Final Flashcards
What are the recommendations for patients with hypothyroidism
- fasting/carb restrictive diets
- goitrogens: broccoli, cauliflower
- Iodine
- selenium
- Iron
- Zinc
Managing imbalances of thyroid function
- get precursors for T4 (protein, I, Zn)
- reduce anti thyroidal antibodies (undiagnosed celiac)
- improve conversation of T4 to T3 (selenium, Zn)
- enhance T3 influence on mitochondria (selenium)
- monitor use of botanicals (guggul extract and ashwagandha)
- avoid thyroid hormone metabolism disruption (avoid flavonoids—celery, thyme, chamomile tea etc)
- caution with supplements (alpha lipoid acid reduces conversion of T4 to T3)
- get adequate vitamin D
Nutritional suggestions for managing thyroid imbalance
Increase protein I Se Zn Fe Vitamin D Caution a-lipoic acid
How is adrenal fatigue measured
ATCH stimulatory test
Diagnosing diabetes. And how often do the tests need to be done to confirm
Oral glucose tolerance test
Fasting blood glucose
Long term: HbA1C (6.5% +)
Must be done 2 weeks later to confirm
Nutritional recommendations to a pre or diabetic patient
Weight loss Mediterranean diet Increase fiber and whole grain Limit sugar sweetened beverages Replace saturated fat with MUFA/PUFA
Carb counting in diabetic patient
Total intake of CHO intake
Count starches, fruits, dairy, sweets
Should diabetic patient exercises? Any precautions?
type 1: check levels before, during and after. Consume 15g of carbs per 30-60min (prior)
Type 2: exercise can improve glycemic response. Often have a lower V02 max so they need to ease into training
Exercise recommendations for diabetics
Min of 150 min
No more than 2 consecutive days without activity
Type 2 encouraged to do resistance at least 2x/wk
What are the long term complications of uncontrolled blood glucose
CVD (due to high TG)
Nephropathy
Retinopathy
Neuropathy
How is hypoglycemia diagnosed
- low blood glucose <50mg/dL
- weakness, fatigue, sweating, palpitations
- symptoms disappear with carb ingestion and blood glucose returns to normal
“Whipped triad”
**if don’t disappear might be pancreatic insufficiency
Causes of microcytic anemia
Iron deficiency
Potentially copper
Causes of macrocytic anemia
Folate or B12 deficiency
Plasma ferritin and iron deficiency
Normal 100+- 60
Iron depletion = 20
Iron deficiency <10
S.s of microcytic anemia
Pallor
Glossitis
Spooning of nails
Pale conjunctiva
What supplementation should be used for microcytic anemia
50-100mg of elemental iron. Add zinc supplement if not responding
vitamin C
Limit binders: oxalate, phytate, tea, coffee
Nutritional therapy for macrocytic megaloblastic anemia
1000mcg folic acid
1000mcg B12
High protein (1.5g/kg)
What is the best biomarkers for macrocytic deficiency
MMA
Methylmalonic acid
When should dietary changes be used and when should dietary and supplement changes be used in hypochromic microcytic anemia?
Stage 4: supplement & dietary changes
(<10 plasma ferritin)
Stage 3: dietary changes
(10 plasma ferritin)
Supplement 50-100mcg Fe + Vit C + Zn
Diet: protein, omegas (decrease inflammation), limit binders: oxalate, phytate, tannins etc.
What nutrients are important for brain function?
Protien
Lipids (3-DHA, 6-ARA)
Iron (myelination/neurotransmitter synthesis)
Iodine
Zinc
Methyl donors (folate B6, betaine choline)
Iron supplements for fullterm breastfed infants and preteen breastfed infants
Fullterm: @ 4 months 1mg/kg/day
Preterm: @ 1 month 2mg/kg/d
Formula fed: none
Zinc functions and results if deficient
Myelination, neurotransmitter release
Poor learning, attention, memory and mood. Altered immune Increased cytokine Increased intestinal permeability Food allergy
What are the methyl donors
Folate
B6
B12
Betaine choline
How is the gut involved in brain development and psychiatric manifestations?
Lactobacillus: GABA and Ach
Streptococcus: serotonin
Bifidobacterium: GABA
Escherichia: serotonin, norepinephrine
More adipocytes= more inflammation. Gut inflammation precedes weight gain and adipocytes inflammation. M___ —> M __
M2 (heal)—> M1 (kill)
Diet stress—> gut changes—> immune cell activation = chronic inflammation
Explain
Diet and stress: causes change in the gut microbiome
Gut changes: inflammation. Increased LPS absorption —> + NF-kB—> + cytokines—> + ROS —> + NFkB etc.
Immune: systemic inflammation
Biomarkers of systemic inflammation
CRP: 3+ is high
IL6
Fibrinogen
Maternal ____ production is associated with fetal neuroinflammation. _____ is an indicator of systemic inflammation. What does it cause?
Cytokine
IL6
Alters brain areas associated with working memory and causes abnormal network connections
Microglia and neuroinflammation
Need for synaptic plasticity and clearance of debris
peaks at 14 days old
Excessive activation from cytokines and LPS may cause brain lesions, sequester iron, secrete: IL1, TNF, ROS, MMP, amyloid precursor
How do microglia become activated and what do they do when they are
Cytokines and LPS
Sequester iron, secrete IL1, TNF, ROS, MMP, and amyloid precursor
How are microglia deactivated
Anti-inflammatory cytokines IL4, 10, 13
Increased oxidative metabolism in microglia drive pro-regenerative phenotype
SIRT1 prevent excessive activation through deacetylation of NFkB
(Berries)
What prevents excessive microglia activation
SIRT1 (deactivates NF-kB)
Eating berries activates more
What dietary recommendations and supplements may be useful for depression?
Omega 3 Folate B12 Mg Zn Probiotics (bifidobact/lactobacillus) Phytochemicals (cocoa/coffee/green tea/honey/blueberries)
Fat type of recommendation and mood disorders
Increase SCFA= improved mood disorders
Nutrient and supplement recommendation for bipolar disorder
Na (moderate and stable intake)
CoQ10
N-acetylcycteine
SAMe
Supplement: fish oil 9g/d
N-acetylcysteine
Mg (300-600)
Anxiety and the gut
Gut inflammation stimulated anxiety behavior
Fermentation products are protective (lactobacillus MC)
Nutrient and supplement recommendation for anxiety
Carbs (reactive hypoglycemia common) Omega 3 Mg (100) B and D vitamins Ashwagandha
Zinc found to be low (but supplements didn’t help)
Dementia and Alzheimer’s prevention
MIND diet
Folate and B12
Mind diet: Veggie 1/d Nuts 1/d Fish 1/wk Poultry 2/wk Berries 2/wk Beans 3/wk Green leafy 6/wk Whole grain 3/d Cheese/fried food 1/wk
Dash diet: low fat, plants, moderate protein
(Mediterranean: moderate fat, olive oil, plants, legumes)
Anti inflammatory diet
Turmeric Fiber Flavones Isoflavones Tea Beta carotene Mg Omega 3
High inflammation and mental health relation
High inflammation= high mental health issues
70% increased risk of depression, 60% anxiety
What are some anti-inflammatory diets
Mediterranean (moderate fat, olive oil, plants, legumes)
DASH (low fat, plants, moderate protein)
MIND Plant based
What nutrients are depleted in NSAID use
Iron and folate
What nutrients are depleted in aspirin use
Folate, iron, Vit C
What are some biomarkers for rheumatic diseases inflammation
CRP (3+) TNF ESR Liver: ALT/AST Eosinophils (4+%)
Nutritional therapy for OA
Anti-inflammatory diet Vitamin D Glucosamine sulfate (1500mg) Chondroitin sulfate (1200mg) Omega 3 3g/d Weight loss/exercise
(SAMe/capsaicin gel)
Nutritional concerns with RA patients
Low vitamin D
Increased metabolic rate due to increased inflammation
Taste alterations
Fasting—potential benefit to decrease inflammation
RA nutritional therapy
Anti-inflammatory diet Increased protein (1.5-2.0g/kg/d) Omega 3 3g/d Vitamin E (nuts/seeds) folate B6,12 vitamin D
Evening primose or black currant herbs
What herbs do you NOT give RA pateints
Thunder god vine
Nutritional therapy for gout
Decrease: Red meat/organ meat Seafood Alcohol-beer** High Purine foods (anchovies, gravy, broth, yeast, seafood)
Increase: Dairy Vitamin C Coffee Tart cherry juice Water
What are dietary strategies that may protect against stroke?
Healthy BMI
Monitor for HTN and Diabetes
Flavonoids (green tea 5cups/d) Omega 3 from fish DASH diet (low fat, plants, moderate protein) Na:K <1 Long term coffee
What recommendations may be useful for patients with TBI
100-140% intake of expenditure
15-20% energy from protein
Omega 3
Mg
Zn
Ketogenic diet
What diet is often used in patients with epilepsy?
High fat/low carb
(Ketogenic)
4:1 (fat: carb+ protein)
What is involved with diet recommended for epilepsy
Ketopancakes with blueberries
Cream, celery, chicken, avacado, olive oil
Cream and strawberries
Cream, tomato sauce, ground beer, spaghetti squash, olive oil
4:1 ratio (fat: carb+protein)
What nutritional recommendations may be made for patients with MS-prevention
Vitamin D adequate intake
Don’t smoke
What nutritional recommendations may be made for patients with MS-treatment
Vitamin D
Anti-inflammatory diet
Keto diet?
Nutritional recommendations for people with Parkinson’s
If on L-Dopa: low protein diet spread throughout day and NO B6 supplements
Adequate fiber and fluid Plant rich—> neuroprotective Vitamin D Omega 3 Keto?
Recommendations for dementia and Alzheimer’s prevention
MIND diet
Prevent type 2 diabetes and monitor HbA1C
Folate B12
For chronic daily HA and migraine: what are the main dietary strategies that would be most useful? And what supplements?
Avoid alcohol
Don’t smoke
Healthy BMI
Regulate blood sugar (reactive hypoglycemia) carb counting
Decrease overall at intake
Increase w-3, decrease w-6
Decrease folate
Increase methyl donors
Decrease tyramine foods (cheese, sausage, soy)
Avoid histamine (sausage, preserved fish, cheese, eggplant, avacado, spinach, tomato, alcohol)
Mg, Riboflavin, CoQ10
Headache comorbidities
IBS
Gastroparesis
Celiac
Chrohns
All more likely to have HA
What is the most common headache trigger
Alcohol
What are headache chemical triggers
Tyramine (cheese, sausage, soy sauce)
Phenyl ethlamine- chocolate
Histamine
What reduces the bodies ability to metabolize histamine (increasing headaches)
NSAIDS
Tricyclics antidepressants
Tagamet
What are things to avoid when on a low histamine diet
Sausage Dried/preserved fish/sauces Cheese Eggplant Avacado Spinach Tomatoes/products Alcohol
What supplements and dose are used to treat headaches/migraines
-Mg: 360-600mg
-Riboflavin: 400mg/d
-CoQ10: 150-300mg/d (100mg 3x/d)
Pediatric: 1-3mg/mg/d
Butterbur:75mg 2x/d
Feverfew—NOT if ragweed allergy
What studies are used to determine the influence of dietary components on cancer risk? Ex: dairy & prostate?
Cohort
Case control
What types of studies are used to determine the influence of dietary components on pathways? W-3 and angiogenesis?
Animal data
In vitro
Estimated that 1/3 of all cancers in higher income countries due to what?
Poor nutrition
Sedentary lifestyle
Excess weight
What things stimulate NF-kB inflammation in regards to cancer
High fat diet with saturated fat and excess w-6
Hyperglycemia
What things increase and decrease apoptosis of cancer?
Decrease:
ROS
Obesity
Increase: w-3 Olive oil Berries Circumcised Cruciferous veggies Garlic
What things increase and decrease metastasis
Increase: glucose (increased invasion of colon CA cells)
Decrease:
W-3
Ketogenic
Milk thistle/silbinin
What is the Warburg effect?
- Decrease in Krebs cycle and electron transport system—> allows tumors to grow anaerobically
- increase in glycolysis—> lactate production created favorable acidic environment
What diets may possibly decrease tumor growth?
Calorie restriction
Ketogenic
How is cachexia diagnosed?
All 3:
- weight loss more than 10%
- caloric intake <1500cal/d
- CRP>10mg/L
What are nutritional recommendations for patients with cachexia?
High fat, high protein
Whatever calories they can get down, let them eat it
Early interventions with nutritional beverages
Protein and energy requirements for maintaining body weight and for regaining weight
Maintaining:
Protein 1-1.5g/kg
Calories= 25-30kcal/kg
Gaining:
Protein 1.5-2
Cal=30-35
Fluid recommendations in cancer patient
20-40mL/kg
1 cup= 250mL
Are supplements recommended for pateints undergoing cancer treatment?
Supplements only considered if deficiency is biochemically or clinically demonstrated
<67%RDA
Avoid use if possible
Recommendations to treat anorexia/poor diet with cancer
Small frequent nutrient dense meals/snacks
Add protein/cal to favorite foods
Eat when feeling best and in a present atmosphere
Recommendations to treat nausea
Small, low-fat meal
Bland food
Easy digestible—> crackers/green grapes
Recommendations for diarrhea in cancer
CRAM
Cereal, rice, applesauce, milk
Small amounts of electrolyte fluid
Avoid fruit juices
Probiotic
Recommendations for constipation in cancer
Increase fiber and fluid
Increase physical activity
Recommendations for sore throat in cancer
Soft moist foods with extra sauce
Avoid alcohol, citrus, caffeine, tomatoes, vinegar, spice
Recommendations for mucousitis in cancer
Maintain good oral hygiene
Only soft, non-fibrous, non-acidic foods
20ml swish and swallow -buckwheat
Recommendations for xerostomia—dry mouth in cancer?
Increase liquids
Avoid alcohol
Increase sour foods (if none present such as frozen pineapple)
Recommendations for altered taste in cancer
Good oral hygiene
Use plastic utensils
Try marinades or spices
Recommendations for thickened saliva in cancer patient
Increase fluids
Try fizzy water
Mucinex
Cool mist humidifier when sleeping
What treatments may lead to neuropathy?
Surgery
Chemotherapy
What increases risk of breast cancer
Heavier Smoking BRCA1/2 Dense breast tissue Years of estrogen exposure (earlier period) Alcohol
What decrease risk of breast cancer
First pregnancy before 35 Breastfeeding Mastectomy Ovarian ablation Exercise Plant based diet + fish
ER+ subtype what increase/decrease risk
Increase: alcohol
Fat
Saturated fat
Decrease: w-3
What decrease risk in ER- subtype
Decrease: Veggies Coffee Mediterranean diet W-3
What increase risk in PR+
Increase:
Total fat
Saturated fat
What decreases risk in PR-
Decrease:
Coffee
Mediterranean
What increase/decrease risk in HER2-
Increase:
Alcohol
Sat fat
Decrease:
Soybeans
What increase/decrease risk in HER2+
Increase:
Western diet
Soybeans
Decrease:
Mediterranean
Breastfeeding
Alpha-linolenic acid
What decrease risk in ER-/PR-/HER2-
Mediterranean
Breastfeeding
What increase risk of prostate CA
Age Genetics Smoking Weight Sedentary Red meat High fat diet Dairy calcium
What decrease risk of prostate
Plants
Cruciferous veggies—broccoli/cauliflower
What increase risk of colorectal ca
Family history History of IBD Alcohol Smoking AA Weight Red meat
What decrease risk of colorectal CA
Healthy weight
Fruits/veggies
Fiber, SE
Increase dairy
Limit red meat, alcohol
What CA is dairy good for prevention and what is it bad for?
Dairy increases risk of prostate but decreases risk for colorectal
Grilling/roasting produce?
Heterocyclic amines HCA
Grilling with charcoal produces
Polyaromatic hydrocarbons (PAH) More flames due to temp, fat content = more PAH
Grilling recommendations to reduce PAH and HCA
Whole cuts Marinate—lemon juice, beer, honey, herbs Cover grill with foil 375-450 Cut off black bits
What decreases risk of lung CA
Dont smoke Healthy BMI Limit red meat Eat veggies SE Quercetin foods (fruit, tea, onion, cocoa, red wine, olive oil) Mediterranean diet (decrease risk of lung CA in 90% smokers) Limit beta carotene
Overall CA prevention recommendations
Healthy weight Exercise Dont smoke Limit red meat Limit alcohol Plants and fish Green tea
What diet is recommended for CA survivors?
Veggies
Fruits
Whole grains
Legumes
Decrease:
Sat fat
Alcohol
Breast cancer prevention guideline
Rich colored plants Salmon w-3 Decrease sat fat First pregnancy before 35 Breastfeed Dont smoke Decrease alcohol
Prostate cancer prevention guideline
Rich colored plants Limit red meat NO ca supplements No smoking Increase green tea Decrease dairy
Colorectal cancer prevention
Rich colored plants Salmon for n-3 Limit red meat Vitamin D Ca Dont smoke Decrease alcohol Increase dairy
Lung cancer prevention guidelines
Rich colored plants Limit red meat Limit beta carotene High intensity exercise Don’t smoke Increase nuts/seeds/veggies
What are the 4 steps of motivational interviewing
Engage
Focus
Evoke
Planning
What are the four micro skills in motivational interviewing
Open ended Q’s
Affirmation/validation
Reflection
Summary
Motivational interviewing is a helpful communication took most useful for people in what stages?
Precontemplation
Contemplation
Autonomy
Avoid directives “ you should etc..”
Instead “how would that work for you?”
Sustain talk
Shows ambivalence
“But”
“I want to do ___ but ____”
Change talk
Ready to make a change
“I need to ___.”
Acronym for micro skills of motivational interviewing
OARS
When talking about open ended questions vs reflection what is the ratio and the motified acronym
ROAS
Twice as many reflections and open ended questions
Moving through ambivalence—preparing
DARN
Desire
Abilities
Reason
Need
Moving through ambivalence-mobilizing
CAT
Commitment
Activation
Taking steps
Parts of planning fr change
Smart goals
VAS confidence scales
Change plan worksheet
Before patient leaves for motivational interveiewing
GAB
Goals
Assessment of confidence
Barriers
