Final Exam Flashcards
What are the similarities in conservative mgmt of calcium oxalate and uric acid kidney stones?
Drink 14+ cups fluid/day
What are the differences in conservative mgmt of calcium oxalate and uric acid kidney stones?
Calcium oxalate
- low oxalate diet
- supplement
Uric acid kidney stones:
- low purine diet
- maint. alkaline uric >pH 6
What foods do you avoid if you’re trying to do a low oxalate diet for calcium oxalate stones?
Spinach Rhubarb Beet greens Nuts Chocolate Tea Bran Almonds Peanuts Strawberries
How much and what types of fluids should be emphasized and which should be avoided to reduce calcium oxalate stone risk?
14+ cups liquid / day
Most beverages even caffeinated, orange juice, lemonade
Citrates counteract dietary acids residues and inhibit crystallization
What type of fluid to avoid to reduce calcium oxalate stone risk?
Soft drinks (d/t sugar, phosphate) Grapefruit juice
What quantitative urine test can help guide doctor in managing kidney stones? Why?
24-hour urine analysis
Identifies patients with high output of CA, oxalate or uric acid
How can calcium supplementation be made safer for patients w/ history of kidney stones?
Calcium in food and with food reduces risk because calcium binds oxalate.
Citrate-containing calcium binds crystal, which inhibits the effect of citrate.
What is the role of Magnesium in the formation of kidney stones?
- quantity
- MOA and where does it act?
200-400 mg/day
Inhibits calcium crystallization in urinary tract
What is the role of Vitamin B6 in the formation of kidney stones?
- quantity
- MOA
50-150 mg/day
Aid oxalate catabolism
What is the role of vitamin C in the formation of kidney stones?
- quantity
- MOA
1000 mg/day
May have to be avoided if they increase urinary oxalate
For people with frequent urinary tract infections, what lifestyle modifications should be recommended?
High fluid intake
Frequent urination
Cotton underwear
What botanicals are suggested for urinary tract infections?
Cranberry
Vitamin A
Chinese herbal medicine
What is Caccinium macrocarpon?
Cranberry
What is the part of cranberry AKA Caccinium macrocarpon that is used?
Berry
Active part of cranberry AKA Caccinium macrocarpon?
Flavonoids
MOA of cranberry AKA Caccinium macrocarpon?
Inhibit adhesion of pathogens to epithelial cells
Dose of cranberry AKA Caccinium macrocarpon?
Juice 10-16 oz
Supplement 400-800 mg 2x/day
Safety concerns of cranberry AKA Caccinium macrocarpon?
GI upset
Weight gaine
Diabetics need more insulin
Who is cranberry AKA Caccinium macrocarpon contraindicated for?
Kidney stone risk
Anticoag therapy?
How much vitamin A should one take for urinary tract infections?
single dose 200,000 IU
What are the botanicals for benign prostatic hyperplasia? (5)
Saw palmetto (Serenoa repens, Serenoa serrulata, sabal serrulata)
Pygeum bark (Prunus africanus)
Nettle root (Urtica dioica)
ß-sitosterol
Pollen
What is Serenoa repens? Serenoa serrulata? Sabal serrulata?
Saw palmetto
What part of Saw palmetto (Serenoa repens, Serenoa serrulata, sabal serrulata) is used?
Berry
What is the MOA of Saw palmetto (Serenoa repens, Serenoa serrulata, sabal serrulata)?
Antiandorgenic
Antiproliferative
Anti-inflamm
What is the one small concern with Saw palmetto (Serenoa repens, Serenoa serrulata, sabal serrulata)?
That it may prolong bleeding in susceptible people
How do you take Saw palmetto (Serenoa repens, Serenoa serrulata, sabal serrulata)?
Lipophilic ripe berry extract 80-90% FA (320 mg/day in 1-2 doses)
Do not take it in tea bc water and FA do not mix
What is prunus africanus (African plum)?
Pygeum bark
What is the active part of Pygeum bark AKA prunus africanus?
Fat soluble sterols and triterpenes
What is the standard for Pygeum bark AKA prunus africanus?
14% triterpenes OR
13% sterols
What is the dose for Pygeum bark AKA prunus africanus?
75-200 mg/day in 1-2 doses
What is Urtica dioica?
Nettle root
What is the dose recommendation for Nettle root AKA Urtica dioica
120 mg 10:1 nettle root extract 2x/day
PLUS 160 mg Saw Palmetto
What is the dose recommendation for ß-sitosterol?
60-130 mg/day
What does pollen contain?
Beta-sterols
Dose for pollen in the use of benign prostatic hyperplasia?
126 mg 3x/day
What are all the gynecological conditions associated with estrogen DOMINANCE (hyper-estrogenism). (4)
- PMS
- Abnormal uterine bleeding
- Benign growths of breast, uterus, ovary
- Breast cancer risk
What causes estro dominance? (5)
Increased body fat (estrogen production)
Poorly functioning liver (estrogen catabolism)
Lack of nutrient cofactors required for estrogen metab
Inefficiency elim of estrogen metabolites
Also, insufficient progesterone production can oppose effects of estrogen
What gyn conditions are estrogen deficiency?
Menopause
Amenorrhea
Some types of infertility
What gyn conditions are better described as eicosanoids imbalance?
Dysmenorrhea
Pain is from combo of eicosanoids-mediated ischemia, uterine mm irritability, and nerve hypersensitivity.
What is a natural therapy strategy to regulate estrogen?
Anything that helps liver function
- reduce dietary fat
- increase fiber and plant food
- improve colon bacteria
- adequate micronutrient intake
How does reducing dietary fat help regulate estrogen?
Animal fat contains arachidonic acid which is a precursor of leuteolytic prostaglandin
How does increasing dietary fiber and plant food help regulate estrogen?
Decreases enterohepatic recycling of estrogen and decreases plasma estrogen levels which increases fecal excretion of estrogen
How does healthy colon bacteria help regulate estrogen?
Improve intestinal elimination of estrogen w/ Lactobacillus acidophilus cultures, which inhibit fecal bacteria and deconjugate estrogen and render it available for absorption back into circulation
What are 4 ways to help liver function?
- reduce dietary fat
- increase fiber and plant food
- improve colon bacteria
- adequate micronutrient intake
How is estrogen metabolism affected by liver function and the intestinal environment?
Ovary makes estradiol
Estradiol converted to estrone and then estriol in the liver.
Estrogen dominance may be because of
1 - incomplete conversion which leads to a build up of estradiol
Estradiol contributes to fibrocystic breast disease, dysfunctional uterine bleeding, breast cancer, endometriosis, PMS.
What is the best diet for PMS?
Longevity diet - vegetarian, low fat, high fiber
What are supplements recommended for PMS? Which one has the BEST EVIDENCE?
B6 Vit D or ***Calcium*** Magnesium Vit E Vitex angus AKA chasteberry L- tryptophan
***BEST EVIDENCE: Calcium is the only supplement routinely recommended by guidelines published by the American College of Obstetricians and Gynecologists and received the highest evidence grade from Natural Standarda and Natural Medicines Comprehensive Database.
What is the suggested diet for fibrocystic breast disease?
Low fat
High fiber
Vegetarian
What are supplements recommended for fibrocystic breast disease? Which one has the BEST EVIDENCE?
***Red clover isoflavones*** reduced P by 44% Vitamin E GLA Botanical supplements for DOM and/or PMS Potassium iodide
What is the recommended diet for menopausal symptoms?
High in soy and other plant food
Flaxseed
What are supplements recommended for menopausal symptoms? Which one has the BEST EVIDENCE?
Vitamin E for Sx Vit C for hot flashes Soy extracts for hot flashes Black cohosh AKA cimicifuga racemosa for hot flashes St. John’s wort Red clover extract Kava extract for anxiety Topical progesterone for hot flashes
What is the recommended diet for dysmenorrhea?
Low-fat vegetarian diet
What are supplements recommended for dysmenorrhea? Which one has the BEST EVIDENCE?
Fish oils OR Neptune krill oil Ginger root powder OR pyenogenol aka pine bark Calcium and magnesium Vit E Botanicals not evaluated
Diet for PCOS?
N/a
What are supplements recommended for PCOS? Which one has the BEST EVIDENCE?
Reishi aka Gandoerma lucidum
Licorice and spearmint
White peony
Green tea
What is Gandoerma lucidum?
Reishi
What is Pyenogenol?
Pine bark
What is cimicifuga racemosa?
Black cohosh
What is Vitex angus?
Chasteberry
Which of the treatments is the only proven effective Tx for one of those 4 conditions?
???
Sx of PMS
- Mood swings
- Water retention
- Breast tenderness
- Other pains
- Cravings
More severe = premenstrual dysphoric disorder
Sx of fibrocystic breast disease
• painful cysts present throughout monthly cycle
Sx of menopause
- Hot flashes
- Skin and vag dry
- Decreased libido
- Easy bruising
Sx of dysmennorhea
• Pelvic and LBP during menses
Sx of PCOS
Class Sx only affect 1/3 women
- Hirsutism 50%
- Obesity 40%
- Infertility 20%
- Amenorrhea 50%
Describe the sources and potential roles of phytoestrogens in prevention and mgmt of gyn conditions. Why can they be helpful for either excessive or insufficient estrogen?
Phytoestrogens inhibit the production and/or effects of circulating human estrogens and so they may reduce effects of hyperestrogenism.
……what about hypoestrogenism?
How often should isoflavone supplements be taken for best results […of what??] ?
Reduction in pain 13% for placebo while 44% for 40 mg of isoflavone per day and 31% for 80 mg per day.
There have been no previous clinical studies of isoflavones for the treatment of mastalgia and the benefit demonstrated in this study adds another valuable arm to therapy.
What are methylxanthines?
Caffeine
Theobromine
Theophylline
What gynecological disorder may be relieved by avoiding methylxanthines (caffeine, theobromine, theophylline)?
Elimination of methylxanthines may relieve fibrocystic breast disease
Which conditions can improve with OTC topical progesterone creams? What dose?
Menopausal Sx
20 mg/day
May reduce hot flashes in 83% women
