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nutrition 2 (semester i) > 3. Assessment and Diagnostics > Flashcards

3. Assessment and Diagnostics Flashcards

1
Q

What is functional testing?

A

Focuses on how body systems are functioning

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2
Q

What is diagnostic testing?

A

Looks for marker to diagnose an illness

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3
Q

What figure is considered in conventional medicine as ok for vit D levels?

A

50 nmol/L

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4
Q

What is the optimal range of vit D in functional medicine?

A

75-125 nmol/L

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5
Q

What are the benefits of functional testing?

A

Helps uncover a deeper understanding of imbalances
Can make a plan more targeted and effective
Allows to quantitatively measure a client’s progress and the client can see that progress from the reports

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6
Q

What are the disadvantages of functional testing?

A

Expensive
Challenging to interpret
Not diagnostic so difficult to communicate results to GPs

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7
Q

What questions do you need to ask yourself when interpreting functional tests?

A

Do the results correlate with the symptoms at time of testing?
Has the client’s diet impacted the results?
Do any activity at the test time affect the results?

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8
Q

Where in the body can microbiome niches be found?

A

GI
Vaginal
Oral
Skin
Urinary

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9
Q

What sort of things can a stool test test for?

A

Increased intestinal permeability
Inflammation
Gas producing bacteria
Pathogenic microbes

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10
Q

What are gram negative bacteria?

A

Bacteria with an outer cell wall rich in LPS

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11
Q

What abilities do LPSs have?

A

Induce inflammation
Induce immune responses

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12
Q

What is a CDSA?

A

Comprehensive digestive stool analysis

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13
Q

What can a CDSA show?

A

Digestive function
GI microbiome

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14
Q

What is metabolic endotoxaemia?

A

Immune response
Sub clinical
Persistent
Low grade inflammation due to increased LPSs

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15
Q

When is metabolic endotoxaemia more prevalent?

A

With poor GI barrier integrity

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16
Q

What can metabolic endotoxaemia be a risk factor for?

A

Insulin resistance
Diabetes
CFS
AI

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17
Q

What are the microbial markers that comprehensive stool tests can evaluate?

A

Commensal bacteria
Pathogenic bacteria
Pathobiont microbes
Mycology
Worms

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18
Q

What are the host markers that comprehensive stool tests can evaluate?

A

Immune
Digestive
Inflammation
Intestinal permeability
Occult blood

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19
Q

Why is it important to know a client’s diet when interpreting a stool test?

A

Different dietary models impact the microbiota in different ways

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20
Q

Which inflammatory host markers are tested for in a stool test?

A

Calprotectin
Eosinophil protein X

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21
Q

What is calprotectin?

A

A protein made by leukocytes when they have migrated to and are active in the GI wall

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22
Q

What is a high level of calprotectin?

A

Over 50 ug/g

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23
Q

In what situations can calprotectin be raised?

A

IBD
Ulcers
Cancer
Pathogens
NSAIDs
Age

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24
Q

In what situations could eosinophil protein X be raised?

A

Intestinal inflammation
Food allergies
Colitis
Parasites

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25
Q

What is beta-glucuronidase?

A

A metabolic enzyme made by some intestinal bacteria

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26
Q

In which situations could beta-glucuronidase be raised?

A

Dysbiosis
Western diet

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27
Q

Beta-glucuronidation can interfere with the elimination of which hormone?

A

Oestrogen

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28
Q

Which digestive host markers are tested for in a stool test?

A

Pancreatic elastase
Faecal fats

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29
Q

What is the normal range for pancreatic elastase?

A

200-500 ug/g

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30
Q

Why can measuring faecal fats be inaccurate?

A

The amount of fat in the stool can change with diet and testing type

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31
Q

What do high levels of faecal fat indicate?

A

Fat maldigestion associated with pancreatic insufficiency, SIBO, hypochlorhydria

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32
Q

What do low levels of faecal fat indicate?

A

Low fat diet

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33
Q

What immune markers are tested for in a stool test?

A

Secretory IgA
Beta-defensin 2

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34
Q

What does low IgA indicate?

A

Chronicity
Increased susceptibility to GI infections

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35
Q

What does high IgA indicate?

A

Upregulated immune response when testing

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36
Q

What is beta-defensin 2?

A

Anti-microbial peptide produced by the GI wall when breached

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37
Q

What does high beta-defensin 2 indicate?

A

Immune system could be responding to a breach by microbes
GI inflammation - e.g. ulcerative colitis

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38
Q

What intestinal permeability marker can be tested for in a stool test?

A

Zonulin

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39
Q

What is zonulin?

A

A peptide produced by the epithelial cells when the GI tight junctions are open

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40
Q

Why might zonulin be raised in a client?

A

Poor nutrition
Heavy metals
Drugs
Alcohol
Dysbiosis
Coeliac disease

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41
Q

What should be checked for when looking at commensal bacteria on a stool test?

A

Diversity
Good levels of SCFAs
Good levels of Bifidobacteria and Lactobacilli

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42
Q

What can impact the diversity of commensal bacteria in the GI?

A

Diets lacking diversity - junk food, FODMAP
Overeating
Antibiotic use
Chronic conditions

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43
Q

What are SCFAs?

A

By products of the bacterial fermentation of fibre

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44
Q

What can impact levels of SCFAs in the GI?

A

Low fibre diets
Diarrhoea
Antibiotic use

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45
Q

What can create low mucosal integrity?

A

Ulcers
IBD
Gastritis
High levels of mucin-degrading bacteria
Low diversity of commensal bacteria
High gram negative bacteria

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46
Q

Examples of mucin-degrading bacteria

A

Akkermansia
Ruminococcus gravus
Ruminococcus torques

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47
Q

Why should levels of Akkermansia be balanced?

A

Mucin-degrading…BUT ALSO
Protective role in the mucosal barrier

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48
Q

What are low/absent levels of Akkermansia a risk factor for?

A

Metabolic endotoxaemia patterns of disease:
Obesity
Insulin resistance
AI

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49
Q

Examples of gas-producing bacteria (and possibly SIBO)

A

Methanobrevibacter smithii
Desulfovibrio spp
Bilophila wadsworthia

50
Q

Examples of methane producing bacteria

A

Methanobrevibacter smithii

51
Q

Examples of sulphur producing bacteria

A

Desulfovibrio spp
Bilophila wadsworthia

52
Q

Which condition is smelly flatulence a sign of?

A

SIBO

53
Q

Examples of pathobiont bacteria

A

Prevotella copri
Klebsiella spp
Staphylococcus aureus

54
Q

Examples of pure pathogenic bacteria

A

Giardia spp
Clostridium difficile
Shigella

55
Q

Examples of anti-microbials to eradicate pathogenic bacteria

A

Oregano oil
Garlic
Neem
Clove

56
Q

Which phytonutrients can be used to increase Akkermansia?

A

Polyphenols
(grape extract, quercetin, dark choc, tea, red wine)

57
Q

If calprotectin tests high, what can be used to lower levels?

A

Reduce gluten/sugar
Increase D3
EPA/DHA
Curcumin
Quercetin
Chamomile

58
Q

If commensal Bacteroides spp. are low, what can be eaten to increase levels?

A

Brown rice

59
Q

What are the 3 gram negative bacteria typically present in a stool test?

A

Bilophila
Hafnia
Veillonella

60
Q

Which gram negative bacteria may explain bloating and possibly SIBO?

A

Bilophila

61
Q

Which gram negative bacteria is linked with liver disorders?

A

Veillonella

62
Q

What bacterial count in the SI is considered as SIBO?

A

Over 105 CFU/ml
(colony forming units)

63
Q

What is SIBO a result of?

A

Fermentation of carbs in the SI

64
Q

Which gases are raised in SIBO?

A

Methane
Hydrogen

65
Q

How is SIBO tested?

A

Breath test

66
Q

What type of substrates can be used for a SIBO breath test?

A

Lactulose
Glucose
Fructose

67
Q

How do you decide which substrate to use for a SIBO breath test?

A

Which ever your client reacts to the most in their food

68
Q

What can be the underlying cause of SIBO?

A

Poor MMC
Low stomach acid/pancreatic juice
Poor ileocaecal valve functioning
Low IgA

69
Q

What foods are allowed 24 hours before a SIBO breath test?

A

Meat/poultry/fish - not cured
Steam white rice
Eggs
Fats/oils
Salt/pepper

70
Q

In hydrogen positive SIBO, what is the result ppm?

A

A rise of 20 ppm before 90 mins

71
Q

In methane positive SIBO, what is the result ppm?

A

A rise of 12 ppm before 90 mins

72
Q

In combined hydrogen/methane positive SIBO, what is the result ppm?

A

A rise of 15 ppm before 90 mins

73
Q

In which conditions is it best to test the vaginal microbiome?

A

Bacterial vaginosis
Recurrent thrush
Infertility
Miscarriages
Endometriosis

74
Q

What the key markers in vaginal testing?

A

pH
IL-1

75
Q

What is the pH of a healthy vaginal microbiome?

A

3.8-4.5
(acidic)

76
Q

Why is the vagina acidic?

A

To prevent pathogenic microbes from growing

77
Q

Which bacteria is important in maintaining the acidic pH of the vagina?

A

Lactobacilli

78
Q

What is a high vaginal pH indicative of?

A

Bacterial vaginosis-associated bacteria
Vaginal dysbiosis

79
Q

What is IL-1?

A

An inflammatory marker made when epithelial cells break apart
(i.e. in an infection)

80
Q

What is considered a healthy IL-1 level?

A

<220 pg/ml

81
Q

Should the vaginal microbiome population be diverse?

A

No

82
Q

How can the vaginal microbiome be supported?

A

Avoid soap, antibiotics, copper coil
Avoid excess carbs, alcohol, smoking
Include probiotics and prebiotics to support Lactobacilli growth

83
Q

What can oral dysbiosis be associated with?

A

Tooth decay
Periodontitis
Oral cancer
CV disease
AI conditions
AZD

84
Q

What pathogen is mostly associated with the oral microbiome?

A

P. gingivalis

85
Q

How can the oral microbiome be supported?

A

Optimise intake of pre/probiotic foods and polyphenols
Minimise intake of processed carbs, trans fats
Avoid mercury fillings
Brush teeth with electric toothbrush
Scrape tongue
Use probiotic mouthwash

86
Q

What is OAT?

A

Organic Acid Testing

87
Q

What are organic acids?

A

Natural by-products (metabolites) created from the functioning of enzymatic pathways

88
Q

How are organic acids measured?

A

Urinalysis

89
Q

Which clients would benefit from OAT?

A

Chronic fatigue
Suspected nutritional deficiencies
Mitochondrial dysfunction
Autism
Mood disorders

90
Q

Benefits of OAT?

A

Overview of metabolic functioning
Where there’s need for certain nutrients
Focuses nutritional plan

91
Q

Downsides of OAT

A

Food eaten before test can influence results
(get food diary completed before test done)
Doesn’t measure vitamin levels directly - just the function

92
Q

What metabolites can be measured with OAT?

A

Nutritional function
Glycolysis
Krebs Cycle
Ketone/fatty acids
Amino acids
Detoxification
Bacterial
Neurotransmitters
Oxalates

93
Q

Why could using OAT be beneficial when testing vitamins and minerals?

A

Blood serum tests only tell you how much of a vitamin or mineral is in the blood stream
They don’t tell you how that vitamin or mineral is being utilised by tissue

94
Q

Which B12 test is better than testing serum B12?

A

Methylmalonic acid

95
Q

What is a functional biomarker for low B9 and B12?

A

Homocysteine

96
Q

Which Fe test is better than testing serum Fe?

A

Serum ferritin

97
Q

What is the best way to test Mg?

A

At cellular level

98
Q

What is the best way to test Ca?

A

OAT
RBC nutrients

99
Q

What is the normal range for CRP?

A

<5 mg/L

100
Q

What is a better measurement when looking for low grade inflammation?

A

High sensitivity CRP
(hsCRP)

101
Q

What is the normal range for hsCRP?

A

0.2-3 mg/L

102
Q

What does a red blood cell nutrient test look at?

A

The amount of minerals that have been taken up inside the RBC
More indicative of tissue levels

103
Q

What nutrients are RBC tests good for?

A

Minerals
Toxic minerals
EFAs

104
Q

What are mixed methodology nutrition tests?

A

Where different markers i.e. serum, organic acids from urine or RBC levels give a more complete profile

105
Q

What are the benefits of hair mineral tests?

A

Non-invasive
Easy to do
Inexpensive

106
Q

What do hair mineral tests measure?

A

Minerals
Toxic metals

107
Q

What does standard thyroid testing measure?

A

TSH
T4

108
Q

What does extended panel thyroid testing measure?

A

TSH
Free T3
Free T4
Reverse T3
Thyroid antibodies

109
Q

What is subclinical hypothyroidism?

A

Normal reading but close to cut off
Symptoms of poor thyroid function

110
Q

What does high TSH and normal T4 indicate?

A

Subclinical hypothyroidism

111
Q

What does low TSH and high FT4 indicate?

A

Hyperthyroidism

112
Q

What does raised anti-thyroid peroxidase antibodies indicate?

A

Grave’s disease

113
Q

Which type of tests are better for viewing adrenal function?

A

Salivary
Urine

114
Q

What is four point testing?

A

Taking four samples during the day to test adrenal function

115
Q

Which metabolites are tested in adrenal testing?

A

Cortisol
DHEA

116
Q

What do high levels of cortisol indicate?

A

Someone is in an intense period of stress

117
Q

What do low levels of cortisol indicate?

A

Someone is in the exhaustion phase of a stress response

118
Q

What does DHEA do?

A

Down-regulates the cellular effects of cortisol

119
Q

How is the DUTCH test conducted?

A

Urine

120
Q

What does the DUTCH test measure?

A

Hormones
(and may adrenal/nutritional markers)

121
Q

When should a DUTCH test be used?

A

Low libido
PMS
Irregular/painful periods
Hormonal imbalances

122
Q

What must you know to read a DUTCH test?

A

Patient’s menstrual history and stage
If they are on hormone-altering medication

nutrition 2 (semester i) (15 decks)

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