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Clinical Nutrition > FINAL (test 3) > Flashcards

FINAL (test 3) Flashcards

1
Q

Describe current clinical guidelines for evaluating overweight patients and establishing whether weight loss should be recommended. What three pieces to of information do you need to perform this evaluati

A

a) Overweight = BMI >25 b) Obese = BMI >30 c) Extreme obesity = BMI > 40 d)Excessive abdominal fat, excessive weight gain (in adulthood, >10lbs after age 20), and BMI

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2
Q

What percentage of the adult population is currently overweight?

A

64.50%

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3
Q

How has the prevalence of overweight in teenagers changed in the last 30 years?

A

Increased from 4.6% to 15.5%

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4
Q

Describe the importance of genetics in the current understanding of obesity

A

humans are physiologically predisposed to conserve calories to guard against future starvation. Individual genetic differences may influence weight gain (appetite patterns, metabolic rate, adipose cell development, hormonal effects, and psychological factors)

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5
Q

Describe the importance of childhood development in the current understanding of obesity

A

environment also plays a role in weight gain, kids who develop eating an abundance of calories with a decrease in activity, tend to be overweight

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6
Q

What life changes in adulthood increase the risk of weight gain?

A

Inactivity levels due to age b) Sedentary job and hobbies c) Having kids (gaining weight during pregnancy)

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7
Q

List the health risks of overweight and obesity

A

a) Coronary heart disease b) Type 2 diabetes c) Hypothyroidism d) Hypertension e) Dyslipidemia f) Gallbladder disease g) Sleep apnea h) Osteoarthritis I) Cancer of colon, breast, prostate, and endometrium j) Menstrual dysfunction

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8
Q

Describe the importance of learned eating behaviors in the current understanding of obesity

A

eating when not hungry (food as entertainment, social situation, mood states, and emotional needs) which encourages overeating

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9
Q

Describe the importance of social environment in the current understanding of obesity

A

overconsumption of calories is facilitated by abundance of high fat, high sugar foods made readily available.

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10
Q

Describe how the clinician can better understand the health risks of his obese patient through history

A

a) Evaluate personal and family history of obesity-related disease as well as current symptoms of undiagnosed disease b) Evaluate history for additional primary cardiovascular risk factors (age, smoker, family hx, or HTN) c) Evaluate patient history for contributors to weight gain and obstacles to weight loss

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11
Q

Describe how the clinician can better understand the health risks of his obese patient through physical assessment process.

A

Measure BMI and waist circumference

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12
Q

Describe how the clinician can better understand the health risks of his obese patient through lab assessment process.

A

R/O endocrine disorder, dyslipidemia, metabolic syndromes, and cardiovascular risk factors

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13
Q

What kind of diet is most likely to decrease metabolic rate, resulting in poorer results and increased risk of weight regain?

A

Atkins

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14
Q

List the possible complications associated with weight cycling

A

Diabetes, osteoporosis, gallstone disease, cardiovascular disease, some cancers, and reduced longevity

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15
Q

List the possible complications associated with rapid weight loss

A

Bone loss, gallbladder attacks, electrolyte disturbances, and lowered metabolic rate

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16
Q

What is “metabolic fitness”?

A

Ratio between mitochondrial capacity for substrate utilization and maximum oxygen uptake of the muscle. - Being fit is more important than being skinny

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17
Q

how does the concept of “metabolic fitness” differ from traditional approaches for treating obesity?

A

Focus of getting body to a healthy state, instead of worrying about weight loss

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18
Q

What is the correct method for measuring waist circumference?

A

Upright relaxed position at level of the iliac crest with normal minimal respiration

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19
Q

What pre-existing risk factors are used to gauge the potential impact of overweight or high waist circumference?

A

a) genetics b)Weight history (including eating disorders) c) Diet history d) Exercise history e) Social history f) personal health history

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20
Q

What falls under “personal health history” when gauging potential of obesity or high waist circumference?

A

a) Endocrine disorders b) Cardiovascular risk c) Metabolic syndrome d) Osteoarthritis

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21
Q

indicate if the following patient should lose weight according to national guidelines: Male, 50 years old, BMI of 27, smoker, waist circumference 37 inches

A

high risk, loss weight

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22
Q

indicate if the following patient should lose weight according to national guidelines: Male, BMI of 33, no risk factors, waist circumference 38 inches

A

high risk, loss weight

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23
Q

indicate if the following patient should lose weight according to national guidelines: Female, BMI of 27, no risk factors, waist circumference 31 inches

A

low risk, should be conscious of her weight

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24
Q

indicate if the following patient should lose weight according to national guidelines: Female, BMI of 26, fasting glucose 105mg/dL, sedentary lifestyle, waist circumference 34 inches

A

high risk d/t possible metabolic syndrome and sedentary lifestyle

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25
Q

indicate if the following patient should lose weight according to national guidelines: Male, BMI 28, hypertensive, waist circumference 41 inches

A

high risk d/t high waist circumference and HTN

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26
Q

What important information about obstacles to your patient’s attempts to lose weight might be discovered in their family history?

A

other overweight/obese family members in household, number of social/family gatherings, and multiple special situation

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27
Q

What important information about obstacles to your patient’s attempts to lose weight might be discovered in their personal health history?

A

history of unsuccessful dieting, eating disorders, endocrine problems, metabolic problems, psychological factors, and smoking/drinking

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28
Q

What therapeutic objectives are even more important than weight loss when considering how to manage an overweight patient?

A

Improvement in blood pressure, blood lipids, glucose tolerance, and other primary health goals are more important than weight loss

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29
Q

list some potential contraindications to recommending weight loss, even when supported by the national guidelines?

A

a) Repeated past failures b) Emotional/psychological issues c) Health conditions that can worsen with dieting

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30
Q

How might contraindications to weight loss be minimized?

A

a) stop trying to diet, and focus on eating healthy. Listen to when your body is hungry, and don’t eat out of boredom b) workout when stressed/sad instead of eating, don’t eat out of boredom, and see a therapist to talk about feelings c) lose weight slowly (ex. history of rapid weight loss can aggravate gallbladder)

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31
Q

What questions are useful to ask patient to determine whether they are truly ready to achieve long-term weight loss?

A

a) Why do they want to lose weight? b) Are they willing to exercise and change their diet?

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32
Q

What is a reasonable initial goal for weight loss?

A

a) Lose 5% of their weight to decrease change of diabetes b)Lose 10% of the current weight to improve health and reduce risk of failure (No more than 2lbs (1kg) per week)

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33
Q

What alternative goals can be set instead of weight loss goals?

A

a) Changes in eating habits b) Changes in exercise

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34
Q

How would you decided which type of weight loss diet is must suitable for a patient?

A

determine whether it is safe, healthy, achievable, and permanent for the patient

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35
Q

How important is exercise as a strategy for weight-reduction and weight-maintenance?

A

A )Very important b) Exercise increases caloric expenditure

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36
Q

What is meant by the following behavioral self-management terms?

A

a) Self-monitoring b) Portion control c) Stimulus control d) Cue suppression e) Contingency contracting

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37
Q

What does self-monitoring entail?

A

keeping a daily diary of food intake

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38
Q

What does Portion control mean?

A

using smaller plates at the table, ordering half portions when eating out

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39
Q

What does stimulus control mean?

A

removing temptations form home or work

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40
Q

What is cue suppression?

A

eating only at one designated place in the home, not pairing eating with enjoyed activities

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41
Q

What is contingency contracting?

A

set up recurring non-food rewards for maintaining diet

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42
Q

Why would joining a support group increase the changes of successful weight loss?

A

a) Sharing success/failure with others b) Help patient learn and practice behavioral self-management techniques may also be valuable as a cost-effective way to sustain use into long term

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43
Q

In what circumstances might referral to counseling professionals be advisable as part of a weight-loss program?

A

To teach specific skills, employ intensive behavior therapy, and to address emotional or psychological issues that may impact eating disorders

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44
Q

What supplements are supported by good scientific evidence that they can help a patient safely lose weight?

A

a) Multivitamin b) Dietary fiber c) Natural/synthetic ephedrine/caffeine combinations d) Bitter orange (citrus aurantium) e) 5-hydroxytryptophan f) Pyruvate g) chromium

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45
Q

How does a multivitamin help with weight loss?

A

ensures nutritional adequacy during weight loss

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46
Q

how does fiber help with weight loss and how much should you take?

A

helps add bulk to diet to provide feeling of fullness after a meal a) 5-7g/day helpful for enhancing weight loss b) 3-4g/day of glucomannan have shown effective weight loss

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47
Q

What are some drawback to fiber?

A

Can cause flatulence, and contraindicated for patients with esophageal/intestinal obstruction

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48
Q

How much of a Natural/synthetic ephedrine/caffeine combination should you take? And how does it help with weight loss?

A

90mg/day of ephedrine or 240mg/day of caffeine. Is a nervous system stimulant

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49
Q

What are the side effects of Natural/synthetic ephedrine/caffeine combinations?

A

Side effects may include increase heart rate, dry mouth, insomnia, and headache

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50
Q

How does bitter orange work on weight loss, and is it recommended?

A

contains similar beta-adrenergic compounds as ephedrine. Not recommended d/t poor clinical evidence and potential side effects (increased BP)

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51
Q

How much 5-hydroxytryptophan should you take for weight loss, and how does it work?

A

600-900mg/day, direct precursor to serotonin, shown to reduce appetite and promote weight loss

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52
Q

What are the side effects of 5-hydroxytryptophan?

A

GI symptoms, headache, sleepiness, muscle pain, and/or anxiety

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53
Q

How much pyruvate should you take for weight loss and how does it work?

A

6-10g/day, may increase metabolic rate and reduce insulin resistance

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54
Q

What are the side effects of pyruvate?

A

diarrhea, GI symptoms, and lowered HDL

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55
Q

How much chromium should you take for weight loss and how does it work?

A

200-600mg/day, affects carbohydrate and lipid metabolism, and promoting insulin sensitivity.

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56
Q

What are the side effects of chromium?

A

excess of 500mg/day maybe unsafe for long-term use

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57
Q

Which weight loss supplements are intended to stimulate sympathetic nervous system activity, and therefore may produce side effects of elevated blood pressure, heart rate, etc.?

A

a) Caffeine b) Ephedrine c) Bitter orange

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58
Q

What are the advantages of a high protein diet for achieving and maintaining weight loss?

A

a) Less hunger for some b) Small increases in metabolic rate

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59
Q

What are the disadvantages of a high protein diet for achieving and maintaining weight loss?

A

a) Deficiencies in some nutrients (fiber and vitamin K) b) Ketosis c) Unhealthy fat effects d) High protein effects

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60
Q

What the advantages of a low fat, high carbohydrate diet for achieving and maintaining weight loss

A

a) More calorically dilute b) Used by more successful dieters c) Usually effective for disease prevention

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61
Q

What the disadvantages of a low fat, high carbohydrate diet for achieving and maintaining weight loss

A

a) Some deficiencies possible b) May worsen metabolic syndrome risk factors

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62
Q

What are the arguments put forward by proponents of the Health at Every Size movement?

A

a) Fatness as bad paradigm is simplistic and not necessarily supported by scientific evidence b) Weight related health problems can be resolved independently c) Being fit is more important than being thin

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63
Q

What are the arguments put forward by Gleen Gaesser, Ph.D. in his article “Obesity, Health, and Metabolic Fitness”?

A

a) Fatness as bad paradigm is simplistic and not necessarily supported by scientific evidence b) Weight related health problems can be resolved independently c) Being fit is more important than being thin

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64
Q

What are the drawbacks of nonintervention studies on dietary cancer prevention?

A

Can’t control diet/lifestyle and supplemental intake

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65
Q

Describe the role of flax seed in the prevention of cancer.

A

reduced established tumor load and metastasis via enerodiol and enterolactone (high estrogenic activity). Researched with breast, melanoma, and prostate cancer

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66
Q

Describe the role of fruits and veggies in the prevention of cancer.

A

can reduce lung cancer, helpful in prevention of cancers of the stomach, esophagus, lung, oral, pharynx, endometrium, pancreas, and colon. Protective. Alium veggies (garlic, onion, leeks, & scallions) protective vs. stomach, prostate, and colorectal cancer

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67
Q

Describe the role of cruciferous veggies in the prevention of cancer.

A

contain sulforphone which has anti-cancer properties. Reduces/helps prevent prostate, bladder, and lung cancer

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68
Q

Describe the role of selenium in the prevention of cancer.

A

protective nutrient for some forms of cancer; present in thioredoxin reductase which induces cancerous cells to undergo apoptosis. Component of anti-oxidants, improves immune system response, triggers formation of natural killer cells, induces P450 enzyme in liver to help detoxify carcinogenic molecules, inhibits prostaglandins, and decreases rate of tumor growth

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69
Q

Describe the role of chlorophyll in the prevention of cancer.

A

green plants, bind to polycyclic aromatic hydrocarbons, heterocyclic amines, aflatoxin, and other hydrophobic molecules that are implicated with cancer development. Chlorophyll-carcinogen complex is much hard to absorb into body

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70
Q

Describe the role of B12 in the prevention of cancer.

A

no evidence that to be anti-cancer but could be beneficial. Methylcobalamin increased survival time and reduce tumor growth in lab mice

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71
Q

Describe the role of folic acid in the prevention of cancer.

A

dark green leafy veggies, essential in DNA methylation and DNA synthesis, reduction in colon, rectal, and breast with higher intakes of folic acid and B6 and B12. Alcohol is an antagonist to folate

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72
Q

low levels of selenium in men =

A

higher cancer risk

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73
Q

Describe the role of vitamin D in the prevention of cancer.

A

1000IU/day minimal amount needed to maintain adequate levels of vit D in absence of sun, up to 4000IU/day is safe for additional benefit. Active form of vit. D has potent anti-cancer properties. Prostate, colon, breast, ovarian, pancreatic, lung, and cervical tissue have ability to convert major circulating form of vit. D (25-D) into active hormonal form (1,25-D)

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74
Q

Describe the role of alpha and beta carotene in the prevention of cancer.

A

beta-carotene actually INCREASED risk of lung cancer in smokers. Does not have powerful protective effect in isolated pharmacological doses. Dietary carotenoids are caner preventative (alpha > beta carotene)

75
Q

Describe the role of lycopene in the prevention of cancer.

A

very protective, PROSTATE cancer! Best source is cooked tomatoes

76
Q

Describe the role of Vitamin C in the prevention of cancer.

A

at high levels, vit. C is toxic to cancer cells. Intravenous > oral doses. Amounts needed are far beyond dietary intake, but no side effects

77
Q

What are the likely reasons that intervention research using beta-carotene supplements could not replicate the promising findings about the cancer prevention potential of a high beta-carotene diet?

A

Due to using synthetic beta-carotene, patients possibly having pre-existing micro-tumors in subjects (50 yr old male smokers), or possibly due to using megadoses of beta-carotene

78
Q

Which vegetables belong to the Brassica family? Also known as the cruciferous vegetables.

A

Broccoli, cabbage, brussel sprouts, cauliflower, kale, and boc choy

79
Q

Which antioxidants have some evidence for helping prevent specific cancers?

A

a) Vitamin C – 750-3000 mg/day and decrease in colon polyp recurrence (only 2/5 trails showed effectiveness) b) Selenium – 200mcg/day and prostate cancer (1/2 trials) c) Vitamin E – 50 IU/day and prostate cancer (1/5, one found harmful

80
Q

Which is the only cancer site where an antioxidant combination was shown to reduce risk?

A

prostate

81
Q

Why is meat intake sometimes, but not always, related to cancer risk? How dose meat preparations appear to influence cancer risk?

A

Processed meats (sausage, bacon, lunch meats, and ham) are associated with colorectal cancer due to the presence of heterocyclic amines and polynuclear aromatic hydrocarbons formed with cooking the meat. Also effect of nitrites used in processed meats

82
Q

Which food is matched with lycopene that is thought to have cancer prevention activity? And how does it work?

A

a) tomatoes b) Protective vs. prostate cancer

83
Q

Which food is matched with indole-3-carbonyl that is thought to have cancer prevention activity? And how does it work?

A

a) cruciferous vegetables (contains glucosinolates) b) Protective vs. cervical cancer

84
Q

Which food is matched with isoflavones that is thought to have cancer prevention activity? And how does it work?

A

a) soy products (contains genistein) b) Protective vs. breast cancer

85
Q

Which food is matched with ligans that is thought to have cancer prevention activity? And how does it work?

A

a) Flax seed (have anti-gonadal hormone effect b) Protective vs. breast and prostate cancer

86
Q

Which dietary fats are associated with lower risk of cancer?

A

Healthy fats (omega-3) (Olive oil, fish oil, and flaxseed oil)

87
Q

How does soy isoflavones and other phytoestrogens affect estrogen?

A

Soy isoflavones and other phytoestrogens can bind to estrogen receptors, mimicking the effects of estrogen in some tissues and antagonizing the effects of estrogen in others

88
Q

How does the anti-estrogenic effect of soy and phytoestrogens affect cancer?

A

Because of the anti-estrogenic effects in reproductive tissue they could help reduce risk of hormone associated cancers (breast, uterine and prostate)

89
Q

What effect on endogenous estrogens does soy isoflavones have?

A

soy isoflavones may alter biological activity of endogenous estrogens

90
Q

Are isoflavones known to have antioxidant effects?

A

Isoflavones known to act as antioxidants in test tube, but extent to which they contribute to antioxidant status in humans is not yet clear

91
Q

How might high intake of soy during adolescence effect risk of cancer later in life?

A

may lower risk of developing breast cancer later in life

92
Q

How does soy effect risk of endometrial cancer?

A

Endometrial cancer d/t prolonged exposure to unopposed estrogen, high intakes of soy w/ its anti-estrogenic activity may protect against endometrial cancer

93
Q

What did one study of the effect of soy on prostate cancer show?

A

One study found that drinking soy milk more than once daily had a risk of prostate cancer that was 70% lower that those who never drank soy milk (Associated with reduction in risk of prostate cancer but association was not statistically significant)

94
Q

Which Malignant tumors have been found to contain vitamin D receptors?

A

Breast, lung, skin, colon, and bone

95
Q

How does Vitamin D effect cancer?

A

Biologically active vitamin D (1,25-D) found to induce cell differentiation and/or inhibit proliferation. May protect against various cancers

96
Q

Which form of Vitamin D is most effective in cancer preventions?

A

Biologically active vitamin D (1,25-D)

97
Q

how much vitamin D should be taken to reduce risk of colon cancer (as shown in a dose-response analysis)

A

Recent dose-response analysis estimated that 1000IU of oral vitamin D would lower one’s risk of colorectal cancer by 50%

98
Q

How much D3 should be taken to achieve a 50% risk reduction of breast cancer? (as shown in another study)

A

Another study found that 4000IU vit D3 would need to be consumed daily to experience a 50% lower risk of developing breast cancer

99
Q

What kind of cancer was shown to have an increase with low concentrations of Vit-D-25?

A

prostate

100
Q

What nutrients found in multivitamin-mineral may help reduce cancer risk?

A

Calcium (colorectal cancer), vitamin D, folic acid, and antioxidants

101
Q

Which B-vitamin may prevent cancer in alcohol users?

A

Folic acid, especially when combined with B12 and B6

102
Q

Which osteoporosis risk factors are considered major risk factors?

A

a) Age > 65 yo b) Vertebral compression fracture c) Fragility fracture after 40 yo d) Systemic glucocorticoid therapy > 3 months e) Malabsorption syndrome f) 1 hyperparathyroidism g) Propensity to fall h) Osteopenia appear on x-ray I) Hypogonadism j) Early menopause (before age 45)

103
Q

Which osteoporosis risk factors are considered minor risk factors?

A

a) RA b) Past history of hyperthyroidism c) Chronic anticonvulsant therapy d) Low dietary calcium intake e) Smoker f) Excessive alcohol or caffeine intake g) Weight 10% at age 25 I) Chronic heparin therapy

104
Q

What medical conditions and medications increase osteoporosis risk?

A

a) Corticosteroid, anticonvulsant, anticoagulant, aluminum-containing antacids and other acid-blockers, aromatase inhibitors, non-thiazide diuretic medication b) Gastric surgery or malabsorptive disease c) RA, diabetes, hyperthyroidism, Cushing’s disease, and other endocrine disorders, alcoholism, and kidney disease

105
Q

How is osteoporosis risk managed in young patients?

A

a) Screen for amenorrhea and disordered eating/exercise b) Healthful diet and lifestyle choices c) Supplemental bone nutrients as needed (Calcium – 1000-1300mg/day, Vitamin D alone or in multi-vitamin)

106
Q

What is the most reliable bone density method of estimating osteoporosis risk and determining the severity of bone loss?

A

DXA (duel energy x-ray absorptiometry)

107
Q

Which patients should receive bone mineral density testing?

A

a) Women 65yo + and men 7 yo + b) Younger women and men with above average risk (unexplained fractures) c) Those considering or receiving osteoporosis therapy

108
Q

Describe the elements of a healthful diet for reducing osteoporosis risk

A

a) Adequate calories and protein b) Moderate to low sodium and caffeine c) Replace soda with calcium-containing beverages d) Soy products e) Dairy products (Milk, yogurt, hard cheeses) f) Some veggies (greens, bok choy, kale, and Chinese cabbage) g) Tofu made with calcium

109
Q

Describe the elements of a healthful lifestyle for reducing osteoporosis risk

A

a) Regular weight bearing and strengthening b) Avoid or stop smoking and chronic alcohol abuse c) Minimize repeated weight loss attempts

110
Q

What are the three reasons that excessive soft drink consumption can increase osteoporosis risk?

A

contain phosphoric acid which can deplete/leach bone of calcium

111
Q

What are some good dairy products?

A

Milk, yogurt, calcium-fortified beverages, hard cheese, tofu, sardines, Chinese leafy greens (bok choy)

112
Q

What are some poorer dairy products?

A

Cottage cheese, frozen dairy desserts, broccoli, kale, white beans

113
Q

What supplement might need to be taken along with multivitamin-mineral to ensure adequate bone nutrition?

A

Calcium and vitamin D

114
Q

For which age group do calcium supplements have little effect on bone preservation?

A

Early menopause (little effect on bone loss)

115
Q

Describe the differences if any, between the various forms of calcium supplement in terms of cost, concentration, safety, and effectiveness

A

Best will contain calcium, magnesium, vitamin D and K, and trace minerals

116
Q

Describe all the mechanisms that help explain the beneficial effects of vitamin D on fracture risk

A

a) Facilitates calcium absorption into bone b) Helps improve muscle weakness and helped reduce falls by 20% c) 800IU per day is probably needed

117
Q

What other nutrient appears to improve osteoprotective effects of vitamin D?

A

Vitamin K (1000mcg/day helped reduce urinary calcium losses in postmenopausal women)

118
Q

Besides calcium, what minerals have been shown to help reduce bone loss?

A

Magnesium, copper, zinc, and manganese

119
Q

What is IpriFlavone, and why is it controversial choice for treating osteoporosis?

A

a) Synthetic isoflavone related to soy phytoestrogens b) One negative study reported low WBC as side effect

120
Q

Explain the role of vitamin K in bone formation.

A

Vitamin K2 plays an important role in bone formation. It is also involved in the prevention of bone loss. Vitamin K modifies the protein osteocalcin and gives osteocalcin the ability to bind to calcium. Calcium can then help to form the bone matrix. vitamin K also works with vitamin D to facilitate the function of osteoblasts, the bone building cells. On the other hand, it works to inhibit the production of osteoclasts (the cells which breakdown bone).

121
Q

Distinguish between the way supplements of vitamin K1 and vitamin K2 have been used in osteoporosis research.

A

a) K1 Reduced calcium loss through urine b) K2 - Osteoprotective and fracture risk-reducing effects.

122
Q

what are the common causes of Microcytic hypochromic anemia?

A

a) MAY be caused my nutritional deficiency (test w/ serum ferritin) b) Thalassemias c) Bone marrow failure d) Chronic disease (affects way nutrient is used or formation of Hgb) e) Iron-deficiency anemia

123
Q

What are the lab findings for Micro hypochromic anemia?

A

low RBC, Hgb, and/or HCT with low MCV and MCHC

124
Q

What are the common causes of Macrocytic normochromic anemia?

A

a) MAY be caused by nutritional deficiency b) B12 deficiency (Pernicious anemia, food cobalamin malabsorption syndrome, crohns/celiac sprue, or dietary deficiency) c) Folate deficiency (Dietary deficiency, alcoholism, or Crohn’s/celiac sprue)

125
Q

What are the common causes of Normocytic normochromic anemia?

A

a) NOT caused by nutritional deficiency b) Acute hemorrhage c) Blood parasite d) Bone marrow failure (Multiple myeloma, sideroblastic anemia, “normal” aging) e) Systemic/chronic disease (Endocrine, kidney, liver, infections, inflammations, malignancies, and severe protein deficiency.) f) Hemolytic anemias (Sickle cell, vitamin E deficiency, autoimmune, spleen, lead poisinign, and drug-induced) g) Athletic pseudodilutional anemia

126
Q

What are the lab findings for Normo normo?

A

low RBC, Hgb, and/or Hct

127
Q

Which conditions lead to normocytic anemia?

A

blood parasite, hemorrhage, bone marrow failure, systemic/chronic disease, hemolytic anemia, and athletic pseudodilutional anemia

128
Q

Which conditions lead to either microcytic anemia?

A

thalassemia, bone marrow failure, chronic disease, and iron-deficiency

129
Q

DDX for iron deficiency?

A

a) In non-menstruating adults, occult GI blood loss is the most common cause of iron deficiency b) Use serum ferritin to diagnose and monitor (optimal 20-200ng/mL)

130
Q

Treatment for iron deficiency?

A

a) Asses and treat any health conditions that affect iron status b) 100mg/day for several months to replenish stores c) Avoid drinking tea or coffee

131
Q

DDX for Folic acid deficiency – macrocytic normochromic

A

a) Most common form b) High risk pt: alcholics, patients with diseases that impair folate absorption c) Use serum folate to dx and monitor

132
Q

TX for Folic acid deficiency – macrocytic normochromic

A

a) Folic acid supplements b) Monitor B12 levels also, folate can mask B12 deficiency

133
Q

DDX for Vitamin B12 deficiency- macrocytic normochromic anemia

A

a) 30% risk in elderly b) High risk pt: dieases that impair absorption c) Pernicious anemia s/sx (End stage of autoimmune inflammation of stomach, May take years to develop if stores are good) d) Vegans e) Patients with unexplained neurologic problems f) Use serum B12 to diagnose and monitor

134
Q

TX for Vitamin B12 deficiency- macrocytic normochromic anemia

A

a) 10-25mcg/day, larger amounts may work faster b) Typically managed with injectable B12, can now be taken orally

135
Q

List the substances that enhance iron absorption

A

animal flesh foods, fortified foods

136
Q

List the substances that inhibit iron absorption

A

coffee, tea

137
Q

Which form of iron supplement causes more gastrointestinal side effects?

A

Ferrous sulfate

138
Q

What is the effectiveness of oral B12 supplements when malabsorption is the cause of B12 deficiency?

A

Individuals with food-bound vitamin B12 malabsorption do not have an increased requirement for vitamin B12, just need it in another form other than food (4000mcg/day for one month, 1000mcg/day thereafter for maintenance)

139
Q

Why should B12 status be of concern when large doses of folic acid are used to treat anemia?

A

Large amounts of folic acid can mask symptoms of pernicious anemia

140
Q

Which sports may encourage calorie restriction in an athlete?

A

Wrestling, boxing, any martial art, cheerleading, crew, and gymnastics

141
Q

What are the three components of the female athlete triad?

A

Low energy availability, irregular menstrual function, and bone loss

142
Q

Why is testing for anemia an unreliable method for screening athletes for iron deficiency?

A

a) Dilutional pseudoanemia @ the beginning of training which will not respond to iron supplementation b) Is d/t increased water (dilutes blood)

143
Q

When are high glycemic carbohydrates helpful for improving athletic performance?

A

During high endurance events (triathlons, marathons, etc)

144
Q

when are important times to guarantee adequate carbohydrate intake for optimal endurance sports performance?

A

a) Pre-event loading b) Carbohydrate supplementation during exercise c) Post-exercise glycogen recovery

145
Q

Of the many strategies for maximizing and sparing glycogen stores, which strategy does not seem to benefit all athletes?

A

Carbohydrate loading

146
Q

Why does carb loading not benefit all athletes?

A

Only helpful for exercises that last over 90 minutes

147
Q

What are two options for carb loading?

A

1) 10grams/day per kg body weight for 3-5 days prior to event while gradually reducing training time, ending with a day of no training; 2) perform exhaustive exercise followed by 1-2 days’ rest and a high carbohydrate diet prior to event

148
Q

Under what conditions are athletes most likely to be at risk for electrolyte deficiency?

A

Several hours of exercise in warm and/or humid conditions may result in significant depletion of sodium/other electrolytes

149
Q

Described the issues regarding how dietary protein may benefit the strength training athlete?

A

more protein is needed when calories are restricted, help provide the building blocks necessary for new muscle - Need at least 10-20g of whole protein

150
Q

Described the issues regarding how amino acid supplements may benefit the strength training athlete?

A

helps in muscle recovery - Need at least 6g essential aminos

151
Q

For which type of exercise is creating loading likely to benefit performance?

A

Those lasting 30 seconds or less (sprinting, weight lifting,

152
Q

For which types of exercise is creatine loading unlikely to benefit performance?

A

Endurance sports - Creatine increases muscle weight d/t water retention, may impair endurance

153
Q

How much creatine should be taken while “loading”? How much for general maintenance?

A

15-25 g/day for 5-6 days - Maintenance: 2-5g/day

154
Q

What enhanced creatine absorption?

A

carbohydrates

155
Q

When should you take creatine?

A

Ingestion following exercise may produce best results (Can cause upset GI or muscle cramping)

156
Q

Describe the possible benefits of glutamine and how much shoudl you take?

A

Strenuous exercise has been associated with immune suppression and increased risk of post-exercise infection, glutamine helps stave off infection - Take 5g immediately after exercise and again two hours later

157
Q

Describe the possible benefits of vitamin C and how much?

A

Strenuous exercise has been associated with immune suppression and increased risk of post-exercise infection, glutamine helps stave off infection - Take 5g immediately after exercise and again two hours laterVitamin C can help combat free radicals produced during strenuous activity and reduce muscle soreness and increase strength recovery after activity (400-3000mg/day for several days prior to and following intense exercise)

158
Q

Describe the possible benefits of alkalizing agents and how much?

A

a) When taken just prior to exercise, may improve performance in events lasting 1-1Strenuous exercise has been associated with immune suppression and increased risk of post-exercise infection, glutamine helps stave off infection - Take 5g immediately after exercise and again two hours laterVitamin C can help combat free radicals produced during strenuous activity and reduce muscle soreness and increase strength recovery after activity (400-3000mg/day for several days prior to and following intense exercise) 0mins or 30-60 minutes d/t reduction of lactic acid in muscle cells b) Sodium bicarbonate (115-180mg per lbs.) dissolved in at least 2 cups fluid taken at least 1 hr prior to exercise

159
Q

Describe the possible benefits of pyruvate and how much?

A

a) May improve results of an exercise program in an untrained person. Specifically, increased weight loss and decreased body fat have been demonstrated. Results in trained athlete is disappointing b) 6-10g/day in combo with exercise

160
Q

Describe the possible benefits of HMB and how much?

A

a) Metabolite of leucine that plays a role in protein synthesis. Research has found that HMB only has benefit in untrainted individuals when combined with exercise b) 17mg/da) May improve results of an exercise program in an untrained person. Specifically, increased weight loss and decreased body fat have been demonstrated. Results in trained athlete is disappointing b) 6-10g/day in combo with exerciseay per lbs (average of 3g/day)

161
Q

Describe the possible benefits of caffeine and how much?

A

a) Stimulates mobilization of fatty acids which may help delay depletion of glycogen stores during exhaustive exercise. b) Intense exercise lasting @ least 30 minutes appears to benefit from caffeine c) Tablets containing 3-5mg/kg body weight taken one hour before exercise (1-3c brewed coffee)

162
Q

Name the most useful supplements for upper respiratory infection (URI)

A

Vitamin C, Zinc lozenges, Echinacea, Andographis paniculata, black elderberry, Eleutherococcus senticosus

163
Q

Name the most useful supplements for Lower respiratory infections (LRI)

A

N-acetylcysteine (NAC), Souther African geranium (Pelargonium sidoides) tincture.

164
Q

Name the most useful supplements for bronchial asthma (BA)

A

Antioxidants (carotenoids, vit C, selenium), B6, Eicosanoid modifiers, Probiotics, English Ivy

165
Q

How does vitamin C help URIs?

A

a) People under severe physical stress experience a 50% less risk when taken regularly b) Shortens duration of severity of cold w/ 2-3g/day

166
Q

How does zinc lozenges help URIs?

A

a) 13-25mg every two waking hours @ starting at first sign of cold b) Must allow for complete ionization of the mineral so it can interact with viruses in oropharynx c) Desirable when it contains: zinc acetate, zinc gluconate, or zinc gluconate-glycine d) Zinc nasal sprays and gels also effective, but may damage sense of smell

167
Q

How should you use echinacea to help URIs?

A

a) E. purpurea as source species b) Liquid extracts that may have local effects in oral cavity c) Beginning treatment at very first sign of symptoms d) Frequent doses (1-5ml extract or 1 cup tea every two waking hours) in first 24 hours, but back to 3-4xday after

168
Q

How does NAC help treat LRIs?

A

a) Antioxidant b) Used to treat acetaminophen poisoning c) Mucolytic activity and 400-600mg/day is effective Tx for chronic bronchitis (Improves symptoms and prevents acute exacerbations)

169
Q

How do carotenoids help with BA and how much should be taken?

A

a) Low carotenoid diets associated with increased risk of severity of asthma b) 30/mg lycopene or 64/mg natural beta-carotene helped prevent episodes of exercise induced asthma

170
Q

How does Vitamin C help BA? And how much?

A

a) Anti-histamine effects on bronchial reactivity b) Less symptoms in diets with high amounts of vitamin C c) 500-1500mg/day help prevent exercise induced asthma

171
Q

What is seleniums relation to BA? And how much to take?

A

a) Low selenium associated with asthma risk b) 100mcg/day improved Sx

172
Q

How does B6 affect BA? How much to take?

A

a) May affect bronchial tone b) 100-200mg/day reduced frequency and/or severity c) Beneficial when people taking B6 depleting drugs (theophylline and aminophylline)

173
Q

How do eicosanoid modifiers help with BA? How much to take?

A

a) Omega-3 FA may help those physically active patients who experience exercise induced asthma in large amounts b) 1mg per lbs. body weight of Pycnogenol (extract of pine bark) has been soon to improve lung function and asthma symptoms

174
Q

What should we look for in an effective zinc lozenge formula?

A

a) Desirable when it contains: zinc acetate, zinc gluconate, or zinc gluconate-glycine b) NOT: citric acid, tartaric acid, vitamin C, sorbitol, and mannitol

175
Q

For which respiratory condition has Andrographis paniculate been effective?

A

URI

176
Q

For which respiratory condition has Sambucus nigra been effective?

A

URI (black elderberry)

177
Q

For which respiratory condition has each Pelargonium sidoides been effective?

A

LRI (south african geranium)

178
Q

For which respiratory condition has Hedera helix been effective?

A

BA (english ivy)

179
Q

What is the active constituent in Andrographis paniculate?

A

andrographolides

180
Q

What is the active constituent in Sambuca nigra?

A

quercetin and anthocyanins (black elderberry)

181
Q

What is the active constituent in Pelargonium sidoides?

A

7-hydroxycouramin and catechin phenolic compounds (african geranium)

182
Q

What is the active constituent in Hedera Helix?

A

saponins (alpha hedarin) (english ivy)

183
Q

What two herbs compose the Chinese herbal combination known as Kan Lang?

A

Combines andrographis and eleuthero

Clinical Nutrition (5 decks)

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