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Botanicals clin nutrition Flashcards

1
Q

What are some common GI sx to look out for?

A
  • Pain
  • N/V or loss of appetite
  • swelling, bloating, prolonged fullness
  • Air/gas
  • Diarrhea or constipation
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2
Q

Burning pain or ache in the upper abdomen between meals and relieved by eating suggests?

A

Peptic ulcer

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3
Q

What infection is associated with peptic ulcer in 60% of cases?

A

H. pylori

It must be treated medically

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4
Q

Can NSAIDs cause peptic ulcers?

A

yes chronic use causes peptic ulcers.

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5
Q

Are peptic ulcers aggravated by stress smoking alcohol and diet?

A

Yaawwss

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6
Q

What foods may a person with peptic ulcers be sensitive to?

A 
– Salt
– Spices
– Alcohol
– Caffeine
– Food allergy?
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7
Q

Does increased fiber intake reduce recurrences of peptic ulcer?

A

Yes, milk or bland food do not help

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8
Q

What are supplements to take for peptic ulcer?

A

Chewable DGL Licorice

Zinc 100mg/day

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9
Q

What does DGL Licorice do for peptic ulcers and GERD?

A 
 Inhibits irritating acid
secretion
 Increases protective mucus secretions
 Inhibits Helicobacter
pylori
 Increases blood flow
and cell growth
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10
Q

What does removal of glyceyrrhizin from DGL licorce do?

A

eliminates undesirable side

effects such as high blood pressure, water retention.

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11
Q

When and how much DGL Licorice do you take?

A

380-760mg before each meal. It must be mixed with saliva for efficacy. They may work for mouth ulcers as well.

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12
Q

WHat is GERD and what are the sx?

A
  • disorder of lower esophageal sphincter
  • chronic recurrent retrosternal burning pain
  • not always associated with hiatal hernia
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13
Q

What are ways to avoid GERD sx after eating?

A 
– Smaller, more frequent
meals 
– Avoid lying down after
meals 
– Avoid abdominal
compression by clothing,
etc.
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14
Q

What increases the risk of GERD?

A

obesity, but weight loss is controversial

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15
Q

What food/drinks may aggravate GERD?

A

– Smoking – Alcohol – Caffeine – Spicy foods – Acidic foods – Fatty and fried foods? may think gall bladder with this
– Chocolate – Mint flavorings

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16
Q

What signals gall bladder disease?

A

RUQ pain sometimes associated with high fat meal

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17
Q

What are those F’s for that make you think gall bladder disease?

A

Family history, Female, Forties/Fifties, body Fat, Fertility, Fair Skin

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18
Q

What is the strategy for treating early gall bladder disease?

A

-Decrease biliary cholesterol, increase bile acids and
phospholipids, increase bile flow.
-Weight loss (but not rapid weight loss)
-Low cholesterol, vegetarian, high fiber, Longevity-type diet

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19
Q

Do coffee drinkers have reduced risk of gall bladder disease?

A

Hell yes! it increases bile flow.

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20
Q

Why does a healthy diet help gall bladder disease?

A

It improves cholesterol metabolism to reduce biliary cholesterol.

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21
Q

What supplements are suggested for gallbladder disease that may affect stone formation or dissolution?

A 
Concentrated bile acids(ox bile salts)
VIt C (bile acid synthesis)
Milk thistle
Artichoke leaf extract 640mg TID
Curcumin(galbladder contraction)
Concentrated lecithin
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22
Q

What is so special about “liptropic” formulas in the treatment of gallbladder disease?

A 
Contain vitamins,
minerals, amino acids,
herbs, etc. thought to
be important for
optimum bile flow and
composition. Mostly theoretical.
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23
Q

Are treatments designed to expel stones safe and effective?

A

No. The gallbladder flush is controversial. uses olive oil, really just passing clumped together olive oil supposedly.

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24
Q

What is celiac disease?

A 
Autoimmune disease triggered by dietary protein
called gluten (aka gluten intolerance, celiac sprue).
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25
Q

What is the mechanism of celiac disease?

A

Immune reaction damages intestinal villi, causing
malabsorption and chronic gastrointestinal distress
affect 1 in 133
Americans, more if there is family history

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26
Q

What are celiac disease sx?

A 
Malabsorption:
– weight loss
– impaired growth in
children – anemia – fatigue – bone loss – Infertility – Dermatitis Herpetiformis – Aphthous stomatitis – Peripheral neuropathy
GI distress:
– flatulence
– recurring abdominal
bloating and pain – chronic diarrhea or
constipation1 – n/v1 – pale, foul-smelling, or
fatty stool
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27
Q

what is the tx for celiac?

A

Gluten free: avoid wheat rye barley , oats may be ok.

Take a multivitamin and maybe enzymes. DPP-IV

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28
Q

What is irritable bowel syndrome?

A

A disorder of gut motility or microflora imbalance.

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29
Q

What are sx of IBS?

A

Symptoms: recurrent cramping pain, bloating, soreness, gas, diarrhea and/or constipation, no
bleeding or signs of inflammation

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30
Q

What are subtypes of IBS?

A

Diarrhea or constipation-predominant, mixed or undetermined

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31
Q

Can stress contribute to IBS?

A

YES, so can flora and food related stressors.

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32
Q

What are possible IBS triggers?

A 
Overeating
Gas-forming foods
 Legumes
 Crucifers (broccoli, etc.)
 Onion
 Bran
 Stress
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33
Q

What are possible sensitiveits of IBS?

A

– Milk products (lactose) – Gluten – Fructose, sorbitol, etc. – Chocolate – Alcohol – Caffeine – Carbonated drinks – Fatty foods – Food Allergies?
(conflicting evidence)

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34
Q

What diet is recommended for IBS?

A

FODMAP. reduction of fermentable foods, avoid large meals, caffeine
avoid:
apple, beans, white bread, milk, wheat, rye, barley,
onion, legumes; lactose-containing products, pears, watermelon,
asparagus, honey, sorbitol, mannitol, maltitol, xylitol, apricots,
peaches, and artificially sweetened products.

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35
Q

does fiber help control sx of IBS?

A

Yes, psyllium husk has in most studies. avoid sensitivites, use brown rice etc.

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36
Q

What kind of peppermint oil is used to improve IBS?

A

enteric coated, prevents side effects. 0.2-0.4 ml TID

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37
Q

What supplement that helps you sleep, can help with IBS?

A

Melatonin. reduction in ab pain and IBS patients have trouble sleeping.

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38
Q

Why are probiotics good for IBS?

A 
Beneficial for Pain, Bloating & Flatulence
Large placebo effect hampers research.
Bifidobacterium Bifidum
adults 
Lactobacillus rhamnosus
peds
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39
Q

What is IBD?

A

Chrohn’s disease and ulcerative colitis?

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40
Q

What is chrohn’s disease?

A 
-Effects small intestine,
proximal colon 
-Symptoms: abdominal
pain, often in the RLQ,
chronic diarrhea, fever,
malabsorption symptoms – Diagnosis confirmed with imaging and/or
colonoscopy
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41
Q

WHat is ulcerative Colitis?

A

– Affects colon only
– Symptoms: abdominal
pain and bloody diarrhea, anemia symptoms
– Diagnosis confirmed with imaging and/or colonoscopy

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42
Q

Crohn’s disease treatment-

A 
Monitor with CBC
Eat healthy
Food allergy elimination
Multivitamin
Probiotic yeast (Saccharomyces boulardii)
Curcumin 
FishOil 3g/day
Boswellia serrata
Vit D
Artemisia Absinthium
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43
Q

Ulcerative Colitis treatment-

A

Monitor with CBC
Eat healthy
Food allergy elimination(lactose, raw fruit and veg)
Probiotic yeast (Saccharomyces boulardii)
Curcumin
FishOil

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44
Q

More fun therapies for Ulcerative colitis-

A

Aloe vera juice 100ml 2x/daily
Wheat grass juice 100ml/day
Boswellia serrata gum resin 900-1050mg/day

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45
Q

What is non ulcer (functional) dyspepsia?

A

Upper GI distress associated with eating but not due to diagnosable disease
Very common

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46
Q

What are possible causes of non ulcer (functional) dyspepsia?

A

– Poor eating habits (too much, too fast, under stress)
– Swallowing air (common in gum chewers, smokers)
– Food sensitivities
– Psychological/emotional factors
– Maldigestion (dysfunction of digestive organs)

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47
Q

How to manage dyspepsia

A

-Rule out diagnosable pathologies and emotional/psychological
factors
-Investigate eating habits
-Try elimination of suspected sensitivity foods
-Consider a trial of digestive aid supplement, using functional digestion tests
and acupuncture.
use food-sx diary

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48
Q

What diet aids should you consider for managing dyspepsia?

A

-Betaine hydrochloride
-Digestive enzymes(lactase, pancreatic enzymes)
- Bile salts
-Probiotics
Peppermint/caraway oil combination
- Artichoke leaf extract
- Iberogast

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49
Q

What is hypochlorhydria associated with?

A

– Increased microbial colonization of upper GI
– Poorer absorption of some micronutrients
– Possibly food allergies due to poor protein
digestion

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50
Q

Who might have hypochlorhydria?

A

-Elderly patient
– History of pernicious anemia, atrophic gastritis
– Low HCl levels detected by gastric analysis

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51
Q

How do you assess for hypochlorhydria?

A

By sampling with nasogastric tube. Heidelberg telemetry device
Swallowed capsule contains battery, pH meter, transmitter
pH levels are recorded and displayed on external device
Patient can eat or drink to stimulate digestion

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52
Q

How much betaine HCl should you prescribe?

A

Depends on the person can be 500-2500mg/meal. if they feel a burn in their stomach decrease by a capsule.
it may irritate inflammatory lesions

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53
Q

What does stool analysis evaluate in people with abnormal GI dysfunction?

A

– Undigested food residues
– Digestive enzyme residues
– Microbial populations and their byproducts
– Markers of gut immune function overgrowth of yeast
-ovum,blood,

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54
Q

What will you treat digestive enzyme insufficiency with?

A

Lactase(may not be lactose it may be casein)
Alpha-galactosidase(Beano)-for the brassica, beans, garlic and onions
Pancreatin
enzyme blends

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55
Q

WHat supplement is effective in improving tolerance to a

high-fat meal?

A 
Pancreatin- highest
lipase activity may be
most effective
potency indicated on label ie: 4x
2-4 capsules/meal
may irritate patients with inflamed upper Gi lesions
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56
Q

What do probiotics do for GI health?

A 
influence digestion and
absorption
– Control pathogenic
populations 
– Help prevent absorption
of antigens and toxins 
– Beneficial effect on gut
immune system
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57
Q

What is associated with dysbiosis(gut flora imbalance)?

A

– History of prolonged or intense antibiotic therapy
– Symptoms of diarrhea
– Low fiber diet

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58
Q

What would a stool analysis indicate with dysbiosis?

A

– Abnormal flora balance
– Elevated pH
– Low levels of probiotic byproducts

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59
Q

What are prebiotics?

A 
These are growth
factors present in non-
digestible food residues,
such as inulin and
oligofructose (aka
fructooligosaccharides,
FOS)
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60
Q

What is the general recommendation for probiotic formulas?

A 
-Contain at least one
species each of
Lactobacillus and
Bifidobacteria
- Contain at least 5 billion organisms per dose
- May contain FOS or other growth factors
- Shelf-life clearly labeled
- May be enteric-coated
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61
Q

Botanicals for Dyspepsia to consider-

A

-Peppermint 180mg/caraway oil 100mg/day combo (indigestion and IBS)
-Artichoke leaf extract 1000-2000mg/day(Reduced complaints of fat intolerance, bloating,
flatulence, constipation,
pain and nausea)
-Iberogast 20 drops TID (9 ingredients for indigestion and IBS)

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62
Q

What is SIBO

A

Caused by increase number and AbN SI bacteria-Gram+, colonic/coliform

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63
Q

What are s/sxs of SIBO?

A

– Bloating, flatulence, abd Pain, belching, diarrhea,

malabsorption, steatorrhea, jt pain, rosacea, anemia

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64
Q

How do you dx SIBO?

A

– Lactulose Breath Test
– Jenjunal aspirate & culture
– Glucose breath test

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65
Q

What is tx of SIBO?

A

– Avoid contributors, antibiotics, peppermint, allium,
– Essential oils- oregano, thyme, clove
 Enteric coated – Specific CHO diet, FODMAP Diet, Elemental diet

66
Q

What is the scientific name of cranberry?

A

Vaccinium macrocarpon

67
Q

What part of the cranberry plant is used?

A

ripe fruit

68
Q

What are the preparations of cranberry?

A

Juice (typically sweetened and diluted)

Powdered whole berry or berry extract.

69
Q

What are active constituents in cranberry?

A

Flavonoids, especially anthocyanidins and
proanthocyanidins unique to these and
some other berries.

70
Q

What are other constituents in cranberry that are not considered sufficiently active?

A

Organic acids, Vit C, natural sugars with anti-microbial activity

71
Q

How much of cranberry flavonoids from oral doses show up in urine?

A

5%

72
Q

What is the likely mechanism of crabverry?

A

Proanthocyanidins/anthocyanidins, and
possibly other compounds, inhibit
adhesion of some urinary pathogens to
epithelial cells. Acids, vitamin C and microbe-inhibiting sugars probably never reach high enough urinary concentrations

73
Q

Who gets recurrent UTIs?

A 
– Adult women (50X more UTIs than men)
– Elderly men and women (typically related
to incontinence)
– Catheterized patients
– Neurogenic bladder patients
74
Q

What is the medical treatment for recurrent UTI?

A
  • low-dose prophylactic antibiotics

- lifestyle modification-high fluid intake, frequent urination, cotton underwear

75
Q

Was cranberry graded possibly effective and likely safe for the risk reduction of adult women UTIs?

A

Yes, grade B evidence

76
Q

What is the effective dose of cranberry for preventing UTIs?

A
  • Cranberry beverage: 10-16oz/day of cocktail that is 26-33% juice.
  • Cranberry supplements: 400-800mg twice/day and 500mg at bedtime(cranmax)
77
Q

What are the reported side effects of cranberry?

A

GI upset
Weight gain(juice)
Need for more insulin in diabetics

78
Q

What are contraindications of using cranberry?

A

Salicylate hypersensitivity
May increase kidney stone risk in large amounts
Anticoagulent therapy possibly

79
Q

Is there an effect on hepatic drug metabolism when using cranberry?

A

Considered unlikely

80
Q

Are there any contraindications for cranberry and pregnancy and lactating?

A

some GI sx reported

81
Q

What vitamin in addition to antimicrobial therapy is useful in decreasing UTIs?

A

Vit A 200,000 IU

82
Q

T/F: Chinese Herbal medicing treatments formulated for recurrent UTI may be more effective than herbal treatments designed to treat acute UTI?

A

T
Er Xian Tang more effective than San Jin Pian for acute infections
Nasturtium herb and horseradish root
containing herbal drug Angocin Anti-Infekt
N Acute pediatric UTI

83
Q

What are 2 other names for kidney stones

A

renal calculi and urolithiasis

12% of pop. affected

84
Q

What are the most common type of kidney stones?

A 
calcium oxalate
uric acid(10%)
85
Q

Can you have a genetic predisposition to kidney stones?

A

Yes, hypercalcuria, hyperoxaluria,

86
Q

What other things cause kidney stones?

A
  • hyperparathyroid (calcium losing disease)
  • kidney disease-UTI
  • Hyperuricosuria-gout
  • nutrition can influence
87
Q

What are some lab studies for the risk of kidney stones?

A
  • 24 hour urine analysis: identify high output of calcium, oxalate or uric acid
  • Serum magnesium: identify magnesium deficiency
88
Q

How do you prevent calcium oxalate stones?

A
  • Drink water-dilute urine
  • Reduce urinary calcium(good for osteoporosis too)
  • Reduce urinary oxalate
  • Inhibit crystal formation
89
Q

How many cups of fluid are recommneded to dilute urine?

A

14+ cups preferably water

even coffee is assoc. with lower risk.

90
Q

What fruit juice contributes to inhibiting crystallization with kidney stones?

A

Orange juice and lemonade contribute citrates that
counteract dietary acid residues and inhibit
crystallization

91
Q

What 2 drinks are associated with increased risk for kidney stones?

A

Soft drinks and greapefruit

92
Q

SHould you avoid calcium to reduce urinary calcium?

A

No! Calcium in food and taken with food reduces

risk for most patients. Calcium can prevent absorption of oxalate from diet.

93
Q

What is the exception for taking calcium when reducing urinary calcium to decrease kidney?

A

patients with absorptive hypercalciuria,
diagnosed with 24-hour urine chemistry, should limit
calcium

94
Q

What kind of diet should one eat to reduce urinary calcium?

A

Plant-based, low animal protein, high fiber diets,
similar to DASH diet, dramatically reduce risk
They are more alkalinizing, which reduces urinary
calcium

95
Q

How does potassium and phytate affect urinary calcium?

A

High potassium may oppose effect of salt on urinary
calcium
Phytate from fiber may reduce calcium absorption

96
Q

What foods do you avoid when reducing urinary oxalate, especially for those with absorptive hyperoxaluria?

A

Start with avoiding spinach, rhubarb, beet greens,
nuts, chocolate, tea, bran, almonds, peanuts, and
strawberries; consider monitoring urinary oxalate
levels
Avoid excess protein, which may increase
oxalate formation

97
Q

What supplements are recommended to reduce urinary oxalates?

A

Calcium and magnesium
supplements WITH MEALS.
B6, 50-150mg/day oxalate catabolism
Vit C 1000 + mg/day may need to be avoided

98
Q

What foods inhibit crystal formation?

A 
Citrate-containing
foods (fruits and
veggies), beverages
(with orange and/or
lemon juice) they bind oxalate.
Magnesium 200-400mg/day
99
Q

Kidney stone lab tests for assessing if patient can take calcium?

A

24-hour urinary calcium before and after

supplementation

100
Q

Should my patient avoid oxalate foods lab test?

A

24 hour urinary oxalate

101
Q

Should my patient take large amounts of Vit C lab test?

A

24 hour urinary oxalate before and after supplemenation

102
Q

What should we know about BPH?

A
  • 1/3 older men develop
  • Altered hormone balance with aging causes cell proliferation and gland enlargement.
  • Sx: incontinence and/or sleep disturbance
103
Q

What are the medical treatments for BPH?

A
  • Alpha-adrenergic blocker (Tamsulosin and Prazosin)
  • 5 alpha reductase inhibitors(reduce hormone conversion)- Finasteride
  • Transurethral resection of prostate.
104
Q

What is the most well known and well studied botanical for BPH?

A

Saw Palmetto:

scientific name: Serenoa repens, Serenoa serrulata, or Sabal serrulata

105
Q

What part of saw palmetto used?

A 
Ripe fruit(berry)
Clinical studies typically
use lipophilic berry extract
containing 80-90% fatty
acids and sterols
106
Q

What are the mechanisms of saw palmetto?

A

Antiandrogenic
• Prevents enzymatic conversion of
testosterone to more active dihydrotestosterone by inhibiting 5-alpha reductase
Antiproliferative
• Slows prostate cell proliferation by inhibiting growth factors, stimulating apoptosis
Anti-inflammatory
• Inhibits eicosanoid pathways, lowers TNF-α,
IL-1β

107
Q

Is saw palmetto tolerated better than older pharmaceuticals?

A

Yes, but not as effective or as quick as alpha-blockers.
Better than placebo only for
nocturia, not peak urine flow, prostate, or total
symptom scores, but comparable to Proscar and
Flomax

108
Q

What are the safety issues with saw palmetto?

A
  • Dizziness, GI complaints
  • Fewer sexual function complaints than Proscar™
  • Prolonged bleeding
  • Contraindicated with Prego/lactation d/t potential hormonal effects on fetus/neonate.
109
Q

What is the effective dose of saw palmetto?

A

Lipophilic ripe berry extract standardized 80-90% fatty acids
320mg/day in one or two doses

110
Q

Can you take saw palmetto as a tea?

A

No. Water extracts will not be high in fatty acids.

111
Q

What is the scientific name of pygeum bark?

A

Prunus africanus,

African Plum

112
Q

What are the benefits of pygeum bark and what properties does it include?

A 
• Actives include fat-
soluble constituents:
sterols and triterpenes 
• Anti-proliferative and
anti-inflammatory
properties similar to
saw palmetto berry 
• Well-tolerated, no
safety concerns
113
Q

What is the dosing for pygeum bark?

A 
Best products will
be standardized for
14% triterpenes or
13% total sterols
– 75-200 mg/day in one
or two doses – Often combined with
other herbs
-Consistent mild to
moderate symptom
reduction
114
Q

What do we need to know about nettle root?

A

AKA: Urtica dioica, Stinging nettle
Actives uncertain
Anti-proliferative and anti-androgenic properties similar to saw palmetto berry
-Safe, eaten if cooked
-Typically available and studied with saw palmetto

115
Q

Where do you find Beta-Sitosterol?

A

Plant sterol found in

foods and herbs

116
Q

How much Beta-Sitosterol should you take?

A 
60-130 mg/day improves
symptoms and some
signs of BPH
– Also treats dyslipidemia in
gram amounts
-It has antiproliferative properties.
117
Q

What is Rye Pollen extract?

A

Machine-harvested rye pollen extract used in clinical trials. It has anti-adrenergic effects
on smooth muscle, possible anti-inflammatory effects. Contains beta-sterols.

118
Q

How much rye pollen extract should you take?

A

126 mg three times daily
improves symptoms and
sometimes signs of BPH using PollenAid brand.

119
Q

What is the bottom line for pygeum & beta-sitosterol and BPH?

A 
– Saw palmetto “possibly
effective,” but a best seller
worldwide
 – PollenAid also “possibly
effective” 
– No other candidates have
good evidence
-use for 1-2 month trial
120
Q

What does hormone imbalance contribute to?

A

– Premenstrual syndrome
– Abnormal uterine bleeding
– Benign growths of breast, uterus, ovary
– Breast cancer risk

121
Q

Why is obesity a possible causes of hormone imbalance?

A

adipose production of estrogen

122
Q

Why is hyperinsulinemia a cause of hormone imbalance?

A

Affects gonadal hormone metabolism

123
Q

Why does an impaired hepatic estrogen metabolism affect hormone imbalance?

A

Estrogen is conjugated and excreted in bile

124
Q

Can Inappropriate reactivation and absorption of
excreted conjugated estrogen from the gut
affect hormone imbalance?

A

yes.

125
Q

Estrogen levels are influenced by diet. What should you eat?

A

– Low fat diets
– High fiber diets
– Vegetarian diets
– These diets tended to increase estrogen
elimination by hepatic, intestinal and phytoestrogen effects. fascilitating elimination pathways and blocking estrogen r/c

126
Q

Does plant fiber enhance excretion of conjugated estrogen?

A

Yes, May influence intestinal flora balance to reduce estrogen deconjugation

127
Q

What do phytoestrogens from soy, flax and herbs do for estrogen?

A

– May block estrogen receptors

– May stimulate estrogen catabolism

128
Q

Do cruciferous veggies stimulate estrogen catabolism?

A

yes

129
Q

Does alcohol increase estrogen levels?

A

yes it may

130
Q

What is needed for hepatic estrogen catabolism?

A

B vitamins, activated B6 can block hormone r/c

131
Q

Does exericse lower estrogen levels?

A

yes

132
Q

What does an estrogen balancing program include?

A

low calorie, low glycemic food that have high fiber, low fat, high plant sources. emphazize soy flax and brassica.
Exercise for Pete’s sake. You could consider phytoestrogen and b vitamins. Avoid pesticides, growth hormones and industrial chemicals.

133
Q

What is another name for hormone imbalance and what does it contribute to in relationship to gynecological disorders?

A 
Estrogen Dominance, Hyperestrogenism 
– Premenstrual syndrome
– Abnormal uterine bleeding
– Benign growths of breast, uterus, ovary
– Breast cancer risk
134
Q

What sx define PMS?

A

mood swings, water retention, breast

tenderness, other pain, cravings, etc.

135
Q

When PMS is more severe and disabling, it may be called?

A

premenstrual dysphoric disorder

136
Q

What is the timeline for PMS?

A

onset 7-10 days before menses, ending

when menses starts

137
Q

What is tx for PMS?

A

PMS is an estrogen dominant state so balance it by:
– Vegetarian, high-fiber, low-fat diet
– Aerobic exercise
– Vitamin B6, at least 100 mg/day
» Higher doses may work better, but must be reduced
eventually to avoid risk of side effects
Moderate salt sugar and caffeine help manage fluid retention and mood changes.

138
Q

What botanicals are suggested for PMS?

A

Vitex agnus: affect progesterone and prolactin levels.

Femaprin by nature’s way 20mg/day of 10:1 thanolic extract or 200mg/day dried berry

139
Q

What are good PMS specific multis?

A 
Ones that include:
– B-complex with extra B6 
– Calcium and magnesium
 – Vitamin E 
– Vitex agnus 
– Phytoestrogens
140
Q

What is fibrocystic breast disease?

A

A benign but painful condition with painful cysts that are present throughout monthly cycle. May be first half or the whole month.

141
Q

Fibrocystic breast disease is associated with estrogen dominance. What are successful ways to treat it?

A

– Low fat diets, except in one recent RCT

– Soy protein, flaxseed, isoflavone supplement

142
Q

Eliminating methylzanthines has proved to be a good treatment for fibrocystic breast disease. What should the patient cut out if they are going to do this?

A

Caffeine! theobromine and theophylline. Must cut out completely.

143
Q

What are the best supplements for fibrocystic breast disease?

A

Red Clover isoflavones 40mg/day: reduced pain by 44%

144
Q

What are sx of menopasue?

A

Include hot flashes, skin and vaginal dryness, decreased libido, easy bruising. It is hypoestrogen state.

145
Q

What may help menopausal sx?

A

Aerobic exercise and plant-based diet may help

Phytoestrogens may be pro-estrogenic rather than anti-estrogenic in perimenopausal women

146
Q

What is a good dose for soy in relationship to hot flashes?

A

At least 50 mg/day isoflavones from food, soy protein, or pills, preferably split into two doses. More effective when symptoms are very frequent. Not effective in breast cancer survivors with hot flashes.
NOTE: big placebo effect

147
Q

What are other potential benefits of soy isoflavones and hot flashes?

A

Lower LDL, blood pressure, decreased arterial stiffness

Osteoporosis prevention

148
Q

Besides soy what other foods are good for menopausal sx?

A

Flaxseed, 40 grams/day added to food, was as effective as HRT in one study, but another
found no benefits from 25 grams/day
-added to diet equaled effectiveness of HRT for mild menopausal symptoms

149
Q

Why do only some diet studies support

phytoestrogenic effects?

A

Further investigations into soy, including soy protein supplements, and flax
» Effectiveness may require optimum colon flora for conversion of phytoestrogens to more effective forms. » Only about half the population make adequate conversion

150
Q

Red Clover is another phytoestrogen that is good for menopause. what are the recommendations for it?

A 
• 80 mg/day isoflavones • Reduced hot flashes
44% in one study
• Other studies had large
placebo effect, but red
clover worked faster in
two of them
• Twice daily dosing may
be best due to short
half-life in the body
151
Q

What is another name for black cohosh and what are the uses and benefits of it?

A

• AKA Cimicifuga racemosa • 20 mg of concentrated
extract (Remifemin™ ) twice
daily was effective in
several studies • Other products may not be
as effective
– Recent negative study used
different product
• Monitor liver function in case of bad effects

152
Q

What sx describe dysmenorrhea?

A

Pelvic and low back pain occuring during menses.

153
Q

What is dysmenorrhea associated with?

A

Associated with eicosanoid imbalances causing:
– Congested circulation and ischemia
– Smooth muscle irritability
– Increased pain sensitivity

154
Q

In relationship to dysmenorrhea, what are some prostaglandin modifications?

A

– 1800 mg/day omega-3
from fish oils was helpful
– Vegetarian diet helped
– Neptune Krill Oil, 2
grams/day was helpful
– Ginger root powder, 250 mg four times daily
– Pycnogenol (pine bark extract), 60 mg/day

155
Q

What helps with smooth muscle relaxation/improved circulation
interventions in relationship to dysmenorrhea?

A

Calcium and magnesium have been helpful

156
Q

T/F, 400-500 IU/day of Vitamin E is helpful for dysmenorrhea?

A

Truish, unclear mechanisms

157
Q

What is the fullblown clinical picture of PCOS?

A 
Hirsutism50%
obesity 40%
infertility 20%
amenorrhea 50%
AUB 30%
158
Q

What are good supplements for PCOS?

A
  • Increase SHBG: soy, flax, nettles, green tea
  • Decrease androgens: saw palmetto, green tea extract
  • Improve insulin resistance: vitamin C, Chromium, diet
159
Q

What botanicals increase ovulation for PCOS?

A

Vitex, rhodiola, tribulus

160
Q

What botanicals decrease testosterone or convert testoterone to DHT?

A 
Reishi
Licorice
White peony
Green tea 
Spearamint

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