Bioenergetics

Question 1

Enzymes that protect body from ROS

Answer 1

Catalase (requires iron)
SOD
Glutathione peroxidase (requires Se)

Question 2

dietary antioxidant for aqueous compartment

Answer 2

vitamin C

Question 3

dietary antioxidant for lipid compartment

Answer 3

vitamin E

Question 4

endogenous antioxidants

Answer 4

glutathione, cysteine, coQ10, lipoic acid, uric acid, cholesterol

Question 5

Nrf-2 important for…

Answer 5

GSH utilization/production/regeneration
quinone detox
iron sequestration
NADPH production

Question 6

Phytochemicals that induce Nrf-2

Answer 6

sulforaphane
resveratrol
quercetin
alpha lipoid acid
EGCG
melatonin

Question 7

Botanicals that induce Nrf-2

Answer 7

Ginkgo
Garlic
Cinnamon
Coffee 
Wasabi

Question 8

S/sxs of mitochondropathy

Answer 8

developmental delays, dementia, Parkinson’s, depression, migraines, HA, weakness, neuropathic pain, muscle wasting, exercise-myalgias, exocrine pancreatic failure, dysmotility, IBS

Question 9

Mitochondrial function work-up

Answer 9

CBC, ferritin (low iron assoc with mitochondrial dysfunction)
CMP, A1c, insulin
LFT
ammonia
lactate
lactate: pyruvate ratio
creatine kinase
quantitative plasma armino acids
quantitative urine organic acids
plasma acyl-carnitine profile
coQ10
ox stress markers, anti-ox capacity

Question 10

best biomarker for monitoring intracellular ox stress

Answer 10

plasma GSH:GSSG ratio

Question 11

key findings suggesting mito dysfunction

Answer 11

lactate: pyruvate ratio (low OR high)
low RBC mag
low ferritin
amino acids: elevated alanine, glycine, sarcosine, tyrosine

Question 12

Mitochondrial dysfunction tx

1. Lifestyle

Answer 12

Sleep, exercise, keto, fasting, cold exposure, Mito Food Plan

Question 13

Mitochondrial dysfunction tx

2. Metabolic Support

Answer 13

B vitamins
Fe, Mg
CoQ10
Carnitine
creatine monohydrate
AA balance
SAMe

Question 14

Mitochondrial dysfunction tx

3. Membrane/lipid support

Answer 14

Support GI absorption of fat
Phosphatidyl choline
EFAs
Phosphatidylethanolamine

Question 15

Mitochondrial dysfunction tx

4. Ox stress mitigation

Answer 15

all the things

Question 16

Mitochondrial dysfunction tx

5. Detox interventions

Answer 16

Sulforaphane
silymarin
NAC
TMG
SAMe
GSH

Question 17

Functional approach to pain tx

Answer 17

Food first
Mito support
Healthy fats
Improve glycemic/insulin
5 R Gut
Stress/lifestyle/self-care
Membrane appropriate exercise (??)

Question 18

Benefit of intermittent fasting/ketogenic diet for mitochondrial dysfunction

Answer 18

increases insulin sensitivity
reduces insulin and leptin
increases mobilizations of FAs
increases BDNF

Question 19

5 common clinical presentations with mitochondrial dysfunction

Answer 19

Fatigue
Headaches
Chronic Pain
MCI/dementia
Depression

Question 20

how do heavy metals mess with mito function?

Answer 20

interfere with heme production

Question 21

how do organophosphates mess with mito function?

Answer 21

decreased NADH, succinate cytochrome c reductase, decreased CcOX activity, reduction of mitochondrial membrane potential, decreased ATP, increased ADP/ATP, LDH release, apoptosis

Question 22

how do organophosphates and organochlorides mess with mito function?

Answer 22

increase ROS damage, increase G6PD activity (impairing glucose metabolism), induce CYP450

Question 23

Protein that is master regulator of mitochondrial biogenesis and energy homeostasis

Answer 23

PGC-1 alpha

Question 24

Which organs have greatest energy use and demands?

Answer 24

Brain (1)
Muscle (2)
Liver
Heart
Kidney
Adipose

Question 25

Patients with mito dysfunction have s/sxs that are exacerbated by minor trigges such as:

Answer 25

stress, illness, general anesthesia, toxins

Question 26

S/sxs suggesting mitochondropathy

Answer 26

``` Ptosis Ophthalmoplegia Kidney wasting Cardiomyopathy Diabetes Hypoglycemia Liver failure Fatigue Depression Migraines/Headaches Neuropathic pain Muscle wasting Exocrine pancreatic failure ```

Question 27

Underlying causes of chronic pain

Answer 27

``` Dysbiosis, IP Microglial activation Inflammation, toxins, meds, LPS Mito dysfunction Neurotransmitter imbalances Excess cortisol, low DHEA Musculoskeletal, TBI, leaky brain ```

Question 28

peripheral fatigue

Answer 28

physical capacity and performance ability measured by gait, strength, endurance energy depletion - low ATP, depleted by glycogen, reduced pyruvate, malnutrition metabolic by products - lactate and H due to glycogen breakdown, ammonia due to aa breakdown dehydration - cardiac output and increased thermal strain

Question 29

central fatigue

Answer 29

psychic, perceived effort governed by neural networks, neurotransmitters, emotions, thoughts measured via TEA - task effort and awareness

Question 30

Fatigue triggers

Answer 30

travel (infections), ticks, sex (HIV, Hep C), sedentary, poor sleep, EBV, vial, HMB (anemia), DM, thyroid dz, heavy metal toxicity

Question 31

Labs in neurodegen disorders

Answer 31

``` Homocysteine, B12, folate A1c, insulin stool test lipids ApoE status ```

Question 32

Functional medicine approach to neurodegen disorders

Answer 32

``` omega 3 and 6 grass fed meat, sprouted legumes 6-9 cups veggies daily (greens, colorful, brassicas/allium/mushrooms) MBSR 5 R low glycemic (avoid dairy based keto) fish oil, esp DHA choline lion's mane ```

Question 33

Underlying causes depression

Answer 33

comorbidities - CAD, asthma, AD, PD, HIV, obesity, osteoporosis, DM poor nutrition inflammation (mold, infections) social

Question 34

ATMs depression

Answer 34

A- FHx, prenatal toxin exposure, genetic SNPs, bonding T- head injury, trauma, toxin exposure/EDC, abx M- isolation, substance abuse, pesticides, heavy metals, chronic inflammation, SAD, stress, lack of sun

Question 35

Functional med approach to depression

Answer 35

``` zinc, B12, EPA vit D chromium sleep exercise (esp HIIT) gut 5R ```