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Final Flashcards

1
Q

What are the recommendations for patients with hypothyroidism

A
  • fasting/carb restrictive diets
  • goitrogens: broccoli, cauliflower
  • Iodine
  • selenium
  • Iron
  • Zinc
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2
Q

Managing imbalances of thyroid function

A
  • 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
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3
Q

Nutritional suggestions for managing thyroid imbalance

A 
Increase protein
I
Se
Zn
Fe
Vitamin D 
Caution a-lipoic acid
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4
Q

How is adrenal fatigue measured

A

ATCH stimulatory test

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5
Q

Diagnosing diabetes. And how often do the tests need to be done to confirm

A

Oral glucose tolerance test
Fasting blood glucose
Long term: HbA1C (6.5% +)

Must be done 2 weeks later to confirm

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6
Q

Nutritional recommendations to a pre or diabetic patient

A 
Weight loss
Mediterranean diet
Increase fiber and whole grain
Limit sugar sweetened beverages
Replace saturated fat with MUFA/PUFA
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7
Q

Carb counting in diabetic patient

A

Total intake of CHO intake

Count starches, fruits, dairy, sweets

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8
Q

Should diabetic patient exercises? Any precautions?

A

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

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9
Q

Exercise recommendations for diabetics

A

Min of 150 min

No more than 2 consecutive days without activity
Type 2 encouraged to do resistance at least 2x/wk

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10
Q

What are the long term complications of uncontrolled blood glucose

A

CVD (due to high TG)
Nephropathy
Retinopathy
Neuropathy

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11
Q

How is hypoglycemia diagnosed

A
  • 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

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12
Q

Causes of microcytic anemia

A

Iron deficiency

Potentially copper

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13
Q

Causes of macrocytic anemia

A

Folate or B12 deficiency

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14
Q

Plasma ferritin and iron deficiency

A

Normal 100+- 60

Iron depletion = 20
Iron deficiency <10

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15
Q

S.s of microcytic anemia

A

Pallor
Glossitis
Spooning of nails
Pale conjunctiva

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16
Q

What supplementation should be used for microcytic anemia

A

50-100mg of elemental iron. Add zinc supplement if not responding

vitamin C

Limit binders: oxalate, phytate, tea, coffee

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17
Q

Nutritional therapy for macrocytic megaloblastic anemia

A

1000mcg folic acid
1000mcg B12

High protein (1.5g/kg)

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18
Q

What is the best biomarkers for macrocytic deficiency

A

MMA

Methylmalonic acid

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19
Q

When should dietary changes be used and when should dietary and supplement changes be used in hypochromic microcytic anemia?

A

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.

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20
Q

What nutrients are important for brain function?

A

Protien
Lipids (3-DHA, 6-ARA)
Iron (myelination/neurotransmitter synthesis)
Iodine
Zinc
Methyl donors (folate B6, betaine choline)

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21
Q

Iron supplements for fullterm breastfed infants and preteen breastfed infants

A

Fullterm: @ 4 months 1mg/kg/day

Preterm: @ 1 month 2mg/kg/d

Formula fed: none

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22
Q

Zinc functions and results if deficient

A

Myelination, neurotransmitter release

Poor learning, attention, memory and mood. 
Altered immune 
Increased cytokine 
Increased intestinal permeability 
Food allergy
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23
Q

What are the methyl donors

A

Folate
B6
B12
Betaine choline

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24
Q

How is the gut involved in brain development and psychiatric manifestations?

A

Lactobacillus: GABA and Ach
Streptococcus: serotonin
Bifidobacterium: GABA
Escherichia: serotonin, norepinephrine

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25
More adipocytes= more inflammation. Gut inflammation precedes weight gain and adipocytes inflammation. M___ —> M __
M2 (heal)—> M1 (kill)
26
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
27
Biomarkers of systemic inflammation
CRP: 3+ is high IL6 Fibrinogen
28
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
29
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
30
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
31
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)
32
What prevents excessive microglia activation
SIRT1 (deactivates NF-kB) Eating berries activates more
33
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) ```
34
Fat type of recommendation and mood disorders
Increase SCFA= improved mood disorders
35
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)
36
Anxiety and the gut
Gut inflammation stimulated anxiety behavior Fermentation products are protective (lactobacillus MC)
37
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)
38
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)
39
Anti inflammatory diet
``` Turmeric Fiber Flavones Isoflavones Tea Beta carotene Mg Omega 3 ```
40
High inflammation and mental health relation
High inflammation= high mental health issues | 70% increased risk of depression, 60% anxiety
41
What are some anti-inflammatory diets
Mediterranean (moderate fat, olive oil, plants, legumes) DASH (low fat, plants, moderate protein) MIND Plant based
42
What nutrients are depleted in NSAID use
Iron and folate
43
What nutrients are depleted in aspirin use
Folate, iron, Vit C
44
What are some biomarkers for rheumatic diseases inflammation
``` CRP (3+) TNF ESR Liver: ALT/AST Eosinophils (4+%) ```
45
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)
46
Nutritional concerns with RA patients
Low vitamin D Increased metabolic rate due to increased inflammation Taste alterations Fasting—potential benefit to decrease inflammation
47
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
48
What herbs do you NOT give RA pateints
Thunder god vine
49
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 ```
50
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 ```
51
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
52
What diet is often used in patients with epilepsy?
High fat/low carb (Ketogenic) 4:1 (fat: carb+ protein)
53
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)
54
What nutritional recommendations may be made for patients with MS-prevention
Vitamin D adequate intake | Don’t smoke
55
What nutritional recommendations may be made for patients with MS-treatment
Vitamin D Anti-inflammatory diet Keto diet?
56
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? ```
57
Recommendations for dementia and Alzheimer’s prevention
MIND diet Prevent type 2 diabetes and monitor HbA1C Folate B12
58
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
59
Headache comorbidities
IBS Gastroparesis Celiac Chrohns All more likely to have HA
60
What is the most common headache trigger
Alcohol
61
What are headache chemical triggers
Tyramine (cheese, sausage, soy sauce) Phenyl ethlamine- chocolate Histamine
62
What reduces the bodies ability to metabolize histamine (increasing headaches)
NSAIDS Tricyclics antidepressants Tagamet
63
What are things to avoid when on a low histamine diet
``` Sausage Dried/preserved fish/sauces Cheese Eggplant Avacado Spinach Tomatoes/products Alcohol ```
64
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
65
What studies are used to determine the influence of dietary components on cancer risk? Ex: dairy & prostate?
Cohort | Case control
66
What types of studies are used to determine the influence of dietary components on pathways? W-3 and angiogenesis?
Animal data | In vitro
67
Estimated that 1/3 of all cancers in higher income countries due to what?
Poor nutrition Sedentary lifestyle Excess weight
68
What things stimulate NF-kB inflammation in regards to cancer
High fat diet with saturated fat and excess w-6 | Hyperglycemia
69
What things increase and decrease apoptosis of cancer?
Decrease: ROS Obesity ``` Increase: w-3 Olive oil Berries Circumcised Cruciferous veggies Garlic ```
70
What things increase and decrease metastasis
Increase: glucose (increased invasion of colon CA cells) Decrease: W-3 Ketogenic Milk thistle/silbinin
71
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
72
What diets may possibly decrease tumor growth?
Calorie restriction | Ketogenic
73
How is cachexia diagnosed?
All 3: - weight loss more than 10% - caloric intake <1500cal/d - CRP>10mg/L
74
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
75
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
76
Fluid recommendations in cancer patient
20-40mL/kg 1 cup= 250mL
77
Are supplements recommended for pateints undergoing cancer treatment?
Supplements only considered if deficiency is biochemically or clinically demonstrated <67%RDA Avoid use if possible
78
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
79
Recommendations to treat nausea
Small, low-fat meal Bland food Easy digestible—> crackers/green grapes
80
Recommendations for diarrhea in cancer
CRAM Cereal, rice, applesauce, milk Small amounts of electrolyte fluid Avoid fruit juices Probiotic
81
Recommendations for constipation in cancer
Increase fiber and fluid | Increase physical activity
82
Recommendations for sore throat in cancer
Soft moist foods with extra sauce | Avoid alcohol, citrus, caffeine, tomatoes, vinegar, spice
83
Recommendations for mucousitis in cancer
Maintain good oral hygiene Only soft, non-fibrous, non-acidic foods 20ml swish and swallow -buckwheat
84
Recommendations for xerostomia—dry mouth in cancer?
Increase liquids Avoid alcohol Increase sour foods (if none present such as frozen pineapple)
85
Recommendations for altered taste in cancer
Good oral hygiene Use plastic utensils Try marinades or spices
86
Recommendations for thickened saliva in cancer patient
Increase fluids Try fizzy water Mucinex Cool mist humidifier when sleeping
87
What treatments may lead to neuropathy?
Surgery | Chemotherapy
88
What increases risk of breast cancer
``` Heavier Smoking BRCA1/2 Dense breast tissue Years of estrogen exposure (earlier period) Alcohol ```
89
What decrease risk of breast cancer
``` First pregnancy before 35 Breastfeeding Mastectomy Ovarian ablation Exercise Plant based diet + fish ```
90
ER+ subtype what increase/decrease risk
Increase: alcohol Fat Saturated fat Decrease: w-3
91
What decrease risk in ER- subtype
``` Decrease: Veggies Coffee Mediterranean diet W-3 ```
92
What increase risk in PR+
Increase: Total fat Saturated fat
93
What decreases risk in PR-
Decrease: Coffee Mediterranean
94
What increase/decrease risk in HER2-
Increase: Alcohol Sat fat Decrease: Soybeans
95
What increase/decrease risk in HER2+
Increase: Western diet Soybeans Decrease: Mediterranean Breastfeeding Alpha-linolenic acid
96
What decrease risk in ER-/PR-/HER2-
Mediterranean | Breastfeeding
97
What increase risk of prostate CA
``` Age Genetics Smoking Weight Sedentary Red meat High fat diet Dairy calcium ```
98
What decrease risk of prostate
Plants Cruciferous veggies—broccoli/cauliflower
99
What increase risk of colorectal ca
``` Family history History of IBD Alcohol Smoking AA Weight Red meat ```
100
What decrease risk of colorectal CA
Healthy weight Fruits/veggies Fiber, SE Increase dairy Limit red meat, alcohol
101
What CA is dairy good for prevention and what is it bad for?
Dairy increases risk of prostate but decreases risk for colorectal
102
Grilling/roasting produce?
Heterocyclic amines HCA
103
Grilling with charcoal produces
``` Polyaromatic hydrocarbons (PAH) More flames due to temp, fat content = more PAH ```
104
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 ```
105
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 ```
106
Overall CA prevention recommendations
``` Healthy weight Exercise Dont smoke Limit red meat Limit alcohol Plants and fish Green tea ```
107
What diet is recommended for CA survivors?
Veggies Fruits Whole grains Legumes Decrease: Sat fat Alcohol
108
Breast cancer prevention guideline
``` Rich colored plants Salmon w-3 Decrease sat fat First pregnancy before 35 Breastfeed Dont smoke Decrease alcohol ```
109
Prostate cancer prevention guideline
``` Rich colored plants Limit red meat NO ca supplements No smoking Increase green tea Decrease dairy ```
110
Colorectal cancer prevention
``` Rich colored plants Salmon for n-3 Limit red meat Vitamin D Ca Dont smoke Decrease alcohol Increase dairy ```
111
Lung cancer prevention guidelines
``` Rich colored plants Limit red meat Limit beta carotene High intensity exercise Don’t smoke Increase nuts/seeds/veggies ```
112
What are the 4 steps of motivational interviewing
Engage Focus Evoke Planning
113
What are the four micro skills in motivational interviewing
Open ended Q’s Affirmation/validation Reflection Summary
114
Motivational interviewing is a helpful communication took most useful for people in what stages?
Precontemplation | Contemplation
115
Autonomy
Avoid directives “ you should etc..” Instead “how would that work for you?”
116
Sustain talk
Shows ambivalence “But” “I want to do ___ but ____”
117
Change talk
Ready to make a change | “I need to ___.”
118
Acronym for micro skills of motivational interviewing
OARS
119
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
120
Moving through ambivalence—preparing
DARN Desire Abilities Reason Need
121
Moving through ambivalence-mobilizing
CAT Commitment Activation Taking steps
122
Parts of planning fr change
Smart goals VAS confidence scales Change plan worksheet
123
Before patient leaves for motivational interveiewing
GAB Goals Assessment of confidence Barriers

Clinical Nutrition (5 decks)

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