Final Exam SQs Flashcards
what are common symptoms associated with GI diseases?
Burning or cramping pain Nausea, vomiting loss of appetite Swelling, bloating or prolonged fullness after eating Increased belching/ flatulence Diarrhea or constipation
What is the first thing to do when a patient comes in with GI symptoms?
Rule out serious disease but checking progressive worsening of symptoms, signs of fever/malaise, weight loss, bleeding or jaundice.
Second, run lab tests: CBC, ESR, liver function test
What are symptoms specific to a Peptic Ulcer?
Burning or aching pain in the Upper abdomen.
Symptoms come on between meals and are relieved when eating.
What bacteria is Peptic Ulcer associated with?
Helicobacter Pylori (found in 60% of cases)
What are some aggravating factors for peptic ulcers that patients should avoid?
Chronic NSAID use, stress, smoking, alcohol and diet.
What is the treatment for peptic ulcers?
Treatment of H. Pylori infection, avoid NSAIDS, avoid food sensitivities.
Supplement with chewable DGL licorice and Zinc and increase fiber intake.
Does eating a bland food diet help treat peptic ulcers?
NO
What are the actions of DGL licorice?
Inhibits irritating acid secretion, increases protective mucus secretions, inhibits H. pylori and increases blood flow and cell growth.
When is DLG licorice supposed to be taken and how long until you see pain relief?
a chewable tablet, taken before meals is shown to improve symptoms and pain within 5-7 days
What is GERD a disorder of?
The lower esophageal sphincter and is not always associated with hiatal hernia
What are the classic symptoms of GERD?
Chronic, recurrent, retrosternal burning pain (heart burn).
What is the treatment for GERD?
Eat smaller meals, avoid lying down after a meal, avoid abdominal compression by clothing to help move food through stomach.
Eliminate all aggravators including: smoking, alcohol, caffeine, spicy/acidic foods, chocolate and mint flavoring.
What supplements can be used to treat GERD?
Digestive aids (like enzymes or HCL) may speed digestion and encourage rapid emptying. Generally is not recommended due to the risk of worsening symptoms.
What is the common name for licorice?
Glycyrrhiza glabra
What part of the licorice plant is used in supplements?
the root
What is the active constituents of Licorice?
Glycyrrhizin (this may be removed to eliminate risk of side effects giving the de-glycyrrhizinated licorice) and flavonoids.
What do they removed glycyrrhizin from licorice supplements?
To prevent interference with corticosteroid catabolism and binding to mineral corticosteroids and prevent high blood pressure and water retention.
What two conditions is licorice a contraindication for?
Liver and kidney disorders
What are the effects of over consumption of licorice?
High blood pressure, electrolyte disturbances, cardiac problems, drug potentiation, preterm birth.
What OTC is DGL licorice normally combined with to decrease GI bleeding?
Apsirin
What is DGL licorice used to treat?
Mouth and stomach ulcers and possibly GERD.
What are the typical symptoms of gallbladder disease?
RUQ pain associated with a fatty meal.
Family hx, female, forties/fifties, increased body fat, fertility and fair skin.
What diagnostic device is used for gallstones?
Ultrasound
What is the goal of Gallbladder disease tx?
decrease biliary cholesterol, increase bille acids and phospholipids, increase bile flow and prevent progression of dz.
What are dietary goals for those with gallbladder dz?
Steady weight loss, low cholesterol, vegetarian and high fiber diet, increased coffee consumption to increase bile flow.
How do supplements for gallbladder disease work?
by affecting stone formation/dissolution by affecting bile flow and bile composition. They decrease concentrated bile acids.
What are some supplements for tx of Gallbladder dz?
Artichoke extract, Concentrated lecithin, vitamin C, Milk Thistle and digestive aids
Artichoke leaf extract is used to treat what disease?
Gallbladder disease
What is celiac disease?
An autoimmune disease triggered by dietary protein call gluten where an immune reaction damaging intestinal villi causing malabsorption and chronic GI distress.
What are symptoms associated with malabsorption?
Weight loss, impaired growth in kids, anemia, fatigue, bone loss and infertility
what are symptoms associated with GI distress?
Flatulence, recurring abdominal bloating and pain, chronic diarrhea and a pale, foul smelling or fatty stool.
What is the treatment for celiac disease?
Gluten free diet avoiding wheat, rye, barley, spelt, etc to allow the vili to recover.
May also take vitamin-mineral supplement, and digestive enzymes to speed recovery
What is DPP-IV supplement used to treat?
One RTC shows that DPP-IV activity may help break down gluten metabolites (is a gluten specific digestive enzyme)
What is irritable bowel syndrome?
Disorder of gut motility
What are the symptoms of irritable bowel syndrome?
Recurrent cramping pain, bloating, soreness, gas, diarrhea and constipation but NO BLEEDING. Symptoms are generally food or stress related.
Is there bleeding associated with IBS?
No
What are the two subtypes of IBS?
Diarrhea or constipation
What are some possible triggers for IBS?
Overeating, gas forming foods (legumes, crucifers, onion, bran) and stress
What are some common food sensitivities for IBS?
Milk products, gluten, fructose, chocolate, alcohol, caffeine, carbonated drinks, fatty foods.
Is fiber a good tx for IBS?
Yes it helps control symptoms. An example is psyllium husk
What supplements have been used to treat IBS?
enteric coated peppermint oil, melatonin and probiotics are shown to decrease IBS symptoms and improve sleep.
What is Crohns Disease?
A disease that effects the small intestine and proximal colon where patient feels abdominal pain in RLQ and has chronic diarrhea, fever, and malabsorption.
What is a way to definitively diagnose IBD (crohns disease and ulcerative colitis)?
Colonoscopy
What are these symptoms of Ulcerative Colitis?
Affecting the colon only, with symptoms of pain and blood diarrhea, and anemia
Which IBD condition is blood associated with?
Ulcerative Colitis.
What are treatment plan options for both IBD conditions?
Monitor malnutrition via CBC and serum protein. Consider food elimination diet, take multivitamin/mineral supplements, take probiotic yeast/bacteria, increase fish oil consumption.
What are natural supplements to treat Ulcerative Colitis?
Aloe vera juice, wheat grass juice, ayurvedic medicine (boswellia serrata gum resin)
What are some foods that decrease Lower esophageal sphincter tone?
Alcohol, chocolate, coffee, spicy foods, acidic foods
What part of the artichoke heart is used?
The Leaf
What is the scientific name for peppermint?
Mentha piperita
What part of the peppermint plant is used?
Leaf and essential oil
What are the active constituents of peppermint?
Menthol, menthone
What are the physiological effects of Peppermint?
Carminative: release of stomach gas and enhances gastric emptying.
Antispasmodic: inhibits smooth muscle contraction by antagonizing Ca receptors and inhibits contraction of gall bladder.
What is the diagnostic criteria for IBS?
based on 12 weeks in preceding 12 month period of abdominal discomfort, pain or two of the three following: pain relieved with dedication, onset of pain associated with change in frequency of stool or instant associated with change in appearance of stool.
What are red flag symptoms not associated with IBS?
Pain that awakens at night, diarrhea that awakens pt from sleep, blood in stool, weight loss, fever, abnormal physic exam.
What is non ulcer dyspepsia?
Chronic indigestion
What is non ulcer dyspepsia treated with?
Peppermint oil with caraway oil.
When should you not use peppermint oil?
With liver or gallbladder disease.
What are the symptoms of non ulcer dyspepsia?
Bloating, excessive or prolonged fullness, gas, nausea, loss of appetite, diarrhea or constipation
What supplements have been proven to help tx non ulcer dyspepsia?
Hydrochloric acid, digestive enzymes, probiotics and three types of herbs: bitters, carminatives and demuculants
What disease is pancreatic enzyme helpful in treating?
Celiac disease
What vitamin deficiency is found in crohns disease and may lead to osteoporosis and bone loss?
Vitamin K
What are some possible causes of Non Ulcer Dyspepsia (NUD)?
Poor eating habits (too much, too fast, under stress), swallowing air (teachers, gum chewers, smokers), food sensitivities, emotional factors, maldigestions
What botanical remedies are proven to help dyspepsia?
Peppermint/caraway oil combo, artichoke leaf extract, and iberogast
Peppermint oil has been proven to help?
IBS and Dyspepsia
What are some replacement products that can be used to manage dyspepsia?
Betaine hydrochloride, digestive enzymes, bile salts, and probiotics
What is hypochlorhydria and what is it associated with??
It is associated with increased microbial colonization in upper GI, poorer absorption, and possible food allergies due to poor protein digestion.
What are clinical clues to look for, in patients with hypochlorhydria?
Elderly Patients, patients with history of pernicious anemia and atrophic gastritis, low HCL level in gastric analysis
What do you use to treat hypochlorhydria?
Betaine hydrochloride capsules take with a meal and digestive enzymes for (pancrease, lactase, food allergies)
What does a comprehensive stool analysis screen for?
undigested food residues, digestive enzyme residues, microbial population and there by products, markers of gut immune function
How do you treat digestive enzyme insufficiency?
Treat with appropriate enzyme examples include: lactase, alpha galactoside, pancreatin (includes amylase, protease and lipase).
What has pancreatin been proven to help treat?
Helps pancreas digestion after a high fat meal. Generally pancreatin contains amylase, lipase and protease (lipase is the most effective) .
What are some precautions with pancreatin?
supplementation may irritate patients with inflammatory upper GI lesions.
What is dysbiosis?
Gut Flora Imbalance
What is dysbiosis associated with?
History of prolonged or intense antibiotic use, symptoms of diarrhea and low fiber diet.
What would you look for in a comprehensive stool exam when screening for dysbiosis?
Abnormal flora balance, elevated pH and low levels of probiotic byproducts.
What do all of the best probiotic formulas contain?
Contain at least one species of Lactobacillus and bifidobacteria, contain 5 billion/dose, have a clear shelf life and are enteric coated.
What do you treat dysbiosis with?
Probiotics
What do you treat hypochlorhydria with?
Betaine hydrochloride
What is boswellia gum resin used to treat?
Ulcerative Colitis
What is wheat grass juice used to treat?
Ulcerative Colitis
What pharmaceuticals are used to treat Benign Prostatic Hyperplasia?
Alpha Adrenergic blockers, 5 alpha reductase inhibitors, or surgery
What is the most well known botanical used to tx BPH?
Saw Lametto
what is the scientific name of saw palmetto?
Serenoa repens, serenoa surrulata, or sabal serrulata
What part of saw palmetto is used?
Fruit (the berry). Clinical studies use lipophilic berry extract at 80-90%.
What are the physiologic actions of Saw Palmetto?
Antiandrogenic (prevent enzymatic conversion of testosterone to active dihydrotestosterone)
Antiproliferative (slows cell proliferation)
Antiinflammatory (inhibits eicosanoid pathway)
Is Saw Palmetto as effective has alpha blockers?
No, it is better than placebo but not comparable to prosper or flummox.
what are the possible side effects of Saw Palmetto?
Dizziness, Gi complaints, fewer sexual function complaints, may prolong bleeding time.
What population of people should not take saw palmetto?
Women who are pregnant or lactating
What form do you not want to consume Saw Palmetto?
Tea or water form due to low fatty acid concentration
What is renal calculi or urolithiasis?
A kidney stone
What is renal colic?
Kidney stone pain that refers to the back and saddle region
What is the typical composition of a kidney stone?
Calcium oxalate (most common type) uric acid stones
What are causes of kidney stones?
Hypercalcuria, hyperoxaluria, calcium losing disease (ex hyperparathyroidism), kidney disease, UTI, hyperuricosuria
Can nutrition (what you eat) influence the formation of kidney stones?
Yes
Why would you preform a 24 hour urine analysis for a patient with a kidney stone?
to identify patients with high output of Ca, oxalate or uric acid.
What serum vitamin deficiency is commonly found with kidney stones?
Serum Magnesium
How do you prevent Ca Oxalate Stones?
Maintain dilute urine, reduce urinary Ca, reduce urinary oxalate, and inhibit crystal formation
How do you maintain dilute urine?
14+ cups of fluid per day of water, coffee, tea, orange juice or lemonade (counteract dietary residues and inhibit crystallization)
What drinks should not be recommended for those with a kidney stone?
Soft drinks and grapefruit juice
How do you reduce urinary calcium?
Reduce Ca intake in diet and follow a traditionally healthful diet that is plant based, low in animal protein, high in fiber, (think DASH). These types of diets are more alkalizing, which reduces urinary Ca, and High potassium may oppose the effect of salt.
How do you reduce urinary oxalate?
Choose a low oxalate diet (this is most important for those with absorptive hyperoxaluria)
What foods should someone with a kidney stone typically avoid?
Usually starts by avoiding: spinach, rhubarb, beet greens, nuts, chocolate, tea, bran, almonds, peanuts, strawberries and excess protein.
What supplements are used to reduce Urinary Oxalate?
Ca and Mg WITH meals
Vitamin B6 (helps catabolism)
Vitamin C
What supplements do you want to take to inhibit crystal formation for those with kidney stones?
Recommend citrate containing foods (fruits and veggies) and beverages like OJ and lemon juice that inhibit crystal formation.
Also can supplement with Mg
What are the useful kidney stone lab test?
24 hour urinary Ca before/after supplementation
Avoid oxalate food and then do 24 hr urinary oxalate
Vitamin C test with then do 24 hr urinary oxalate before/after supplementation
Mg Supplementation
How do you prevent uric acid stones?
Maintain dilute urine with fluids
Maintain alkaline urine to inhibit precipitation of uric acid
Reduce uric acid formation (low purine diet, and meds to lower serum uric acid)
Scientific Name: Vaccinium macrocarpon=
Cranberry
Parts of plant used: – Ripe fruit (berry)
Cranberry Preparations=
– Juice (typically diluted
and sweetened)
– Powdered whole berry or berry extract
Cranberry Active constituents=
Flavonoids, especially anthocyanidins and proanthocyanidins unique to these and some other berries
Cranberry constituents not considered sufficiently active=
– Organic acids
– Vitamin C
– Natural sugars with anti-microbial activity
What % of flavonoids from oral cranberry
doses show up in urine?
Only about 5% of flavonoids from oral
doses show up in urine.
Cranberry Likely mechanism of action=
Likely mechanism of action
– Proanthocyanidins/anthocyanidins, and possibly other compounds, inhibit adhesion of some urinary pathogens to epithelial cells
Cranberry unlikely mechanisms of action=
Unlikely mechanisms
– Acids, vitamin C and microbe-inhibiting sugars probably never reach high enough urinary concentrations
Cranberry Clinical Uses=
Recurrent UTI Prevention
Cranberry and UTIs in Adult women Five controlled trials, all report significant reductions in UTIs
Recurrent UTI Patients
– Adult women (50X more UTIs than men)
– Elderly men and women (typically related to incontinence)
– Catheterized patients – Neurogenic bladder patients
Medical Treatment for Recurrent UTI=
- Low-dose prophylactic antibiotics
* Lifestyle modification (high fluid intake, frequent urination, cotton underwear, etc.)
Cranberry and UTIs research in adult women summary=
• Some used juice, some used pills. Juice trials had many dropouts
• Some not placebo-controlled • One showed comparable
efficacy to an antibiotic
Cranberry and UTIs research in elderly/catheterized summary=
Trials in the elderly, catheterized, and neurogenic bladder patients are fewer, with questionable efficacy
What is the efficacy of cranberry for UTI prevention according to one systematic review?
– UTI risk reduction of ~35% over controls, mainly for adult women
– Noted many dropouts/withdrawals
• Graded Possibly Effective and Likely Safe
• Evidence grade of B
Effective Dose Cranberry beverages –
10-16 oz (300-500 ml) per day of cocktail (26-33% juice)
Cranberry supplements (standardization inconsistent) effective dose=
– 400-800 mg twice daily – 500 mg at bedtime (CranMax)
Clinically proven or third party verified brands of Cranberry products according to Nat. Standard=
– Juice: only Ocean Spray – Supplements
• CranMax, Nature’s Way, Nature’s Resource, Spring Valley, Sundown Herbals Celestial Seasonings
Cranberry Reported side effects
– GI upset
– Weight gain (juice)
– Need for more insulin in diabetics (juice)
Cranberry Contraindications=
– Salicylate hypersensitivity
– May increase kidney stone risk in large amounts
– Anticoagulant therapy?
What is the verdict on cranberry as an anticoagulant therapy?
- Some case reports suggest increased bleeding when combined with anticoagulant medication
- However, a short-term RCT found no interaction
Cranberry Effects on hepatic drug metabolism=
– Considered unlikely according to clinical and pharmacokinetic studies
Cranberry Effects on Pregnancy/Lactation=
– Only some GI symptoms reported in one study
Vitamin A helped decrease the frequency of recurring lower UTIs in one study at what dose?
200,000 IU vitamin A
Kidney Stones AKA=
renal calculi, urolithiasis
Many types with different compositions
Kidney Stones Will affect % of population in their lifetime
12%
Incidence is rising for unclear reasons…
Kidney Stones may be mistaken for other causes of _____, and vice versa
low back pain
Common Kidney Stones=
Calcium oxalate stones
– Most common type by far
Other calcium stones
Uric acid stones (10% of all kidney stones)
Most common type of kidney stone=
Calcium oxalate stones
Kidney Stone Causes
Genetic predisposition
Calcium-losing diseases
Kidney disease, urinary tract infection
Hyperuricosuria
Nutrition can influence stone formation, but is not a primary cause
Conditions associated with kidney stones=
– Hypercalcuria
– Hyperoxaluria
-hyperparathyroidism
-Gout (Hyperuricosuria)
T/F: Nutrition can influence stone formation, but is not a primary cause.
T
Laboratory Studies for Risks for Kidney stones=
24-hour urine analysis
Serum magnesium
What is the value of 24-hour urine analysis and Serum magnesium for assessing kidney stone risk?
24-hour urine analysis – May identify patients with high output of
either calcium, oxalate, or uric acid
Serum magnesium
– May identify patients with magnesium deficiency
Steps of Preventing Ca Oxalate Stones=
Maintain dilute urine Reduce urinary calcium – Similar advice as given for osteoporosis prevention Reduce urinary oxalate Inhibit crystal formation
How many cups of fluid per day is recommended to maintain dilute urine and prevents stones?
14+ cups of fluid per day is recommended
Better choices for hydration to prevents stones=
Water
Most beverages, probably because any fluid is better than less fluid
– Even caffeinated beverages (coffee and tea) lower risk
Orange juice and lemonade contribute citrates that counteract dietary acid residues and inhibit crystallization
Worse choices for hydration to prevents stones=
Soft drinks are associated with kidney stones in many studies and one RCT
– Possibly due to sugar, phosphate and/or caffeine content
Grapefruit juice dramatically raises risk
Should Pts avoid calcium to avoid stones?
No! Calcium in food and taken with food reduces risk for most patients
Calcium can prevent absorption of oxalate from diet
What Pts should avid dietary calcium?
Exception: patients with absorptive hypercalciuria, diagnosed with 24-hour urine chemistry, should limit calcium
Calcium can prevent absorption of _____ from diet?
oxalate
______ from fiber may reduce calcium absorption.
Phytate
_______ may oppose effect of salt on urinary calcium.
High potassium
Plant-based, low animal protein, high fiber diets, similar to DASH diet, dramatically reduce risk of _______.
Kidney stones.
They are more alkalinizing, which reduces urinary calcium
A Low oxalate diet is most important for those with ________.
absorptive
hyperoxaluria
Avoiding all oxalate-containing foods will mean greatly reducing _______.
fruit and veggie consumption
How to Reduce Urinary Oxalate=
Start with avoiding spinach, rhubarb, beet greens, nuts, chocolate, tea, bran, almonds, peanuts, and strawberries; consider monitoring urinary oxalate levels
T/F: excess protein may increase oxalate formation
T
What supplements with meals can reduce dietary oxalate absorption?
Calcium and magnesium
Vitamin _____, appears to aid oxalate catabolism in the body
Vitamin B6, 50-150 mg/d,
Vitamin ___ supplements of 1000 mg/day or more may have to be avoided if they increase urinary oxalate
Vitamin C
What inhibits crystal formation?
Citrate-containing foods (fruits and veggies), beverages (with orange and/or lemon juice) and supplements inhibit crystal formation
Magnesium supplementation, 200- 400 mg/d, may inhibit calcium crystallization in the urinary tract
What are Good Calcium Choices for avoiding stone formation?
Citrate-containing calcium, taken with meals
Oxalate-binding effect of calcium + crystal-inhibiting effect of citrate
Can my patient take calcium?
Lab test=
– 24-hour urinary calcium before and after
Should my patient avoid oxalate foods?
Lab test=
– 24-hour urinary oxalate
Can my patient take large amounts of vitamin C?
Lab test=
– 24-hour urinary oxalate before and after vitamin C supplementation
Will magnesium supplements help?
Lab Test=
– Serum magnesium
Preventing Uric Acid Stones=
Maintain dilute urine with fluids
Maintain alkaline urine to inhibit precipitation of uric acid
Reduce uric acid formation
How do you maintain alkaline urine to inhibit precipitation of uric acid?
– Same plant-based diet as recommended for preventing calcium stones
– Alkalinizing medications are available also
Kidney stone prevention research using nutritional approaches generally takes either of two approaches:
1) long-term observational studies that try to correlate certain dietary habits with increased or decreased risk of symptomatic stones, and 2) short-term laboratory studies that evaluate urinary changes in response to different dietary changes.
T/F: Recommendations for preventing calcium stones are also appropriate for preventing uric acid stones.
T
Low purine diet to decrease uric acid formation requires=
Alkaline fruits, vegetables and their juices (e.g. oranges)
Sodium bicarbonate or potassium citrate, 3-4 times daily
Maintain alkaline urine ______ to increase solubility of uric acid
above pH 6
Hormone Imbalance (AKA Estrogen Dominance, Hyperestrogenism) May contribute to several common disorders=
– Premenstrual syndrome – Abnormal uterine bleeding – Benign growths of breast, uterus, ovary
– Breast cancer risk
T/F: Hormone Imbalance May be affected by nutrition or botanical agents
T
Hormone Imbalance Possible causes=
– Obesity
– Hyperinsulinemia
– Impaired hepatic estrogen metabolism
– Inappropriate reactivation and absorption of excreted conjugated estrogen from the gut
» Requires deconjugation by certain intestinal flora
Estrogen is conjugated and excreted in _____.
bile
Hyperinsulinemia affects gonadal hormone _______.
metabolism
How does obesity lead to hormone imbalance?
Obesity: adipose production of estrogens
These diets tended to increase estrogen elimination in clinical studies=
– Low fat diets
– High fiber diets
– Vegetarian diets
Mechanisms affecting estrogen=
– Hepatic effects – Intestinal effects – Phytoestrogen effects » Facilitating elimination pathways » Blocking estrogen receptors in some tissues
• Plant fiber Phytochemical Effects on Estrogen=
– May enhance excretion of conjugated estrogen
– May influence intestinal flora balance to reduce estrogen deconjugation
• Phytoestrogens from soy, flax, herbs Phytochemical Effects on Estrogen=
– May block estrogen receptors – May stimulate estrogen catabolism
• Cruciferous veggies (Brassica family) Phytochemical Effects on Estrogen=
– Stimulate estrogen catabolism
Other Influences on Estrogen=
Alcohol, B-vitamins, Exercise…
• Alcohol may increase estrogen levels
• B-vitamins
– Needed for hepatic estrogen catabolism
– Activated B6 can block hormone receptors
• Exercise may lower estrogen levels
Alcohol may ______ estrogen levels
increase
Activated _____ can block hormone receptors
B6
______ may lower estrogen levels
Exercise
Avoid environmental estrogens like _____
– Pesticides, growth hormones, some industrial chemicals
Estrogen Balancing Program=
– Low calorie, low glycemic index – Low fat/high fiber/high in plant sources – Phytoestrogen - Emphasize soy, flax, Brassica veggies • Regular exercise – B-vitamins, especially B6
Premenstrual Syndrome is Defined by _______.
symptoms and their timing
Premenstrual Syndrome Symptoms:
mood swings, water retention, breast
tenderness, other pain, cravings, etc.
Premenstrual Syndrome; When more severe and disabling, it may be called _______
premenstrual dysphoric disorder
Premenstrual Syndrome Timing:
onset 7-10 days before menses, ending when menses starts
• Estrogen dominance appears to play a role
PMS Treatment Estrogen-balancing approaches=
– Vegetarian, high-fiber, low-fat diet
– Aerobic exercise
– Vitamin B6, at least 100 mg/day
» Higher doses may work better, but must be reduced eventually to avoid risk of side effects
PMS Tx Symptomatic approaches=
– Healthy diet moderate in salt, sugar and caffeine to
help manage fluid retention, mood changes
PMS Botanical Therapy
• Vitexagnus(chasteberry) – May affect progesterone and prolactin levels
• Bestchoices
– Femaprin by Nature’s Way
– 20 mg/day of 10:1 ethanolic extract or 200 mg/day dried berry
Vitexagnus(chasteberry) – May affect _______.
progesterone and prolactin levels
PMS-specific multis may contain several useful ingredients=
– B-complex with extra B6 – Calcium and magnesium – Vitamin E – Vitex agnus
– Phytoestrogens
Fibrocystic Breast Disease=
- A benign but painful condition – Painful cysts are present throughout monthly cycle
- Associated with estrogen dominance
Fibrocystic Breast Disease is Associated with estrogen dominance; successful Tx trials used:
– Low fat diets, except in one recent RCT – Soy protein, flaxseed, isoflavone supplement
Fibrocystic Breast Disease May be associated with ________ sensitivity, elimination works for some.
methylxanthine
– Family includes caffeine, theobromine, theophylline
Fibrocystic Breast Disease Best supplement=
– Red clover isoflavones, 40 mg per day
– Reduced pain by 44%
– Available in North America
Menopausal Symptoms=
- Include hot flashes, skin and vaginal dryness, decreased libido, easy bruising
- Most studies focus on hot flashes
T/F: Recent warnings against the use of HRT has
increased interest in alternative therapies for menopausal symptoms
T
T/F: Aerobic exercise and plant-based diet may help menopausal symtpoms
T
Phytoestrogens may be pro-estrogenic rather than anti-estrogenic in _______.
perimenopausal women
Soy helps Hot Flashes according to many RCTs, but not others –Best results=
-50% reduction in frequency/severity
– At least 50 mg/day isoflavones from food, soy protein, or pills, preferably split into two doses – More effective when symptoms are very frequent
Soy supplementation is Not effective in________with hot flashes
breast cancer survivors
Other potential benefits of soy isoflavones=
– Lower LDL, blood pressure, decreased arterial stiffness
– Osteoporosis prevention
Other Phytoestrogens – Flaxseed=
- Contain phytoestrogenic lignans
* 40 grams/day added to diet equaled effectiveness of HRT for mild menopausal symptoms
Other Phytoestrogens – Red Clover=
• 80 mg/day isoflavones
• Reduced hot flashes
44% in one study
• Twice daily dosing may be best due to short half-life in the body
Black Cohosh
• AKA Cimicifuga racemosa=
- 20 mg of concentrated extract (RemifeminTM ) twice daily was effective in several studies
- Other products may not be as effective
Dysmenorrhea=
- Pelvic and low back pain occuring during menses
* Rule out secondary causes (e.g. uterine pathologies)
Dysmenorrhea is Associated with eicosanoid imbalances causing:
– Congested circulation and ischemia
– Smooth muscle irritability
– Increased pain sensitivity
T/F: Exercise, healthy diet, stress reduction can be effective in limiting dysmenorrhea
T
Dysmenorrhea Research on Prostaglandin modification intervention on omega’s=
– 1800 mg/day omega-3 from fish oils was helpful
– Vegetarian diet helped
– Neptune Krill Oil, 2 grams/day was helpful
Dysmenorrhea Research
on prostaglandin-modification interventions with ginger and pine bark dosing=
– Ginger root powder, 250 mg four times daily
– Pycnogenol (pine bark extract), 60 mg/day
Dysmenorrhea Research on Smooth muscle relaxation/improved circulation interventions with what supplement?
– Calcium and magnesium have been helpful
Dysmenorrhea Research with Unclear mechanisms of diet and vitamins=
– Low-fat vegetarian diet was helpful
– Vitamin E, 400-500 IU/day was helpful
Potential Hot Flash “Triggers”=
Alcohol Caffeine Hot drinks Hot or spicy foods Stress Warm environmen
Non-vasomotor Symptoms of Menopause=
Anxiety Depression Difficulty with concentration Difficulty with decision making Difficulty with memory Headaches Insomnia Irritability Joint pain Loss of libido Mood swings Tiredness Vaginal dryness
Isoflavones=
legumes (soy, chickpeas or garbanzo, red clover, lentil, beans)
Lignans=
flaxseed, lesser amounts in lentils, whole grains, beans, fruits, vegetables
Coumestans=
red clover, sunflower seeds, sprouts
