CNM N1 S2 Sample Paper 1

Question 1

Name TWO vitamins and TWO minerals found in chlorophyll (2 marks)

Answer 1

Potassium
vit A, C, E,
Magnesium,
Iron,
Calcium
vit K,

Superfoods Slide 6.

prompt word ‘PACEMICK’ (Potassium, vA, vC, vE, Mg, I, Ca, vK)

Question 2

List FOUR specific factors that make fats more prone to oxidation (2 marks)

Answer 2

Fats are prone to oxidation if :
- Are high in polyunsaturated fat.
- Are exposed to prolonged heat, light or oxygen.
- Are naturally low in antioxidants.
- Are refined or heavily processed.

Lipids; Slide 39

Question 3

Name FOUR rich plant sources of alpha-linolenic acid (2 marks)

Answer 3

flaxseeds,
chia seeds,
hempseeds,
walnuts,

flaxseed oil,
hempseed oil
.

(0.5 for each correct answer- max 2 marks) Pop diets: slide 51

Question 4

4. Zahra would like to understand why breast feeding is important. Give FOUR benefits
   of breast feeding for mothers (4 marks)

Answer 4

cheap; convenient; delays the return of regular ovulation, lengthening
birth intervals (prolactin inhibits GnRH release); conserves iron stores (= energy and cognition).
Studies show protection against breast and ovarian cancer (↓oestrogen and ↓ovulation). Aids post-birth weight loss due to increased energy
expenditure.
Supports the mother-baby relationship (oxytocin release). Assists in a swifter recovery from symptoms of postpartum depression (PPD)

(1 mark for any- max 4 marks). Life stages; Slide 4

Question 5

Name FOUR therapeutic uses of N-acetyl cysteine (NAC) (2 marks)

Answer 5

Liver support (including heavy metal detox) * Healthy ageing support
- Ulcerative colitis.
- Infertility.
- Respiratory infections e.g. bronchitis
- Cystic fibrosis
- Asthma.
- Diabetes mellitus
- PCOS

slide 58/59. (½ mark per point to a max 2)

Question 6

Outline TWO prohibited claims within supplement legislation (2 marks)

Answer 6

Reference to the rate or amount of weight loss. Reference to recommendations of individual doctors or health professionals.
Health claims on alcoholic beverages.
Claims which suggest that health could be affected by not consuming the food.

Supps in practice; slide 15.

Question 7

List THREE of Hering’s laws of cure and give an example for each (3 marks)

Answer 7

From the inside out; a boil clears internal toxins away from more vital
organs to the skin.
2. From more important organs to less; from the lungs
(asthma) to the skin (eczema).
3. The mind gets better before the body; anxiety
starts improving before IBS does.
4. Symptoms disappear in the reverse order to
when they arrived.
5. From above to below; progression of disease — fingers,
wrists, elbows →elbows, wrists, fingers.

Advanced nat case study; slide 4.

Question 8

Explain why you would recommend broccoli sprouts to someone who is oestrogen dominant (1 mark)

Answer 8

High in I3C.
Selectively binds to oestrogen
receptors acting as an oestrogen antagonist.
Influences phase I CYP enzymes to ↑ the conversion of oestradiol to the weaker / protective form of oestrogen (2-hydroxyestrone) over 4 and 16-hydroxyestrone (carcinogenic potential).
Inhibits
aromatase, reducing conversion of testosterone to oestrogen. (1 mark total)

½ mark for any 2 of the above

Superfoods; slide 74

Question 9

How would you describe the energetics of chia seeds? (1 mark)

Answer 9

Cooling, moistening.

Superfoods; Slide 71

Question 10

Cracks (called ‘fissures’) on the tongue are signs of potential health issues and may
indicate imbalances in the area where located. Describe a medial fissure and
explain what this indicates (2 marks)

Answer 10

A shallow vertical crack through middle of tongue (not to the tip) — can
be a sign of deficiency of digestion. This indicates an under-secretion of digestive
juices. Advanced nat case taking; Slide 67

Advanced nat case taking; Slide 67

Question 11

Your client has hypocholesterolaemia and is taking statins. Describe the mechanism
of action of statins, including the enzyme they specifically inhibit (3 marks)

Answer 11

The Mevalonate Pathway:
* This metabolic pathway is required for the
production of cholesterol and CoQ10 — two crucial molecules for health.
* Statins
act on this pathway. Inhibits HMG-CoA reductase.

Ortho; slide 13.

Question 12

Name the THREE amino acids that are required for the synthesis of glutathione (3
marks)

Answer 12

cysteine, glutamic acid, and glycine.

Proteins; slide 7

Question 13

List FOUR adverse reactions to iron supplementation (2 marks)

Answer 13

Nausea, diarrhoea, constipation, heartburn, upper gastric pain.
Taking
with food seems to decrease adverse effects.
Toxicity: Organ damage and death.
Toxicity is more common in conditions such as: Haemosiderosis: Overload of iron
in organs or tissues. - Haemochromatosis (iron overload) ― often genetic
condition causes the body to absorb more than normal. - Thalassaemia and
sideroblastic anaemias.

Supps in practice; slide 68.

Question 14

List FOUR food sources of sulphur compounds (2 marks)

Answer 14

Garlic, onions, leeks, ginger, white cabbage, mushrooms, parsnips.

(0.5 per food source) Phytonutrients; slide 14.

Question 15

Name FOUR possible factors which could inhibit the activity of delta-6-desaturase (2
marks)

Answer 15

Magnesium, B6, zinc deficiency. Insulin resistance. Viruses. Refined
sugars. Alcohol Stress hormones, e.g. cortisol High intake of EPA / DHA. Excess
trans fats and cholesterol (0.5 each- max 2 marks).

Lipids; Slide 74

Question 16

.Name TWO allergenic foods to consider when weaning (1 mark)

Answer 16

eggs,
peanuts,
fish,
wheat,
cow’s milk,
tree nuts

(1 mark) Life stages; slide 31.

½ mark for any 2 of the above:

Question 17

What are the recommendations on how to take zinc? (1 mark)

Answer 17

How to take: Zinc is best taken at night on an empty stomach, or at least one hour before, or two hours after meals. If zinc supplements cause
stomach upset, they may be taken with a meal.

Supps in practice; slide 72.

Question 18

SECTION B (45 marks) (QUESTION IS BROKEN UP for ease of remembering)
Answer ALL THREE of the following questions:
1. Discuss the different supplement forms of magnesium, describing their
positive and negative clinical attributes. In addition, discuss TWO drug
interactions including what adverse reactions may occur (15 marks)

Answer 18

• Magnesium aspartate: * Bound to an amino acid; high absorption.
• Magnesium chloride: * Transdermal form; higher absorption than oral.
• Magnesium citrate: * Excellent absorption and utilisation.
• Magnesium gluconate: * Good absorption: avoids laxative effects.
• Magnesium malate: * Malic acid is an intermediary in the Krebs cycle.(1 mark)

Support for use of this form to facilitate malate dehydrogenase activity and
magnesium for energy production, particularly in fibromyalgia. (2 marks)
- Magnesium glycinate: * An amino acid chelate, glycine may also be useful for
sleeplessness. Good choice for insomnia.
- Magnesium sulphate (Epsom salts): * Osmotic laxative; great in the bath, both
magnesium chloride and sulphate can be absorbed through the skin.
- Magnesium orotate: * Cardiovascular support; orotic acid enhances energy
production in the heart. (2 marks)
- Magnesium oxide: * Cheapest form available / commonly used. An osmotic
laxative.
- 1 mark per name
- 1 mark per point unless stated otherwise
- Magnesium drug interactions: 4 MARKS
- Antibiotics: * Taking magnesium supplements may reduce the absorption of
quinolone and tetracycline antibiotics, fluoroquinolones and nitrofurantoin. (2
marks, 1 mark for listing antibiotic and 1 for explanation)
- Supplements should be taken one hr before, or two hrs after these.
- Blood pressure medications, calcium channel blockers: * Magnesium may
increase the risk of negative adverse effects. (2 marks, 1 mark for listing BP
meds and 1 for explanation)
- HRT, OCP, diuretics and penicillamine: * May decrease magnesium levels;
concomitant supplementation may be beneficial. (2 marks, 1 mark for listing HRT,
OCP or penicillamine and 1 for explanation)
- Contraindications:
- Heart block (unless there is a pacemaker present).
- Renal failure.
2. Gwen is worried that her teenage son’s diet is not healthy. Discuss the
nutritional needs during adolescence and suggestions on how to support
healthy nutrition in adolescence, including energy and micronutrient
requirements (15 marks)
Life stages: slide /54/55/56/57/58/59/60
- 1 mark per point unless stated otherwise.
- Protein:
- Adolescent protein needs vary with the degree of physical maturation.
- Insufficient protein intake is uncommon among adolescents in Western countries;
however quality is often an issue, with teenagers opting for processed meats and
dairy products. * Protein insufficiency can occur in teens, e.g. in those on weight-loss
diets or on inappropriately planned diets (i.e. junk food).
- Inadequate protein can = loss of lean BM and delayed growth
- Carbohydrate:
- Refined carbohydrate intake is often high and fibre intake low in adolescence (most
do not meet the daily requirements).
- This can be a key factor in common conditions such as acne (due to the effect of
insulin on sebum production → oily skin).
- To support GI health, focus on foods with a high nutrient intake: whole grains,
sourdough breads, sprouts, fresh fruits / vegetables. * (0.5 each – max 2 marks)
- E.g. muesli or porridge for breakfast, green smoothies, sweet potatoes, colourful
salads and burrito bowls with brown rice. (0.5 each – max 2 marks)
- Fat:
- Fat intakes should not exceed 30–35% of total caloric intake.
- EFAs are important for the production of sex hormones (e.g. testosterone,
oestrogen, progesterone) which is crucial during this time. (2 marks)
- They are also needed for skin, hair and nail health (consider teenage acne).
- Include healthy fats contained in nuts and seeds, oily fish, avocado, olives and olive
oils. (0.5 each – max 2 marks)
- Micronutrient needs increase during adolescent years.
- Calcium:
- Adolescence is a crucial time for bone development and the requirement for calcium
reaches its peak during these years.
- Low calcium diets and physical inactivity compromise the development of peak bone
mass (the best protection against osteoporosis).
- Encourage daily exercise and avoidance of fizzy drinks, caffeine, alcohol, fast food.
(0.5 each – max 2 marks)
- Include bone supportive nutrients such as vitamin D and magnesium rich foods
(almonds, barley, leafy greens, legumes). (0.5 each – max 2 marks)
- Iron:
- Iron requirements increase in adolescence for both males and females as their blood
volume increases with growth.
- Iron needs increase for females as they start to menstruate, and for males as their
lean body mass develops.
- For females, iron needs remains high (heavy menstruation and pregnancy) until late
adulthood / menopause.
- Menstruation makes women more susceptible to iron deficiency.
- Include non-haem iron foods such as almonds, apricots, avocado, sunflower,
pumpkin seeds as well as vitamin C-rich foods to aid absorption (broccoli, citrus
fruits, peppers, rosehips, strawberries, sweet potatoes etc.) (0.5 each – max 2
marks)
- 5 marks must come from suggestions on diet:
- During adolescence, nutrients that support growth, metabolism and reproductive
health are crucial.
- So ensure an adequate intake of calcium, iron, zinc, protein, B vitamins and
selenium etc (0.5 each – max 2 marks).
- This can also be achieved by:
- Supporting their digestive health (i.e. with digestive juices → supporting hydrochloric
acid levels, bile and pancreatic juice flow (0.5 each – max 2 marks);
- supporting microflora health with a diet rich in prebiotics and lacking refined
carbohydrates).
- Proving the supportive nutrients for absorption (for example, vitamin C rich foods
eaten with non-haem iron sources such as lentils, spinach, pumpkin seeds, beans,
sesame seeds) and eliminating inhibiting substances (e.g. caffeine) (0.5 each – max
2 marks)
- Supporting healthy nutrition in adolescence:
- Encourage them to eat well despite peer pressure.
- Encourage activity (vs. phone / iPad / videogames).
- Encourage high micronutrient intake and vitamin C-rich foods to increase iron
absorption.
- Suggest cooking / nutrition and health classes: teenagers like information better if
they find it themselves.
- Recognise the stresses of adolescence and the need for them to show
independence and develop their own lifestyles.
- Maintain contact with children at this critical point in life — this may be more
important than diet!
3. Discuss the functions and therapeutic uses of lignans, including food
sources, intake recommendations and dosages. Include who should take
caution when ingesting lignans and any safety cautions (15 marks)
Phytonutrients: slide 38/39/40/41/42/43
- 1 mark per point unless stated otherwise.
- Lignans can be metabolised by intestinal bacteria to form the phytoestrogen
compounds enterodiol and enterolactone: (2 marks)
- They are said to be the ‘Western equivalent’ of phytoestrogens and are a soy
alternative.
- It is thought that variations in the intestinal bacteria mean that in Western
populations tend to tolerate lignans more than soy.
- Food sources: * Flaxseeds (most abundant source). * Sesame seeds, beans and
pulses, cruciferous vegetables. (0.5 each – max 2 marks)
- 0.5 per food – max 4 marks
- Functions:
- Therapeutic uses:
- Oestrogen modulation:
- Bind to oestrogen receptors exerting an oestrogenic effect that is milder than
endogenous oestrogens.
- Where oestrogen levels are low the net effect is to ↑ oestrogenic activity.
- Where oestrogen levels are high, lignans antagonise endogenous oestrogens.
- Functions:
- Menstrual irregularities Dosage: 2 tbsp whole flaxseed per day (i.e. seed cycling).
* Menopause support — ↓ frequency and intensity of hot flushes; improves
vaginal atrophy and cognitive function; supporting bone density, ↓ osteoporosis
risk. ( 0.5 each – max 3 marks)
- Dosage: 2 tbsp flax per day
- Therapeutic uses:
- Anti-cancer: * Lignans anti-cancer properties — especially in hormonally driven
breast and prostate cancer.
- There is also evidence for a role in endometrial and ovarian cancer.
- The following anti-cancer mechanisms have been found: – Modulation of
oestrogen metabolism and receptor signalling pathways leading to decreased cell
proliferation and angiogenesis. – (2 marks)
- Strong anti-oxidant properties. – Reduces 5α-reductase activity, thereby reducing
the more biologically potent DHT (prostate) (2 marks).
- Dosage: 25 g / day (providing 50 mg lignans).
- MUST INCLUDE AT LEAST 1 mark to gain full marks
- Intake and dosage:
- Consume 25 g flaxseed (approximately 50 mg lignans) daily.
- Lignans are not associated with the oil fraction of foods so intake of whole
flaxseeds (ground) are needed to obtain benefits.
- Flaxseeds contain polyunsaturated fatty acids that are unstable and oxidise
readily if exposed to oxygen, light and heat (avoid cooking — use to garnish).
(2marks)
- Best consumed from flaxseeds that are freshly ground.
- Ground flaxseeds also oxidise easily so do not purchase them ground.
- MUST INCLUDE AT LEAST 1 mark to gain full marks
- Safety:
- Lignan precursors in foods are not known to have any adverse effects.
- Flaxseed may lower blood glucose levels and might have additive effects when
used with anti-diabetic drugs. (MUST INCLUDE TO GAIN FULL MARKS)
- The safety of lignan supplements in pregnant or lactating women has not been
established. (MUST INCLUDE TO GAIN FULL MARKS)