Assessment and Diagnostics Flashcards
1
Q
What is the ‘rule of 3’ used to inform the naturopathic nutritional plan?
A
As a naturopathically-trained nutritional therapist, you have a variety of evaluation tools including tongue, nail and facial diagnoses to help you better understand a client’s problems.
It is important to have three pieces of evidence (ie. Symptoms, tongue observation, test results) to confirm any hypothesis.
2
Q
How is functional testing different from diagnostic testing?
A
Functional testing focuses on how body systems are functioning while diagnostic testing looks for markers to diagnose an illness.
3
Q
What is the difference between ‘reference ranges’ and ‘optimal ranges’?
A
‘Reference ranges’ are diagnostic, whilst ‘optimal ranges’ indicate a need for support to maintain homeostasis.
4
Q
In terms of Vitamin D, what is the
a) Reference range (diagnostic testing)
b) Optimal range (functional testing)
A
a) Conventional medicine considers levels over 50 nmol / L sufficient.
b) The optimal range is approx. 75-125 nmol / L.
5
Q
List two benefits of functional testing
A
- Helps to uncover a deeper understanding of imbalances to help inform a naturopathic plan.
- Can make a plan more targeted and effective.
- Allows to quantitatively measure a client’s progress, which benefits the client as they can clearly see improvements.
6
Q
List two downsides to functional testing
A
- Functional tests are provided privately, and so can be expensive. Always ask yourself: is the test likely to change the outcome / the plan you create?
- They can sometimes be challenging to read and interpret.
- As they are not diagnostic, it can be difficult to communicate results to medical doctors.
7
Q
What contextual considerations are to be kept in mind when interpreting functional test results?
A
- What were the symptoms at time of testing? Do they correlate with the results?
- What is the dietary pattern this person adheres to? Can this impact the results in a predictable way?
- Is there any activity at the test time that could affect the results?
8
Q
Define the following terms as they relate to the microbiota:
* Commensal
* Pathogenic
* Pathobiont
* Gram negative bacteria
* Lipopolysaccharides (LPS)
A
- Commensal — microbes that live in harmony with the host (us) and provide a benefit to us.
- Pathogenic — microbes that possess certain evolutionary advantages to invade our microbiome at a cost to our health.
- Pathobiont — microbes that live with us and normally don’t pose a problem unless there is clear opportunity.
- Gram negative bacteria — bacteria that possess an outer cell wall, normally rich in lipopolysaccharides (LPS).
- LPS — the major component of gram-negative bacteria which have the ability to induce inflammation and immune responses.
9
Q
Why might you consider a ‘CDSA’ for a client with GI complaints or for more chronic systemic illnesses in
which poor GI function might be relevant?
CDSA = ‘comprehensive digestive stool analysis’
A
Stool testing is a good way of getting a comprehensive snapshot of digestive function and the GI microbiome at a given time. This can help you to identify underlying root causes and guide or confirm your nutritional plan.
10
Q
What is Metabolic Endotoxaemia?
A
An immune response that becomes a sub-clinical, persistent, low-grade inflammation because of increased circulating endotoxins (LPS).
11
Q
Why is knowing the client’s diet important to be able to read a stool test accurately?
A
Different dietary models are well known for impacting the microbiota in different ways
12
Q
Which two broad types of markers can be evaluated by comprehensive stool tests?
A
- Microbial markers such as commensal bacteria, pathogenic bacteria, parasites, pathobiont microbes, mycology, sometimes worms (these are often best seen visibly in the stool).
- Host markers — markers made by the human host such as immune, digestive, inflammation, intestinal permeability and occult blood.
13
Q
What is calprotectin and what can raised levels be indicative of?
A
Calprotectin is a protein made by leukocytes when they have migrated to and are active in the GI wall.
It is a marker of inflammation and is flagged as high over 50 μg / g. Between 50-175 is ‘mid-range inflammation’. The elevation is triggered by damage to the epithelial lining - in worst case scenarios IBD, ulcers, cancer, but in most scenarios, relates to pathogens or NSAIDS.
14
Q
What is Eosinophil Protein X and what conditions might a raised level indicate?
A
Eosinophil Protein X is a marker of eosinophil-driven inflammation and can be raised with intestinal inflammation and in cases of food allergies, parasites, colitis.
15
Q
Which elevated metabolic host marker can point to issues with oestrogen excretion?
A
Beta-glucuronidase
16
Q
What would be your interpretation of Pancreatic elastase (PE-1) result of < 200 μg/g?
A
It shows exocrine (digestive) pancreatic insufficiency and there is need for digestive support. Below 100 μg/g is considered severe insufficiency.
17
Q
How might you increase PE-1?
PE-1 = Pancreatic elastase
A
Naturopathic approach to pancreatic insufficiency:
* Don’t overeat, chew adequately, avoid snacking between meals.
* Correct stomach acid levels.
* Stimulate the Vagus nerve to activate the parasympathetic nervous system:
‒ Deep (diaphragmatic) breathing before meals.
‒ Gargle, hum or sing.
‒ Laughter and social enrichment.
‒ Using bitters such as gentian, artichoke and dandelion.
* Pancreatic enzyme replacement therapy (PERT).
18
Q
What is sIgA (secretory IgA)?
A
SIgA is secreted by mucosal tissue and provides the first line of immune defence in the GI mucosa.
19
Q
Upon reviewing a client’s stool test, you see that sIgA is low. What could this correlate with?
A
Low sIgA (<100 μg / g) correlates with chronicity. ↑ susceptibility to GI infections. Always identify why (e.g. chronic stress).
20
Q
What could a high sIgA result signify?
A
High sIgA (>750 μg / g) signifies an upregulated immune response (e.g., acute GIT infection) at the time of testing.
21
Q
What is Beta–defensin 2 and why might it be high?
A
High >62ng / g - might be a sign of the immune system responding to a breach by microbes, or due to GI inflammation e.g., UC.
22
Q
What nutraceuticals might you suggest for a client experiencing chronic stress to help with low sIgA levels?
A
Saccharomyces boulardii and medicinal mushrooms can elevate IgA when levels are low
23
Q
What is zonulin?
A
A peptide produced by epithelial cells when the GI tight junctions are open.
24
Q
What might zonulin levels of > 100 μg / g indicate?
A
Zonulin may be raised in severe intestinal permeability (e.g., due to poor nutrition, heavy metals, drugs, alcohol, dysbiosis) and coeliac disease.
25
What nutrients can be taken to support the intestinal barrier?
Support the intestinal epithelial barrier with:
- Glutamine — supplemented or from food e.g., cabbage juice, spirulina, asparagus.
- Zinc carnosine, vitamin A and N-acetyl glucosamine.
- Bone broth (rich in glycine).
26
When assessing the levels of commensal microbiota, what would you be looking for as indicators of health?
In the commensal markers, check for:
- Plenty of diversity (check that all bacteria are accounted for).
- Good levels of short-chain fatty acid producers.
- Good levels of Bifidobacterium (check that it is taking up more space than E. coli) and Lactobacilli.
27
Which dietary and lifestyle factors are likely to adversely affect the levels of commensal microbiota?
Diets lacking diversity (e.g., junk food diet, FODMAP diet), over-eating, antibiotic usage and chronic conditions can impact these levels in an adverse way.
28
List three of the most common short chain fatty acids (SCFAs). What are they and why are important for health?
**Butyrate, propionate and acetate.**
--
- SCFAs are by-products of bacterial fermentation of fibre.
- The epithelial cells of the colon use butyrate as their main fuel source — maintaining the intestinal lining.
- SCFAs can also affect appetite and modulate inflammation.
29
What is 'mucin'?
Mucin = a glycoprotein constituent of mucus
30
What symptoms can be indicative of low GI mucosal integrity or too much cross-talk between the gut microbiota and immune system?
Symptoms such as ulcers, IBD and gastritis
31
What underlying mechanism would you suspect in a client with gastritis and test results revealing high levels of mucin-degrading bacteria (ie. *Akkermansia, R. gnavus, R. torques*), low diversity of commensal bacteria and high gram-negative bacteria?
Low mucosal integrity
or metabolic endotoxemia
32
Which important mucin-degrading bacteria, when absent, has been shown as a risk factor for metabolic endotoxemia patterns of disease (obesity, insulin resistance, autoimmunity)?
*Akkermansia muciniphila*
33
Which of the following bacteria are well known for their ability to cause gas, and can sometimes be implicated in ‘gassy’ symptoms or SIBO:
a) *Akkermansia muciniphila*
b) *Bilophila wadsworthia*
c) *Desulfovibrio spp.*
d) *Hafnia alvei*
e) *Methanobrevibacter smithii*
b) *Bilophila wadsworthia*
c) *Desulfovibrio spp.*
e) *Methanobrevibacter smithii*
34
Which bacteria are associated with methane gas production?
*Methanobrevibacter smithii*
35
In the context of healthy and diverse microbiome, which of these at any level could pose concern?
a) *Klebsiella spp.*
b) *Giardia spp.*
c) *Entamoeba histolytica.*
d) *Prevotella copri*
b) *Giardia spp.*
c) *Entamoeba histolytica.*
These microbes are purely pathogenic in nature, and we would rather not carry them at all if possible. It is worth checking symptoms to make sure it correlates with your case, and also check the levels.
36
List three pathobionts of which high levels are of concern in the context of low commensals.
*Prevotella copri, Klebsiella spp., Staphylococcus aureus*.
Always read them within the context of the host markers, symptoms and the health of commensals.
37
When *H. pylori* levels test higher than expected, which other two markers can be used to confirm an overgrowth that needs to be tested?
Calprotectin and FIT.
FIT = faecal immunochemical test (detects minute amounts of blood in faeces).
38
List four natural antimicrobials that could be used to eliminate pathogens such as *Giardia spp., Clostridium difficile., Entamoeba histolytica & Shigella.*
* oregano oil
* garlic (allicin)
* barberry bark (and berberine)
* thyme
* clove
* sage
39
Do parasites such as *blastocystis hominis* always need to be eradicated?
Many of us carry some weird and wonderful sounding amoebas and parasites that might be picked up with extensive testing.
In a small number of the population, it
may cause IBS-like symptoms. But it can be found in a high level of healthy population groups, and may also be a sign of health and a diverse microbiome.
40
A stool test shows *A.muciniphila* is absent. What might this indicate and what can you recommend to increase this marker?
Low levels of *Akkermansia* indicate possible GI mucosal damage. Increase polyphenols such as grape extract and pomegranate.
41
Which three species of commensals should always be abundant and in roughly the same number (in individuals consuming a western diet)?
*Bacteroides spp.
Faecalibacterium prausnitzii
Ruminococcus bromii*
42
Which three gram negative bacteria are typically present on stool tests?
*Bilophila wadsworthia*
*Hafnia alvei*
*Veillonella spp.*
43
# Name the microbe:
High levels of this gram negative bacteria indicates a need for liver support to help remove excess LPS through the biliary system (e.g., dandelion root, burdock root, artichoke).
*Veillonella spp.*
44
*Methanobrevibacter* along with which other two microbes is suggestive of SIBO?
*Bilophila* and *Desulfovibrio*
45
What is a reading of 12.8 of *R. gnavus* suggestive of?
*Ruminococcus gnavus* is often present and is normal up to about 8 — beyond this it is associated with mucosal degradation.
46
Define: Small intestinal bacterial overgrowth (SIBO)
SIBO = a bacterial count in the small intestine of over 105 CFU / ml.
| CFU = colony forming units
47
Explain in detail how the SIBO breath test works. Include details of the possible substrates and preparation to be done before the test.
## Footnote
[15]
- In SIBO, fermentation of carbohydrates in the small intestine results in raised hydrogen or methane.
- Breath-testing is a non-invasive test that is looking for the gases made by fermenting bacteria (hydrogen or methane) after set points in time in which the patient has ingested a substrate that the bacteria eats.
- After the substrate is taken, breath samples are collected every 20 or 30 minutes.
- **Types of substrates (bacterial food) used for the breath test:**
‒ **Lactulose:** Very popular and preferred by a lot of practitioners — may give false positives as it is known to speed up transit time, making it hard to read.
‒ **Glucose:** Most substantiated and used by NHS. There are less false positives, but absorbs quickly so might not pick up distal positives.
‒ **Fructose:** Less commonly used; gives you the bonus of seeing if there is fructose intolerance.
- A strict **preparation diet** should be done 24 hours before to get an accurate baseline, where microbiota-feeding foods need avoiding.
The only foods allowed are:
Any meat / poultry / fish / seafood that is not cured or brined; Plain, steamed white rice (not brown); Eggs; Clear meat broth (made only from the meat, no bone / cartilage or vegetables); Fats / oils (coconut / olive / vegetable oils, butter, or lard); Salt and pepper (no other herbs / spices).
48
In SIBO breath testing, what is interpreted as a positive result?
- **Increase in hydrogen:** A rise of 20 ppm before 90 minutes.
- **Increase in methane:** A rise of 12 ppm before 90 minutes (or in severe constipation, a rise as little as 3 ppm might indicate a problem).
- **Increase in combined methane / hydrogen:** A combined rise of 15 ppm before 90 minutes.
49
Why is the cut-off for reading SIBO breath tests usually at 90 minutes?
The substrate transitions to the large intestine at around 90 mins
50
SIBO is frequently associated with poor MMC functioning, low stomach acid and pancreatic juice, poor ileocaecal valve functioning and low IgA. What could these result from?
- Chronic stress
- Chronic PPI, NSAID or antibiotic use
- Improper chewing
- Constant eating or snacking
- Nutrient deficiencies (malabsorption) e.g., iron, zinc, folate and B12.
- Structural dysfunction of ileocaecal valve
51
What is bacterial vaginosis (BV)?
An imbalance of the *Lactobacilli* dominant vaginal composition
52
When would testing the vaginal microbiome (VMB) be a consideration?
In cases of:
- bacterial vaginosis (BV)
- recurrent thrush
- infertility
- miscarriages
- endometriosis
and to provide an insight into vaginal ecology and its interaction with host immunity.
53
What is a healthy pH of the vagina of reproductive age women?
The vagina has an acidic pH of around 3.8 to 4.5 to prevent pathogenic microbes from growing.
54
What is a high vaginal pH (>4.5) indicative of?
High vaginal pH (>4.5) is indicative of overgrowth of BV-associated bacteria and vaginal dysbiosis.
55
On a vaginal microbiome test, what is Interleukin beta-1 and what is a healthy level?
Interleukin beta-1 is an inflammatory marker made when epithelial cells break apart (e.g., infection).
A healthy level is considered <220 pg/ml while levels above that can indicate BV or candida overgrowth.
56
TRUE OR FALSE:
Vaginal health is associated with low microbial diversity.
TRUE.
Vaginal health is associated with
low community diversity, but
*Lactobacilli* dominance. More
diversity = a shift in pH and host immune response modifications.
57
What is the dominant microbial species in a healthy vaginal microbiome?
*Lactobacilli*
58
How can the vaginal microbiome (VMB) be supported?
**Supporting the VMB:**
**- Avoid:** Soap in the vagina (wash with water only); antibiotics; the copper coil (↑ the colonisation of BV-associated microbiota); common lubricants (opt for jojoba oil which is similar to semen pH); excessive simple carbohydrates and alcohol; smoking (by-products are secreted into the vagina); vaginal douching.
**- Include:** Vaginal probiotics. Optimise the oral and GI microbiomes which have been shown to have an impact on the vaginal flora.
Menopausal oestrogen support (e.g. flaxseeds, black cohosh etc.)
**- Diet:** Focus on a diverse range of prebiotic and probiotic foods to support Lactobacilli growth, as well as polyphenols.
59
What diseases/conditions are associated with dysbiosis of the niche oral microbiome?
Dysbiosis of the oral microbiome is associated with:
- tooth decay
- periodontitis
- oral cancer.
Some of the more pathogenic oral bacteria can release endotoxins (LPS) into the bloodstream can also
be associated with:
- cardiovascular disease
- autoimmune conditions (e.g., RA)
- Alzheimer’s disease,
60
Name one oral pathogen in the 'red complex' that is highly associated with disease.
- P. gingivalis
- B. forsythus
- T. denticola
61
What is the 'orange complex' on an oral microbiome test?
The ‘orange complex’ bacteria are ones that are starting to biofilm together and recruit an unhealthy biofilm in the mouth.
62
How can the oral microbiome be supported?
**Diet:**
- Optimise levels of prebiotic fibres and polyphenols. Probiotic foods (e.g., kombucha, kefir).
- Minimise processed carbohydrates and trans-fats.
- Avoid snacking (it does not allow time for the oral pH to recover between meals).
**Oral care:**
- Avoid mercury fillings / remove them using a specialist dentist.
- Brush your teeth at least twice a day. Floss with a ‘water-pik’. Oil pull. Rinse salt water around the mouth.
- Scrape your tongue (balances the oral microbiome).
- Use a probiotic mouthwash.
- Avoid smoking, antibiotics.
- Use biofilm disruptors such as NAC where appropriate.
63
List 2 reasons why commensal bacteria are beneficial for health.
* They give us unique benefits (i.e, boost our immune system and produce SCFAs)
* They help to crowd out non-beneficial bacteria.
64
Are lipopolysaccharides (LPS) always bad?
No. Many of our own cells have LPS (i.e, our blood cells), but fragments of bacterial LPS are problematic, especially in our immune system (they cause inflammation).
65
What is the difference between septicaemia and metabolic endotoxaemia?
Septicaemia: bacteria in the blood
Endotoxaemia: LPS (bacteria cell wall) particles in the blood
66
Pancreatic elastase is a measure of pancreatic enzyme output.
What can cause low pancreatic elastase (<200 ug/g)?
* Stress
* Low HCl
* SIBO
67
What are short chain fatty acids (SCFAs)?
SCFAs are by-products of bacterial fermentation of fibre.
68
Desulfovibrio spp. and Bilophilia Wadsworthia are gas-producing gut bacteria. Which gas do they produce?
Hydrogen sulphide
69
In the vaginal microbiome, lactobacilli produce ________ acid, which creates an acidic environment inhospitable to other commensals and potential pathogens.
Lactic acid
70
What are organic acids?
Natural by-products (metabolites / metabolic wastes) created from enzymatic pathways in the body - including mitochondrial activity.
71
Organic acids can be measured by ___________.
Urinalysis
72
Which clients might benefit from organic acid testing (OAT)?
Clients presenting with:
- Chronic fatigue
- Suspected nutritional deficiencies
- Suspected mitochondrial dysfunction
- Autism
- Mood disorders
73
Why can Organic Acid Testing (OAT) be useful?
- They are used to get a window into the functioning of many metabolic pathways — all of which need certain nutrients as co-factors.
- It is an indirect way of identifying needs for vitamins and minerals, and other factors.
- It is a functional assessment of nutrient status.
74
List two benefits of OAT testing
- Can give you a good overview of metabolic function — helping you to see where areas of weakness might be in biochemical pathways and therefore, an extra need for certain nutrients.
- Can help to guide your naturopathic care plan into clear areas that need addressing or further investigation
75
List two downsides to OAT testing
- Can be hard to interpret — use the specific interpretation guides provided by each lab and their support materials.
- Diet eaten at the time of the test can really impact on markers — changing the results.
- Not measuring the vitamin directly — so you are making an assumption based on function.
76
Which clients might benefit from organic acid testing?
OAT testing might be useful in cases of:
- chronic fatigue
- suspected nutritional deficiencies
- suspected mitochondrial dysfunction
- autism
- mood disorders.
77
List three of the metabolite groups that are tested by OAT
OAT metabolite groups:
- Markers associated with
**nutritional function**.
- Metabolites associated with the **Krebs Cycle**.
- Some **neurotransmitter** metabolites.
- **Oxalate** metabolism.
- **Glycolysis** metabolites (balance between lactate / pyruvate).
- **Ketone and fatty acid oxidation** metabolites.
- Indicators of **detoxification**.
- **Amino acid** metabolites.
- **Bacterial** metabolites
associated with dysbiosis.
- Some tests include **environmental toxins** such as exposure to phthalates, parabens, toluene etc.
78
List three options for nutritional testing
1. Serum testing - i.e, B12, D3 or inflammatory markers.
2. Red Blood Cell (RBC) testing - shows minerals/toxins.
3. Urine testing - organic acid testing or toxic metal profiles.
4. Hair mineral testing
79
What does hair mineral testing show?
Which minerals have been laid down in the hair.
80
Why is serum testing not always a reliable method of assessing nutrient status?
Serum testing doesn’t always tell you how the tissue is utilising a vitamin or mineral, and as many are under homeostatic control, the blood levels stay quite stable until an extreme is reached.
81
Name the ‘active form’ of vitamin B12
Holotranscobalamin
82
`_____________` is a functional biomarker for low B9 and B12
Homocysteine
83
``____________ _____`` is a more sensitive index of B12 status compared to serum B12.
Methylmalonic acid
84
How can you test for methylmalonic acid?
Serum or urine
85
What is the most common cause of raised methylmalonic acid in the urine?
Vitamin B12 deficiency
86
Which marker of iron storage capacity is more accurate than testing serum iron?
Serum ferritin
87
What is the approximate optimum range for ferritin?
30 - 100 ug/L
88
What is the optimal level for serum Vitamin D?
Over 75 nmol/L
Many functional practitioners prefer it to be between 100 - 150 nmol/L
89
What is the problem with testing serum magnesium?
It only shows up in cases of very frank deficiency.
Consider testing red blood cell Mg levels instead.
90
Why is serum calcium not a reliable way of testing functional nutrient status?
Serum calcium is generally only for showing kidney / hormonal problems as it is under such strict homeostatic control, it only drops out of reference range in the extreme.
91
What is the best way to test functional calcium levels?
RBC nutrients or OAT testing
92
What can C-reactive protein (CRP) testing identify?
Levels of inflammation in the body
93
Normal CRP range = < `___`mg/L
5 mg/L
94
When might high sensitivity CRP (hsCRP) be a better option than CRP?
hsCRP is a better measurement when looking for low grade inflammation (when looking for numbers between 2–5).
95
Which type of testing can give a good indication of ‘tissue levels’ of minerals?
Red blood cell nutrient testing
96
What are the advantages of RBC nutrient testing?
* Helpful for the more nuanced minerals and toxic minerals, and for essential fatty acid testing.
* These are easier to read than OATs profiles, and more direct.
97
List one advantage and one disadvantage of mixed methodology nutrition tests
+ Advantage: It can give a more complete profile and often come with lots of interpretation.
- Disadvantage: These tests are often more expensive.
98
Which tests can give an *indication* of mineral status and toxic metal accumulation?
* Hair mineral analysis
* Urinalysis
* RBC levels of minerals (often the preferred option)
99
High TSH & normal T4 suggests `____________ ____________`.
subclinical
hypothyroidism
100
What could Low TSH and high FT4 indicate?
hyperthyroidism
101
What is the presence of raised anti-thyroid peroxidase (TPO) antibodies suggestive of?
Grave’s disease
102
What is the best way of testing of adrenal function: serum, saliva or urine?
Salivary or urine testing of adrenal metabolites is not very invasive and can give a more nuanced view of adrenal function than serum testing which is only good for picking up extreme abnormalities of function.
103
What are the main metabolites measured in adrenal tests?
Cortisol and DHEA
104
What might high cortisol readings indicate?
That the person is experiencing an intense period of stress right now.
105
Low readings of` ___________` and `_______` may show that someone is in the exhaustion phase of a stress response.
Cortisol and DHEA
106
What does an optimal 'DHEA : Cortisol' ratio indicate?
Proper HPA axis homeostasis.
107
What is the DUTCH test?
The **Dried Urine Test for Comprehensive Hormones** (‘DUTCH’) is a popular urine test that covers an array of hormones and their metabolites.
108
When would you consider recommending a DUTCH test?
For reproductive hormone imbalances such as low libido, PMS, irregular / painful periods or any other symptoms where you suspect a hormonal imbalance — especially if stress is involved.
109
The DUTCH test measures many different metabolites of which major hormones?
1. Oestrogen
2. Progesterone
3. Testosterone
4. Cortisol
110
List the three main oestrogens, which are metabolised down different Phase-I pathways
E1 - Estrone
E2 - Estradiol
E3 - Estriol
111
Which oestrogen metabolism pathway is considered the safest?
2-OH
112
Which oestrogen metabolism pathway is considered the most genotoxic, as its metabolites can create reactive products (quinones) that damage DNA?
4-OH
113
Which is the weakest of the three oestrogens?
E3, Estriol
114
Which oestrogen metabolism pathway creates the most oestrogenic metabolite?
16-OH
115
What should be considered before supporting increased oestrogen detox?
Optimise bowel function. If this is impaired, oestrogens will likely be reabsorbed due to beta glucuronidase activity.
(Consider stool testing for beta glucuronidase levels.)
116
What advice could feature in the nutritional plan of a client with very high levels of E1, E2 and E3?
**Reduce oestrogens by avoiding:**
Dairy, excess alcohol and caffeine, non-organic meat and eggs, water from plastic bottles, anti-perspirants, hormonal contraceptives.
**Increase oestrogen clearance:**
Increase levels of I3C (e.g. in broccoli sprouts) to push oestrogen down the 2-OH pathway (upregulating CYP1A1).
117
What does low daily free cortisol indicate?
It may indicate that the client may be experiencing adrenal insufficiency / exhaustion.
118
List 2 things that can cause decreased methylation activity
1. Low levels of nutrients required for methylation
2. Methylation SNPs (i.e. COMT, MTHFR)
119
Does caffeine speed up or slow down COMT and oestrogen detoxification?
It is slowed down by caffeine (avoid).
120
List three ways in which increased progesterone levels can be encouraged.
* Reduce stress
* Optimise sleep
* Increase Vitamin A-rich foods
* Address any oestrogen dominance
* Seed cycling
* Consider *Agnus Castus* (Vitex) tincture
121
Low levels of which hormone could give rise to low libido?
Testosterone
122
Which mineral can inhibit 5-a reductase and thus increase low testosterone?
Zinc
123
How can low glutathione levels be addressed?
* Increase sulphur donors, i.e, selenium, NAC, brassicas
* Milk thistle
* Resveratrol
124
How can high oxidative stress (as shown by 8-OHdG marker) be addressed?
INCREASE: antioxidant rich foods.
REDUCE: Exposure to environmental toxins, refined sugar, processed foods.
