Environmental Health

Question 1

enterohepatic recirculation

Answer 1

is the cycling of drugs, xenobiotics, and metabolites after excretion in the biliary systems, which are then reabsorbed in the intestines

Question 2

Lipolysis and detoxification

Answer 2

Lipolysis can be expected to increase the burden on the phase II biotransformation systems. lipolysis mobilized lipophilic toxins, which then need to be conjugated by Phase II to facilitate excretion.

Question 3

F postmenopausal - HTN, HAs, myalgia, numbness, tingling. A recent Dexa revealed moderate osteoporosis. which toxic agent would suspect be involved.

Answer 3

Lead - stored in the bone, demineralization - competed with calcium

Question 4

55 yo male initial program for MSG score 110, chemical sensitivity, smoker,

Answer 4

detox food plan + lifestyle change

Question 5

stooped posture, blue black lines of the gums, osteopenia - signs of which toxic exposure

Answer 5

lead

Question 6

49 yo F - planting and weed control for landscaping business - which additional lab biomarker would further suggest probable xenobiotic toxicity?

Answer 6

gamma-glutamyl transferase (GTT) elevation is associate with xenobiotic exposure (pesticides/herbicides_

Question 7

What are the components of glutathione?

Answer 7

glutamine, glycine, cysteine

Question 8

What is the rate limiting step of glutathione synthesis?

Answer 8

Cysteine

Question 9

Phase 1 detox is dependent on what nutrient?

Answer 9

Iron

Question 10

what nutrient is a co-factor for glutathione peroxidase?

Answer 10

selenium

Question 11

Fasting has the what effect on biotransformation?

Answer 11

decreased sulfonate conjugation and glucuronidation

Question 12

What is the influence of fasting on Gilbert?

Answer 12

Gilberts has jaundice after fasting - because fasting slows down glucuronidation

Question 13

What is the general function of Phase II transformation?

Answer 13

conjugates reactive intermediated from phase I and makes them less lipophilic and more readily excreted in bile and urine

Question 14

Green tea (Camellia sinensis)

Answer 14

Green tea inhibits certain phase 1 and induces certain phase 2 enzymes

Question 15

Provide examples of phytochelators?

Answer 15

bran/fiber/chlorella?

Question 16

which agents are recommended for use on the day of a dental amalgam removal procedure?

Answer 16

activated charcoal capsules and chlorella swish

Question 17

dioxin exposure has been associated with which chronic illness?

Answer 17

DM II

Question 18

What dietary trigger is associated with new onset migraine and elevated blood pressure?

Answer 18

red wine

Question 19

What plant-based food are helpful for increasing sulfur-containing amino acids?

Answer 19

walnuts, oats, chocolate

Question 20

A 36‐year‐old female returns to see you. She has been taking HCG and been on a very low calorie diet for the past four weeks. She has lost 16 pounds. New symptoms include loss of appetite, fatigue, and nausea. Laboratory elevations in blood levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are noted. You suggest that rapid weight loss may result in:

Answer 20

Increased levels of circulating, fat‐soluble xenobiotics.

Question 21

.Biotransformation occurs more in which of the following organs

Answer 21

intestines

Question 22

What are the primary biotransformation pathways and nutrient/food cofactors that detoxify xenoestrogens?

Answer 22

CYP‐P450 hydroxylation, sulfation, glucuronidation, glucosinolates, and methyl factors.

Question 23

A 45‐year‐old woman comes to you as a new patient. She has a slightly depressed mood and is under a lot of stress. You recommend meditation because it has been shown to

Answer 23

increase serotonin

Question 24

A 59-year-old male presents with bilateral foot pain and chronic fatigue. He has a history of nausea, depression, mood swings, and low libido. He looks tanned even though it is winter. Laboratory findings include a moderately high GGT, normal fasting insulin, slightly high hemoglobin A1C, and a borderline TSH. What is the likely causativefactor?

Answer 24

iron overload

Question 25

Two days before collecting a specimen for a toxic metals panel, a patient ingested crabmeat at an all-you-can-eat buffet restaurant. Which metal elevation could be a false positive?

Answer 25

Arsenic

Question 26

A mother brings in her teenage son to see you. They moved into a newly developed area. They are in a new construction house, and he started high school last month. He reports that since they moved in, he has been waking with a dull headache. It is generally relieved with aspirin. The first thing you would want to investigate is

Answer 26

Chemical off-gassing at home or at school

Question 27

What is insufficient in Gilberts syndrome?

Answer 27

Gilbert’s syndrome is associated with insufficient conjugation of bilirubin with glucuronic acid

Question 28

A 58-year-old male has smoked cigarettes for 30 years and worked as an electroplate operator in a metal refinery for 10 years. Findings include elevated blood pressure of 165/100, reduced glomerular filtration rate, increased urinary beta-2 microglobulin, and recent history of urolithiasis. The likely toxic element associated is

Answer 28

Cadmium

Question 29

A 37-year-old male presents to your office following a rapid weight loss program. His height is 68 inches and weight is 200 pounds. He has lost 30 pounds over the past two months. While he is pleased with the weight loss, he is concernedthat he is fatigued and “fuzzy headed,” with poor memory recall. You suggest to him that the most likely reason for his symptoms is

Answer 29

Persistent organic pollutants (POPs) accumulate in fat, and he likely has had significant mobilization of those POPs.