txs:

A
  • Mg 300-600mg - vasodilation
  • Genistein 50mg - inc NO, dec endothelin
  • EFAs 3-6g - inc mitochondrial membrane integrity
  • L-arginine 50-100 mg/kg TID - inc NO, dec endothelia
69
Q

COPD is an obstructive lung disease characterized by incomplete (inhalation/exhalation). Increased oxidative stress in the lung tissue results in hyperactivation of: (4)

A

exhalation

  • neutrophils (elastase/MMP)
  • macrophages (pro inflammatory cytokines)
  • fibroblasts
  • mucus-producing cells
70
Q

COPD risk factors:

A
  • smoking
  • 2nd hand smoke
  • air pollution
  • dust/particulate inhalation
71
Q

COPD prevention:

A
  • dietary antioxidants (preserve lung fxn)
  • Vit C
  • EPA/DHA
  • reduce risk factors
72
Q

COPD nutritional txs:

A
  • high antioxidant diet (high catechin)
  • allergy elimination diet
  • antioxidant supplementation
  • resveratrol 180mg TID (inc GSH, Pa02; dec macs)
  • curcumin 2g (inhibits NFkB)
  • Vit C 2-3g (tissue repair, host immunity)
  • NAC 1.2g+ (dec sx, exacerbations)
  • Mg 300-600mg (inc mm tone)
  • K+ 2g
  • Vit A 5000 IU (host immunity, epithelial repair)
  • EFAs 2g+
  • L-carnitine 2-4g (inc mm tone)
  • proteolytic enzymes (bromelain 3000GDU)
73
Q

Key ssx of bronchiectasis: (4)

A
  • chronic cough
  • mucopurulent sputum
  • SOB
  • hemoptysis
74
Q

Bronchiectasis txs:

A
  • proteolytic enzymes (bromeliad, trypsin)
  • NAC 600-1200mg (mucolytic)
  • Vit D 1-2000 IU (AI, dec infx)
  • allergy elimination diet
75
Q

_____ is an acute inflammatory pulmonary condition occurring in the critically ill, with a __% mortality rate. It occurs in 3 phases:

A
ARDS
40%
* acute (up to 7 days)
* fibroproliferative (weeks)
* resolution (months to a year)
76
Q

ARDS risk factors:

A
  • multiple transfusions (any reason)
  • advanced age
  • cigarette smoking
  • drug OD (narcotics, tricyclic antiD, salicylates)
77
Q

ARDS nutritional txs - phase 1 and 2:

A

Phase 1, 2 - inpatient

  • enteral feeding
  • EFA
  • Vit E
  • Taurine
  • NAC 40-210mg/kg
78
Q

ARDS nutritional txs - phase 3:

A

Phase 3 - outpatient

  • diet
  • EFA therapy 2-4g
  • NAC 300-400 mg TID
  • Supplements (curcumin 1g, boswelia 400mg)
79
Q

RRP nutritional txs:

A
  • I3C 200mg BID (brassicas)

* Vit D 1-2000 IU

80
Q

Pulmonary hemosiderosis (PH) nutritional txs:

A

dietary modifications - links to:
* milk hypersensitivity
* celiac
elimination diet

81
Q

Sarcoidosis nutritional txs:

A
  • melatonin 20mg (dec lesion, inc lung fxn)
  • flaxseed oil (ALA) 4-8g
  • low dose fish oil 1-3g
  • curcumin 1-2g
  • low calcium diet
  • Vit D (gran tissue overproduces 1a-hydroxylase)
82
Q

Sarcoidosis therapeutic goals:

A
  • bone mineral density preservation (w/steroid tx)
  • dec disease activity (anti-inflammatory)
  • dec opportunistic infx (antimicrobial peptide)