Energy

Question 1

mitochondiopathies has the greatest effect on which tissue type?

Answer 1

brain and muscle (large and dynamic energy processes/high energy demands)

Question 2

Which are the most important mechanisms associated with pain?

Answer 2

Neuromuscular imbalances and microglial activation.

Question 3

What are the common nutritional deficits that are correlated with recurrent migraine HAs?

Answer 3

Coq10, D3, magnesium, B6 (pyridoxine), and EPA

Question 4

Lab findings that are signs of mitochondrial dysfunction?

Answer 4

low RBC magnesium and low ferritin

Question 5

critical nutrients for ATP synthesis via electron transport pathway

Answer 5

riboflavin (B2) and niacin (B3)

Question 6

What is the critical co-factor/nutrient for CYP450 activity?

Answer 6

iron

Question 7

What can increase levels of brain-derived neurotropic factor (BDNF)?

Answer 7

moderate calorie restriction and docosahexaenoid acid (DHA) - they are pro fasting/keto and cog decline

Question 8

What are important triggers/mediators of altered membrane potential than can lead to chronic pain?

Answer 8

toxic exposure and type II diabetes can contribute to alterations in resting membrane potentials, perpetuating chronic pain

Question 9

What nutrient could be protective against Alzheimers disease?

Answer 9

Vitamin D

Question 10

What FM labs might be utilized to determine mitochondrial dysfunction?

Answer 10

Lactate/pyruvate, low magnesium, low COQ10, ox stress marries, organic acid urine testing , acylcarnitines,

Question 11

What enzymes protect from ROS and what are key nutrients for their function?

Answer 11

catalase (Fe)
superoxide dismutase-SOD (zn, Cu, Mn)
Glutathione peroxide (se) and reductase

Question 12

What are key dietary anti-oxidants?

Answer 12

vitamin C, vitamin E, Carotenoids

Question 13

What are key endogenous anti-oxidant molecules?

Answer 13

glutathione, cysteine, coq10, LPA, uric acid, cholesterol

Question 14

How do you build a stone foundation for pain patients?

Answer 14

food, mito support, healthy fats, health glycemic response, address the gut (5 Rs), modulate stress, movement,

Question 15

Which treatments would be most helpful to encourage mitochondrial biogenesis?

Answer 15

exercise and fasting

Question 16

what nutrient has the potential to be toxic to the mitochondria?

Answer 16

Iron

Question 17

What is the potential impact of metals on heme production?

Answer 17

heavy metals inhibit, energy suffers

Question 18

What is a plant constituent that is a strong inducer of NRF-2?

Answer 18

broccoli/sulfuraphane - NRF-2 is good thing = glutathione = antioxidants

Question 19

What are the signs and symptoms/conditions of mitochondropathy?

Answer 19

hypoglycemia, fatigue, depression, migraines, muscle wasting, HAs, neuropathic pain,

Question 20

38yo with headaches, fatigue, and cognitive dysfunction - what lab testing would confirm mitochondrial dysfunction?

Answer 20

elevated oxidative stress markers in association with mitochondrial dysfunction

Question 21

Is the ketogenic diet potentially therapeutic for mitochondrial dysfunction?

Answer 21

Yes - mimics fasting state

Question 22

Is exercise beneficial to mitochondrial dysfunction?

Answer 22

Yes - stimulates important signals that control mitochondrial biogenesis and function

Question 23

What nutrient co-factors are considered with mitochondrial dysfunction?

Answer 23

B vitamins
Fe, mag (ATP production)
CoQ10
Carnitine

Question 24

Know examples of direct antioxidants

Answer 24

vit C, A, E
ALA, CoQ10
NAC
Se, Cu, Mn (cofactors for antioxidant enzymes)

Question 25

Know examples to indirect antioxidants

Answer 25

``` ex: sulforaphane/cruciferous, silymarin (milk thistle) ECGC Resveratrol Curcumin ```

Question 26

what are examples of lipid replacement therapies?

Answer 26

phosphatidylcholine, phosphatidylethanolamine

Question 27

Glutathione peroxidase is an enzyme whose action is most dependent on what metallic co-factor?

Answer 27

Selenium

Question 28

common clinical findings associated with centralized pain?

Answer 28

irritable bowel syndrome

Question 29

What are some underlying mechanisms of pain?

Answer 29

inflammatory mediators, neurotransmitter/receptor imbalances, microglia activation, neuro-muscular structural/functional imbalances, genetic

Question 30

highly recommended diet/nutrient status points to check in patients at risk for neurodegenerative conditions with hx or labs tests include

Answer 30

N3:6 and vitamin D, Phytonutrient diversity and brassica intake, mindful of protein and quality if vegan/veg

Question 31

nutrients for depression

Answer 31

EPA, vitamin D, mag, Bs, Same, 5HTP, tyrosine, NAC, zinc

Question 32

Which of the following, if prescribed in excess, is most likely to be associated with peripheral neuropathy?

Answer 32

B6

Question 33

Ketone production is upregulated by

Answer 33

Medium‐chain triglycerides

Question 34

A 43‐year‐old male presents with fatigue, depression, headaches, exercise‐induced myalgia, muscle cramping, pain in his lower extremities, gastroesophageal reflux, irritable bowel, and type 2 diabetes. His occupation involves cabinet lamination, painting, and staining for the past 15 years. Physical examination noted moderate muscle loss and absent deep tendon reflexes. His laboratory findings include elevated plasma pyruvate, lactate, alanine, glycine analytes, and a low reduced glutathione/oxidized glutathione ratio. Which group of nutrients would be considered primary for this patient?

Answer 34

Phospholipids, lipoic acid, n‐acetylcysteine, riboflavin, and coenzyme Q10

Question 35

Which fatty acids are most rapidly absorbed to transiently increase ketone body formation?

Answer 35

Medium chain triglycerides

Question 36

A 42-year-old female presents with a history of depression for the past 20 years. She has tried a variety of SSRIs and other antidepressants over that time with only partial response and is interested in a more comprehensive approach. She has a strong family history of depression, as well as a history of schizophrenia on her paternal side. The most useful single nucleotide polymorphism to test would be

Answer 36

MTHFR (methylenetetrahydrofolate reductase)

Question 37

``` Which of the following is a late sign of neurodegenerative disease? A.Decreased sense of smell B.Difficulty with word finding C.Memory loss D.Fatigue ```

Answer 37

Memory loss

Question 38

A 42-year-old male presents with depression, insomnia, brain fog, and chronic low back pain. Which is not a clinical finding associated with central sensitization of pain? A.Depression B.Insomnia C.Brain fog D.All of the above can be associated with central sensitization of pain

Answer 38

All of the above can be associated with central sensitization of pain

Question 39

The most important nutrients for fatty acid oxidation are:

Answer 39

Carnitine, riboflavin (B2), and niacin (B3)

Question 40

Which of the following nutrients are considered conditionally essential? A.Glutathione and arachidonic acid B.Betaine and ketones C.Short-chain fatty acids and tyrosine D.Taurine and pantethine

Answer 40

A.Glutathione and arachidonic acid

Question 41

Which of the following are the most important nutrients or enzymes that protect the body from oxidative stress?

Answer 41

Superoxide dismutase and vitamin E

Question 42

The Mito Food Plan features include

Answer 42

Emphasis on high fat and low grain

Question 43

Advanced glycation end products are found highest in:

Answer 43

Oven fried chicken