Environmental Health Flashcards
enterohepatic recirculation
is the cycling of drugs, xenobiotics, and metabolites after excretion in the biliary systems, which are then reabsorbed in the intestines
Lipolysis and detoxification
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.
F postmenopausal - HTN, HAs, myalgia, numbness, tingling. A recent Dexa revealed moderate osteoporosis. which toxic agent would suspect be involved.
Lead - stored in the bone, demineralization - competed with calcium
55 yo male initial program for MSG score 110, chemical sensitivity, smoker,
detox food plan + lifestyle change
stooped posture, blue black lines of the gums, osteopenia - signs of which toxic exposure
lead
49 yo F - planting and weed control for landscaping business - which additional lab biomarker would further suggest probable xenobiotic toxicity?
gamma-glutamyl transferase (GTT) elevation is associate with xenobiotic exposure (pesticides/herbicides_
What are the components of glutathione?
glutamine, glycine, cysteine
What is the rate limiting step of glutathione synthesis?
Cysteine
Phase 1 detox is dependent on what nutrient?
Iron
what nutrient is a co-factor for glutathione peroxidase?
selenium
Fasting has the what effect on biotransformation?
decreased sulfonate conjugation and glucuronidation
What is the influence of fasting on Gilbert?
Gilberts has jaundice after fasting - because fasting slows down glucuronidation
What is the general function of Phase II transformation?
conjugates reactive intermediated from phase I and makes them less lipophilic and more readily excreted in bile and urine
Green tea (Camellia sinensis)
Green tea inhibits certain phase 1 and induces certain phase 2 enzymes
Provide examples of phytochelators?
bran/fiber/chlorella?
which agents are recommended for use on the day of a dental amalgam removal procedure?
activated charcoal capsules and chlorella swish
dioxin exposure has been associated with which chronic illness?
DM II
What dietary trigger is associated with new onset migraine and elevated blood pressure?
red wine
What plant-based food are helpful for increasing sulfur-containing amino acids?
walnuts, oats, chocolate
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:
Increased levels of circulating, fat‐soluble xenobiotics.
.Biotransformation occurs more in which of the following organs
intestines
What are the primary biotransformation pathways and nutrient/food cofactors that detoxify xenoestrogens?
CYP‐P450 hydroxylation, sulfation, glucuronidation, glucosinolates, and methyl factors.
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
increase serotonin
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?
iron overload
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?
Arsenic
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
Chemical off-gassing at home or at school
What is insufficient in Gilberts syndrome?
Gilbert’s syndrome is associated with insufficient conjugation of bilirubin with glucuronic acid
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
Cadmium
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
Persistent organic pollutants (POPs) accumulate in fat, and he likely has had significant mobilization of those POPs.
