CNM S1 Sample Paper 1

Question 1

Compare and contrast the use of HOT and COLD water in hyrdrotherapy (2m)

History Slide 21

Answer 1

A
Cold Water decreases circulation and numbs the area

Hot Water relaxes muscles and increases circulation

Question 2

Name the TWO enzymes released by the stomach wall and explain the action of each (2m)

Digestion Slide 9

Answer 2

Gastric Lipase - Breaks down Lipids (fats)

Pepsinogen - inactive enzyme activated by Hydrochloric Acid (HCI). pepsinogen is converted to active form pepsin - breaks down protein to smaller protein chains

Question 3

Name TWO focuses of naturopathic nutrition

Foundations Slide 4

Answer 3

Use of whole Organic food as medicine
Finding the root cause of the disease rather than treating the symptom
Respecting the person as an Individual with their own Constitution
Detoxification and Cleansing - importance

Question 4

Name TWO side affects of ingesting artificial sweeteners

Food Labelling Slide 32

Answer 4

Raise Insulin levels and affect Insulin Sensitivity
Cause DNA damage (mutations)
Addictive and increase sweet cravings
Sugar Receptors over stimulated - making fruit / veg not tasty

Question 5

List TWO foods that should be reduced and TWO foods that should be increased for someone showing signs & symptoms of HEAT EXCESS (2m)

Energetics Slide 13

Answer 5

Increase salads, raw food, smoothies, bitter greens
Fresh Air, fasting , detox and balance excess heat
Reduce hot foods, chilli, ginger, red meat, oily food, deep fried, smoked, BBQ
If ACUTE - then have warm teas, spices, wraps leads to sweating, treat fever

Question 6

Where is calcium absorbed in the body? What are the TWO absorption processes that facilitate this? what is the co-factor nutrient needed in this process? (3m)

Answer 6

Calcium is absorbed by all parts of intestine - especially duodenum
Active and passive absorption
Vit D for active absorption only

Question 7

What is the pH of Hyrochloric acid and what two nutrients are required to produce it (2m)?

Answer 7

2-3 pH for HCL
Zinc and B6 (to a lesser extent B1 thiamine)

Question 8

Name FOUR foods that contain Thiamine (B1)

Vits sl 49

Answer 8

Pork Potatoes Pulses Peas
Seeds Beans Soybeans
Oranges Nuts

Question 9

Name THREE functions of triglycerides (3M)

Answer 9

Fats provide a source of energy BUT process of energy released is less efficient than carbs.
Fats provide a handy form to store excess calorific intake (extra glucose also turned into triglycerides)
INSULATION
Protection of body parts & organs (e.g., kidneys)

Question 10

Explain the main reason why low energy can be a symptiom of magnesium insufficiency (3m)

Answer 10

ATP - energy currency of body - is always present as a magnesium ATP complex
Without Magnesium, ATP isn’t BIOLOGICALLY ACTIVE.
Magnesium binds to phosphate groups in ATP, holding the molecule in a shape that aids the loss of phosphate, facilitating energy release.

Question 11

Describe TWP examples that illustrate suppression of symptoms (2m)

Answer 11

Suppression of emotions
“ Natural body secretions
“ Recurring infrections
“ Fever & Pain
“ NAtural immunity
Topical Application
Surgical Removal

Question 12

Which acid is required to make coenzyme A (CoA) (1m)

Answer 12

PANTOTHENIC Acid vit B5

Question 13

Briefly explain how dairy products create acidity in the body (2m)

Answer 13

Before consumption, dairy is not very acidic and is high in CALCIUM, an ALKALINE mineral. Dairy is more acidic due to higher protein / sulphur amino acid CONTENT.
Sulphur amino acids increase SULPHURIC acid formation which disrupts blood pH drawing calcium from bones and increasing calcium loss in URINE.

Question 14

Describe how proteins become denatured

Answer 14

3d structure of a protein is key to its function proteins work like a lock & KEY.
If a protein’s 3d shape changes or unfolds - it’s denatured.
Denatured proteins no longer function correctly.
Proteins denatured by heat pH changes and heavy metals and lead and murcury.

Question 15

What are FOUR therapeutic uses of Cruciferous Vegetables

Answer 15

Cancer Prevention -
(DNA protective
Hormone Deactivation
Estrogen reduces apoptosis
& inhibits angiogenisis)

Respiratory health
Liver detox support

Question 16

Name TWO Metalloenzymes that zinc is a component of (2m)

Answer 16

Superoxide Dismutase SOD
Alcohol dehydrogenase
Caroboxipeptidase
Alkaline Phosphatase
Metallothionein
Carbonic anhydrase B
Other enzymes involved in HAEM synthesis, folate absorption and DNA/RNA synthesis

Question 17

Who is described as father of medicine and describe one of his philosophies (1m)

Answer 17

Hippocrates

Food is primary source of medicine, health, healing

First use food, then herbs, then intervention

Question 18

DNA has FOUR possible nucleotide bases (amino acids), name them (2m)

Answer 18

Adenine A - a purine
Cytosine C
Guanine G - a purine
Thymine T

Question 19

answer all 3 of following questions:-
Signs & Synotoms of ZINC deficiency.

Answer 19

S&S of deficiency
Poor sense of taste and smell
Recurrent infection, delayed wound healing
Skin disorders, acne dandruff white spots on finger nails
Infertility (M&F) and low libido
Signs of weak digestion, (bloating fatigue)

Question 20

Discuss how zinc can be used therapeutically for reproduction and cell proliferation and describe functions of each

Answer 20

Therapeutic uses of Reproduction
Infertility erectile dysfunction, low testosterone

Therapeutic uses for cell proliferation
Wound healing, Acne Cancer, Cirrhosis, Burns

Functions of zinc for reproduction
Production of sex hormones (!zinc usage during adolescence) . Needed for Spermatogenesis, inhibits 5a-Reductase which inhibits the conversion of testosterone to the more potent adrogen (DHT)

Functions of zinc for cell proliferation

needed for cell proliferation in skin, and differentiation.
Needed for DNA binding proteins involved in gene expression.
Aids tight junctions in skin and GIT

Aa

Reproduction
• Production of sex hormones
(↑ zinc usage during adolescence)
• Required for spermatogenesis
• Inhibits 5a-reductase (e.g., inhibits
the conversion of testosterone to the more potent androgen DHT).
• Infertility (male and female)
• Erectile dysfunction
• Low testosterone
Endocrine
• Needed for T4 to T3 conversion.
• Thyroid health

Cell proliferation
• Needed for cell proliferation (e.g., in the skin) and differentiation.
• Required for DNA binding proteins involved in gene expression
• Aids tight junctions (i.e. in skin / GIT)
• Wound healing
• Acne
• Cancer
• Cirrhosis
• Burns

Question 21

Define EFA essential fatty acid and what types and what foods have them

Answer 21

EFA are polyunsaturated fatty acids that cant be constructed within the body from other components and so must be obtained from diet
2types, omega 3 and omega 6

Body can convert omega 3 to another omega 3 BUT cannot create omega 3 from scratch

Omega 3 fatty acids alpa-linolenic acid ALA - essential in the diet.
Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) (1/2 m )

Omega 3 fats include
ALA - flax seeds, walnuts, green leafy veg
EPA & DHA - oily fish

Omega 6 fatty acid LINOLENIC acid (LA) - essential in the diet.
GAMMA linolenic acid (GLA) and Arachidonic Acid (AA)

Omega 6 fats include
LA vegetable oils most nuts and seeds
GLA borage oil, evening primrose oil
AA meat dairy eggs

For healthy cells and healthy cell-to-cellcommunication, diet need a variety of 3 and 6

How would you explain why these fats could be dangerous and how to safely consume EFAs without consuming free radicals?

cconversion of ALA to EPA and DHA is only about 10% efficient, even lower for LA to GLA and AA.
This conversion for LA and ALA is dependent upon the same enzymes.
It will ultimately favour the EFA that is in abundance (often omega 6).
Conversion between them involves adding in double bonds. this involves DESATURASE enzymes.
Most western diets are rich in omega6 especially arachidonic acid. this is pro-inflammatory.

Oxidation of fatty acids
Polyunsaturated fats such as EFAs are prone to becoming free radicals.
When these fats are heated, electrons can be lost. this means a fat is formed that becomes a FREE RADICAL.
This then further reacts with oxygen in the air over the cooking pan which becomes even more damaging.
The CH2 group between double bonds are especially vulnerable as radicals formed in the molecule are very stable.
The damaged fats formed will be incorporated into cell membranes.
Radical formation is accelerated by light, oxygen and heat.
Keep polyunsaturated fats in dark glass bottles in the fridge - never use for cooking!
To cook with, use saturated fats, eg., organic coconut oil (for higher temps)
Olive oil can be used to cook at lower temps as it only has one double bond. however, Extra virgin olive oil remains stable when cooked at higher temps. this exception is thought to be due to its higher antioxidant content.

Question 22

You suspect your client has dysbiosis. Discuss the microflora found in the large intestine and explain at least FIVE functions of it. Detail what influences the diversity and dominant species (15m)

Answer 22

Digestive slides 37 38 41

One mark for each point unless instructed otherwise

100t, 1000b FINnutEXT Mferm plus fermCARB waste M&H plus fermAA hydSulpH thr4 xcFart poordig bactACT

The large intestine hosts a vast community of around 100trillion microbes.
It often contains over 1000 bacterial species
The microflora performs the following crucial functions.
The final stages of nutrient extraction through microbial fermentation.
This includes the fermentation of remaining carbs to create the odorous waste byproducts methane and hydrogen as well as the fermentation of amino acids to create hydrogen sulphide.
Therefore, excess flatulence with a strong odour can indicate poor digesgtion as a result of the bacterial action on the remaining food.

Question 23

Microflora functions

Answer 23

Synvit biotin k2, sprt IntB, b make scfa fib>entcytes LG. Pathprot 🚗 GALT if, appSAT, 🦠regPro moodRegSynNT, poorNT pathg
Stress T2DM

Synthesises vitamins

Synthesises vitamins such as biotin and K2
Supports intestinal barrier. bacteria produce short-chain fatty acids from fibre they ingest, that is then used by enterocytes. this supports the intestinal barier and is hence protective against leaky gut.

pathogen protection. out-competes for attachment to the intestinal epithelium and nutrients (eg., against candida)

Gut associated lymphoid tissue GALT
crucial for effective functioning of the immune system

regulates appetite / satiety
Bacteria prodcuce appetite regulating proteins.

Mood regulation
As indicated by EDWARD BACH (bach therapy). The microflora can synthesise neurotransmitters.

Dietary composition strongly influences the diversity and dominant species in the microflora.
By feeding bacteria with a typical western diet (refined sugars, damaged fats, concentrated proteins, including animal prote3ins and processed soya, low in fibre. , the strains become pathogenic.
The diversity of the mircoflora helps to support the immune system.
It helps leukocytes to learn from the microbes, making them more effective at combatting pathogenic organisms.
As well as poor nutrition, the colonies of bacteria can also be altered negatively by:-
Chronic stress and diabetes
Medications such as antibiotics and antacids
Lack of digestive secretions - stomach acid

Question 24

Vitamin A

Answer 24

Vitamin A was the first vitamin to be discovered (hence ‘A’).
• The active forms (vitamers) which execute the functions of vitamin A are: Retinol, retinal and retinoic acid.
• Depending upon what the body requires, retinol will be oxidised to the different forms (retinolretinal retinoic acid). If the body doesn’t need it, it will remain as retinol and be stored in the liver.

Question 25

The 2 forms of vitamin A:
• Pro-vitamin A  converted into the active (usable) form of vitamin A (retinol) in the small intestinal epithelium and liver.
– Carotenes (or carotenoids) are examples
of pro-vitamin A. The most active pro-vitamin carotenes are: α- (alpha), β- (beta) and
γ- (gamma) carotenes and cryptoxanthin.
– Found in non-animal foods.
• Pre-formed vitamin A  this is active vitamin A the body can use as it is.
– Only found in animal foods.
carotene = from the Greek karoton for ‘carrot’ — orange pigments
Pro-vitamin = a substance that can be converted into a vitamin Pre-formed vitamin =
a vitamin that is already formed

Vitamin A
Food sources:
• Pro-vitamin A is produced by plants, algae, fungi and bacteria. Rich food sources: Dark green, yellow / orange vegetables and fruit, e.g., carrots, squash, mango, spinach, sweet potatoes.
• Pre-formed vitamin A is only
found in animal foods e.g., liver, fish liver oils, egg yolk, mackerel, salmon.

Answer 25

Vitamin A
Pro-vitamin A absorption:
• Dietary carotenes are converted to vitamin A only as needed, so do not have toxicity concerns.
• The absorption of carotenoids in the small intestine varies between 5% and 60%.
• Ensure that there are adequate healthy fats in the diet as carotenoids are fat-soluble. Drizzle with coconut oil or olive oil to optimise absorption.
• Another way to increase the bioavailability of carotenoids is to cook (slightly steam) these foods, e.g., carrots. This cooking method is thought to most effectively liberate carotenoids from cells.