LMBR Study Grp: Nutrition #4

Question 1

The Nurses’ Health Study showed all the following findings except:

A. Consumption of processed meat five or more times per week was associated with an increased risk of diabetes.

B. A vegan diet was associated with a 48% reduction in diabetes medications.

C. Overweight or obesity was the single most important predictor of diabetes.

D. Abstinence from alcohol was associated with a significantly increased risk of diabetes, even after adjustment for BMI.

Answer 1

B is false.

B is not from Nurses Health study, it’s from Barnard ND et al 2006 A low-fat vegan diet improves glycaemic control.

A is from Nurses health study 8 year follow up

C 16-year follow up from nurses health

D 16-year follow up from nurses health, lack of exercise, a poor diet, current smoking, and abstinence from alcohol use were all associated with a significantly increased risk of diabetes, even after BMI adjustment.

Question 2

Insulin resistance is dependent upon which factors?

A. Changes in microbiome

B. Epigenetic factors

C. Diet and Lifestyle factors

D. B and C

Answer 2

Answer is D (that is, options B and C)

Changes to microbiome can cause dysbiosis (microbiome imbalance) which decreased short-chain fatty acids production like butyrate which assist in blood sugar management, but insulin resistance is not dependent on it.

Question 3

The fasting-mimicking diet promotes Beta-cell regeneration through which model?

A. Murine (Mice)

B. Murine (Rat)

C. Bovine

D. Human

Answer 3

A. Murine (mouse)

Question 4

Select the false statement in the following:

Flaxseeds are:

1. A rich source of essential omega 3 fatty acids.
2. Able to assist in improving digestive health, relieve constipation and reducing total cholesterol.
3. One of the most potent dietary interventions to reduce blood pressure.
4. Best consumed whole.
5. Recommended as part of Dr Gregers Daily Dozen Checklist.

Answer 4

Answer 4: They are best consumed ground.

https://www.researchgate.net/…/233954194_Flaxseed_-_A… - Flaxseed - A miraculous defense against some critical maladies

Question 5

Select the false statement in the following:

Advanced glycation end products:

1. Levels can be influenced by the way a food is prepared.
2. Are compounds formed when fat or proteins combine with sugar in the bloodstream.
3. In high levels are associated with an increased risk of many diseases including diabetes, heart disease and Alzheimers.
4. Continually accumulate in the body as there is no means of elimination.
5. Levels are typically higher in animal based and processed foods

Answer 5

Answer 4.

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704564/) - Information on AGE’s

Note on Answer 2: Although some references mention fats being implicated in the chemical reaction, the prinicipal pathway appears to be “a spontaneous reaction between an amino acid (protein) and a monosaccharide (simple sugar like glucose).” BR p134

Question 6

Select the false statement in the following:

Fibre:

1. Are carbohydrates that are not typically digested for energy.
2. Promotes the growth of ‘good’ bacteria in the GI tract, which can improve gut and overall health.
3. Daily recommended intakes of 25g for women and 38g for men are met by most Americans.
4. Are found in plant foods, however refining processes can reduce levels.
5. Can lower cholesterol, stabilise blood sugar and decrease the risk of colon cancer.

Answer 6

Answer 3.

p132

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124841/) a 2016 study estimates that 95% of adults and children in the USA are not meeting daily fibre targets

Question 7

Which is true and the best correct answer regarding Advanced Glycation End Produces (AGES)?

A. AGES increase over time with increasing age, accumulating in the eye lenses and skin collagen.

B. Directly related to DM types 1 and 2, atherosclerosis, kidney disease and slow wound healing.

C. Build up leads to cell damage particularly in cells that have long life such as nerve and brain cells, renal collagen proteins, blood vessels and eye cells.

D. A and C.

E. ALL of the above.

Answer 7

E.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2ND Edition pp 134-35

Question 8

Which is true of AGES?

A. Associated with oxidative stress and inflammation. B. Formed by a spontaneous biochemical reaction between and an amino acid and a monosaccharide (eg glucose).

C. AGES form with high temperatures greater than 120 degrees C or 248 degrees F.

D. Moisture and lower heat cooking methods produce less AGES.

E. All of the above

Answer 8

E.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2ND Edition pp 134-35

Question 9

Regarding atherosclerosis, atherosclerotic plaques and cholesterol, which is incorrect?

A. Plaque progression ceases with total cholesterol < 150mg/dl (3.879mmol/L).

B. Hypercholesterolemia is the only direct risk factor for atherosclerosis.

C. Cigarette smoking, hypertension, DM, inactivity, and obesity directly produce atherosclerotic plaques.

D. At Serum cholesterol between 90-140mg/dl (2.327 -3.620mmol/L) plaque formation is not seen.

E. LDL at 50-70mg/dL (1.293- 1.810) is ideal.

Answer 9

C.

Hypercholesterolemina is the only DIRECT risk factor for atheroscleoris. There is no evidence that cigarette smoking, hypertension, DM, inactivity, and obesity directly produce atherosclerostic plaques, but if they do, it is indirect.

Foundations of Lifestyle Medicine. See The Lifestyle Medicine Board Review Manual 2nd edition pp 144

Question 10

Which is incorrect about epigenetics?

A. Epigenetics are like “set switches” passed on from parents to their children.

B. Methyl groups from plant foods and B vitamins help improve methylation.

C. Obesity, heart disease and diabetes can be due to epigenetic changes.

D. Epigenetic changes occur in the DNA sequence components of genetic inheritance.

E. These non-DNA sequence components of epigenetics control gene expressions through histone acetylation, methylation of the DNA, micro-RNA and a growing number of other molecular changes.

Answer 10

D.

Epigenetics is the study of the non-DNA sequence components of genetic inheritance through DNA methylation, micro-RNA, histone acetylation, and growing number of other molecular changes.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp 156

Question 11

Which are correct?

A. Key influencers of epigenetic expression are diet, sleep, exercise and obesity.

B. Factors that stabilizes the epigenome are polyphenols, B vitamins, exercise and parental diet.

C. Bad influences on the epigenome include sugar, alcohol, saturated fat and processed foods.

D. Epigenetics is influenced by one’s age, gender and height.

E. A, B and C

Answer 11

E.

(ie. A, B and C are all correct)

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual. 2nd edition Pp 156-157

Question 12

The suggested pathology for the increased risk of diabetes according to the eight-year follow up of the Nurses’ Health Study of 91,246 women eating processed meat 5 or more times a week include the following:

A. Nitrite exposure

B. Inflammation

C. Obesity

D. Smoking

E. Heme iron stores

Options:

1. A and B
2. A, B and C
3. A, B and E
4. E only
5. None of the above

Answer 12

3.

(ie. A, B and E are all correct)

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual. 2nd edition pp 153

Mnemonic - “HIN = Health In Nurses” (from the Nurses’ Health Study):

• Heme iron stores
• Inflammation
• Nitrite exposure

Question 13

Understanding the Dietary Guidelines for Americans and knowing the science-base that goes beyond the guidelines and why they are important is part of the learning objectives for health workers. Which is true of the Dietary Guidelines for Americans?

A. Dietary Guidelines (DG) for Americans are jointly issued by Dept of Agriculture, Dept of health and human services.

B. They are updated every 5 yrs.

C. Recommendations made by the Dietary Guidelines Advisory Committee (DGAC) – involving academia, government and industry experts.

D. Food industry influence public policy, therefore there is “compromise” or middle position or discrepancy between scientific evidence and current recommendations.

E. All of the above are true.

Answer 13

E.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual. 2nd edition Pp 115

Question 14

The Dietary Guidelines for Americans have limitations in regard to the science for nutrition versus the political nature of the Dietary Guidelines for Americans. Which of the following are incorrect?

A. Nutritional recommendations are not affected by the food industry and the United States Dept of Agriculture (USDA)’s commission to promote US agricultural products.

B. Some experts question the conclusion and methodology of the Dietary guidelines due to the involvement of biased food industries in the creation of the guidelines.

C. Food is big business and diet is a highly charged matter with political and religious overtones, so “what to eat” is about much more than science.

D. The two foods that have limitations on the Dietary Guidelines for Americans are dairy and eggs. For example, yoghurt consumption may have a protective effect on lowering inflammation but cheese is pro-inflammatory with higher plasma inflammatory biomarkers.

Answer 14

A.

Numerous nutritional recommendations are affected by the food industry and the United States of Agriculture (USDA)’s commission to promote US agricultural products.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp115 -116

Question 15

Dairy is an essential component of the “MyPlate” Dietary Guidelines and in the Standard American Diet (SAD) with dairy comprising 10% of calories consumed with about 50% of dairy consumed as “fluid milk” and about half consumed as “cheese”. With this in mind, which of the following is/are true:

A. Dairy has no or weak inverse relationship with cardiovascular disease. There is mild association with dairy and lower stroke risk; and yoghurt has lower diabetes risk.

B. Dairy has higher content of sodium and saturated fats.

C. Prior studies show moderate evidence that dairy consumption improves blood pressure and lowers the risk of diabetes.

D. Moderate evidence shows dairy improves bone health in children. 1 cup (240ml) milk decreases fracture risk by > or =5% in Caucasians and Chinese women and fortified dairy increase BMD by about 0.7-1.8% over 2 years.

E. All of the above

Answer 15

E. All of the above.

Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual. 2nd edition pp115

Question 16

Regarding eggs and the limitations on the Dietary Guideline for Americans and available studies, which of the following is/are TRUE:

A. An egg contains approximately 141- 234mg of cholesterol which can increase LDL cholesterol.

B. The 2015 Dietary Guidelines recommend eating as little cholesterol as possible but there is no limit because of inadequate evidence. The prior 2010 guidelines suggested a limit of <300mg/day.

C. Clinical studies show that for 2/3 of the population eating eggs produces a mild rise in LDL (5.55mg/dL or 0.143mmol/L) and HDL (2.13mg/dL or 0.055 mmol/L).

D. For the 1/3 of population who are considered high responders, significant rises in both LDL and HDL cholesterol are seen.

E. HDL appears to improve with egg consumption

F. Studies suggest an increased risk of diabetes with consumption of 3 or more eggs per week but no association with increased risk of cardiovascular risk.

G. All the above are true.

Answer 16

G. They are all true.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp115 -116

Question 17

Choose the best option. Which of the following are overconsumed foods:

A. Added sugars or high fructose corn syrup (HFCS) eg candies, desserts, sugar sweetened beverated and savoury snack food.

B. Cholesterol, saturated fats, and transfat, and processed grains like white rice, white pasta and white flour.

C. Potassium.

D. Sodium.

E. A, B and D

F. A and B

Answer 17

E.

(ie A, B and D are correct)

Sugar and HFCS, cholesterol, saturated fats, and sodium are the most over-consumed foods in America.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition. pp116 -117

Question 18

Regarding over consumed foods which are correct?

A. High cholesterol foods are almost exclusively of animal foods, except for some fungi.

B. Liquid calories (from sweetened beverages) contribute more sugar calories to the American diet.

C. Generally, foods highest in sodium content are the commercially prepared foods. And 50% of dietary salt come from “mixed dishes” defined by the USDA Dietary guidelines as “burgers, sandwiches, and tacos; rice, pasta and grain dishes; pizza; meat, poultry, and seafood; and soups.

D. Transfats (trans-fatty acids) are declared to be unsafe by the Food and Drug Administration (FDA) and mandated they be removed from food in 2018.

E. Potatoes and tomatoes are the most consumed vegetables but most vegetables are consumed as part of the “mixed dishes”.

F. All the above are correct.

Answer 18

F. All the above are correct.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp116 -117

Question 19

All foods containing fat have a small percentage of saturated fat. The highest concentrations are found in meats, dairy, eggs, processed foods, and oils (including coconut oils and palm oils). Which of the following is true:

A. Foods high in saturated foods have more than 8 grams per serving eg high fat cuts of beef, lamb, pork, salami, sausages, processed meats, many fast foods (cheeseburgers) and coconut ( 1 ounce dried or 28 grams dried coconut), and coconut oil (1 tablespoon).

B. Foods moderately high in saturated fats contain 4 to 7 grams per serving eg whole milk (1 cup or 240ml), leaner meats, cheese (1 ounce or 28grams), other full fat dairy and palm oil (1 tablespoon or 15ml).

C. Foods with lower saturated fats contain 1 to 3 grams per serving. Examples include nuts and seeds per ounce or 28 grams: Avocado has 2.1 gram per avocado; oils have 1-2 grams per 15m except coconut oil with 12grams/ 15ml and palm oil with 7gram/15ml. And fish varies between 1-3g per serving.

D. The top 5 sources of saturated fats include: burgers and sandwiches (especially cheese, meat or both at 19%), snacks and sweets (18%), protein foods (15%), dairy at 13%, and condiments/gravies/spreads and salad dressings at 7%.

E. All the above.

Answer 19

E. All the above are true.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp117

Question 20

True or False: A shortfall nutrient is an under consumed nutrient that at least 25% of the US population is not consuming in adequate amounts.

A. True

B. False

C. Neither true nor false

Answer 20

A. TRUE.

A shortfall nutrient is an under consumed nutrient that at least 25% of the US population is not consuming in adequate amounts.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition, pp118

Question 21

Which of the following are shortfall nutrients?

A. Calcium, magnesium and potassium

B. Fibre

C. Sodium

D. Vitamin A, D, E and K

E. Vitamin C

F. A, B, D and E are correct.

G. All the above are correct.

Answer 21

F. (ie A, B, D and E are correct)

Calcium, magnesium, potassium, fibre, Vitamins A, C, D, E and K are all shortfall nutrients whereas sodium is an over-consumed food.

p118-120

Question 22

Regarding shortfall nutrients which is false:

A. Some vegetables like spinach, beet greens and Swiss chard are high in calcium and oxalates.

B. Oxalates do not limit the absorption of calcium.

C. 40-60% of calcium are absorbed from low oxalate dark greens like okra, kale, and bok choy but only 32 to 34% from dairy are absorbable.

D. Foods containing “high” shortfall nutrients usually provide more than 20% daily value per serving and foods providing “moderate” shortfall nutrients provide between 5-20% daily value per serving.

E. Usually, adequate Vit D is synthesized by the body if large body areas (including the face, arms, legs, back or chest) are exposed to direct sunlight between 10am and 3pm.

Answer 22

B. Oxalates reduce absorption of calcium and certain nutrients.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition, pp118

NB: For additional information outside the LMBR Manual: Oxalates, phytate, tannins, and cyanide are anti-micronutrients. (Ref: Minerals and antinutrients in fluted pumpkin (Telfairia occidentalis Hook f.) https://doi.org/10.1016/S0308-8146(99)00207-1

Question 23

The healthiest foods are nutrient dense foods with the most “shortfall” nutrients with the least “over-consumed” nutrients per calories. The top foods in descending order are:

A. Vegetables including mushrooms, herbs and spices in small quantities, fruits, legumes, whole grains, nuts and seeds.

B. Vegetables, mushrooms, herbs and spices, fruits, whole grains, seeds and nuts.

C. Vegetables including mushrooms, herbs and spices in small quantities, legumes, fruits, whole grains, nuts and seeds.

D. Vegetables including mushrooms, fruits, legumes, herbs and spices in small quantities, whole grains, nuts and seeds.

E. Vegetables including mushrooms, fruits, legumes, whole grains, nuts, seeds, herbs and spices.

Answer 23

A.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition. pp 120

Edit: somewhat dodgy mnemonic - “VHF links world news services” (…VHF is a type of radio frequency…)

Vegetables incl mushrooms

Herbs

Fruits

Legumes

Whole grains

Nuts

Seeds

Question 24

The following are general principles on foods to consume. Which are true?

A. Think holistically about the total profile of the food in terms of it’s nutrients and components, thinking of the “food package” choosing the healthier options.

B. Choose whole foods which generally do not have an ingredient list because they are usually single ingredient foods eg an apple. Generally, the less processed the food, the healthier the food.

C. Check the ingredients list to make sure “nothing bad added; nothing good taken away, “ as per Dr Michael Greger MD, author of “How Not To Die”.

D. Centre on whole plant foods “Eat Food, Not Too Much, Mostly Plants” as per food writer Dr Michael Polan.

E. Eat a rainbow every day

F. All of the above

Answer 24

F.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp 121

Question 25

The basic nutrition assessment includes the elements of ABCD. These include the following except:

A. Anthropometric data

B. Bio-identical hormones

C. Clinical assessment

D. Dietary assessment

E. Biochemical data

Answer 25

B.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp 122-123

Question 26

The Role of the physician or medical provider in nutritional assessments include the following except:

A. Get a baseline history and physical.

B. Determine patient risk factors and comorbidities.

C. Create a framework for treatment.

D. Lead an integrated care team.

E. Coach patients towards personal goals with consideration of medical history.

F. Help patients set short and long term lifestyle and dietary goals.

G. Oversee recommendations by the dietitian.

Answer 26

E.

See Foundations of Lifestyle Medicine. The Lifestyle Medicine Board Review Manual 2nd edition pp 124-125

Question 27

Regarding harmful fats, which one of the following are is/are incorrect?

A. Transfat, found mainly in processed oils, is harmful.

B. Oxidized fat formed through oxidation by heat or rancidity is harmful.

C. Solid fats found in dairy, tropical fats, lard, butter, meat are harmful.

D. Stearic acid, found in dark chocolate, is not harmful.

Options:

1. A and B
2. C and D
3. C only
4. D only

Answer 27

4.

Stearic acid is found in cheese, meat, poultry, dairy and dark chocolate. Although it may lower LDL because it is unlikely to be made into cholesterol, it is harmful because it decreases endothelial cell healing, it increase endothelial damage and cell death, and it is associated with increased risk of colorectal cancer. pp 131.

Transfat, oxidized fat and solid fats are all listed as harmful fats. See pp 134

Question 28

Which is /are incorrect?

1. Partially hydrogenated vegetable oils are a source of trans fat which increase the risk of strokes and heart attack.
2. Palmitic acid is the least common saturated fat and can increase heart disease risk.
3. Palm oil and nutmeg have small amounts of myristic acid which are beneficial to health.
4. Lauric acid, a saturated fat in coconuts increases total cholesterol, both LDL and HDL.
5. Lauric acid, stearic acid, palmitic acid, myristic acid are all monounsaturated fats.

Options:

1. A
2. B and D
3. A and C
4. B, C and E

Answer 28

4. B, C and E

A. Partially hydrogenated vegetable oils are a source of trans fat which increase the risk of strokes and heart attack- -this is TRUE.

B is incorrect because Palmitic acid is the MOST common saturated fat and can increase heart disease risk. Palmitic acid is found in palm oil, butter, cheese and milk and meat.

C. Myristic acid is harmful and is found in dairy (cheese, butter, milk), coconut oil, palm kernel oil; and in small amounts in nutmeg and palm oil.

D is correct because Lauric acid, a saturated fat in coconuts increases total cholesterol, both LDL and HDL.

E is incorrect because Lauric acid, stearic acid, palmitic acid, myristic acid are all SATURATED fat.

See Lifestyle Medicine Board Review Manual 2nd edition pp 131

Question 29

All the following are true except ONE. Which ONE is False?

1. Omega 3 is a polyunsaturated fat and is anti-inflammatory.
2. Omega 6 is generally considered pro-inflammatory.
3. Arachidonic acid is neuroinflammatory.
4. Linolenic acid is anti-inflammatory.
5. The relationship between omega 3 and omega 6 is simple and well understood.

Answer 29

E.

The relationship between omega 3 and omega 6 and inflammation cannot be oversimplified because it is complex and not well understood yet.

See Lifestyle Medicine Board Review Manual 2nd edition pp 131

Question 30

Which one is incorrect?

1. Hempseed in 3 tablespoons (33g) contain 15grams of protein which is higher in percentage compared to animal foods such as beef (grass fed, chuck roast) at 85grams yields of 22 grams of protein.
2. Animal protein have more sulfur-containing amino acids which are metabolized into acidic metabolites. This requires the buffering system to leach out calcium from the bones as a buffering substate which long term contributes to good strong bones.
3. Soy protein, wheat gluten and wheat flour have ileal digestibility at 90% similar to animal based proteins which have 95% ileal digestibility.
4. Saturated fats and transfat in the diet are generally better replaced by monounsaturated fats and polyunsaturated fats from plants and seafoods.

Answer 30

B.

According to T. Colin Campbell, a more acidic diet requiring buffering to alkalinize causing calcium to leach out into the blood out of the bones can cause poor bone strength long term.

Lifestyle Medicine Board Review Manual 2nd edition see pp 129.

For additional information see https://nutritionstudies.org/animal-vs-plant-protein/

Question 31

Which ONE of the following is incorrect?

1. Obesity is the most common nutritional problem.
2. A low-fat vegan diet is superior to the American Diabetes Association Diet regarding Type 2 Diabetes.
3. Antioxidant supplements do not seem to reduce cancer risk but whole foods do.
4. There is clear evidence that pancreatic cancer, ovarian cancer, and endometrial cancer have lowered risk with high fibre plant-based diet.

Answer 31

D.

There is NO clear evidence yet for nutrition associations with pancreatic, ovarian and endometrial cancers. See pp 139
Obesity is the most common nutritional problem correlating western diseases and lifestyle. See pp 140.

A low-fat vegan diet is superior to the American Diabetes Association Diet regarding Type 2 Diabetes. See pp 141.

Antioxidant supplements do not seem to reduce cancer risk but whole foods do. pp 139

NB: additional info for interest and discussion purposes only – some studies are available now showing anti-oxidants eg polyphenols, sulforaphane, etc and their role in cancer/cancer risk management.

Question 32

Regarding Nutritional prescribing and behavioural change from patients which ONE of the following is incorrect?

1. Patients make more changes when health providers ask for more behavioural changes from their patients.
2. Patients do not accept dramatic changes.
3. Optimal therapeutic dosing must be prescribed in terms of lifestyle intervention.
4. Nutritional prescription can be used to prevent and treat some specific chronic conditions.

Answer 32

B.

The more behavioural change providers ask for, the more changes patients make. It’s not necessary to prescribe smaller changes that may not create an effect. Dramatic change is more acceptable to patients. As lifestyle medicine prescribers we need to prescribe lifestyle medicine treatment at the optimal therapeutic dosages.

See Lifestyle Medicine Board Review Manual 2nd edition pp 142

Question 33

Choose the best answer. In a study article in 1972 (Reference titled “The Etiological significance of related disease connecting Western disease and lifestyle) by Dr Dennis Burkitt, which of the following is/are incorrect?

1. Lack of dietary fiber was proposed to be a common cause of these western diseases.
2. Colorectal cancer was the 3^rd most common cause of cancer after lung cancer.
3. Haemorrhoids was present in almost one third of people over 60 years old.
4. Hiatus hernia was found in nearly one of four upper gastrointestinal tract radiological examinations.

Options:

1. A only
2. B and C
3. D only
4. B, C and D
5. C only

Answer 33

4. B, C and D.

B is incorrect – Colon and rectal cancers are the 2nd most common cause of cancer after lung cancer.

C is incorrect – Haemorrhoids are seen in almost half of the people over 50 yrs old.

D is incorrect – hiatus hernia is found in nearly one of five upper GIT radiological examinations.

See Lifestyle Medicine Board Review Manual 2nd edition pp 140

Edit. The manual has a typo regarding the date of this study: it was actually published in 1976.

Question 34

Regarding aggressively lowering blood sugars with medication to help lower cardiovascular disease risk, which of the following is/are false? Choose the best option.

1. In the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study in 2008, aggressively reducing blood sugar levels below guidelines with medications was beneficial.
2. In the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study in 2008, low risk to medium risk patients with type 2 diabetes were involved.
3. In other studies, increased insulin dosing is associated with decreased risk of cancer, cardiovascular disease and weight gain.
4. In other studies, increased insulin dosing is associated with increased risk of cancer, cardiovascular disease and weight gain.

Options:

1. A
2. B
3. A, B, C
4. A, B, D

Answer 34

C.

(A, B and C are all incorrect)

A is incorrect – The ACCORD study (Action to Control Cardiovascular Risk in Diabetes) completed in 2008 showed that aggressively reducing blood sugar levels below guidelines with medications was HARMFUL.

B is incorrect – In the ACCORD study HIGH risk patients with Type 2 Diabetes were involved.

C is incorrect but D is correct – Other studies show that increased insulin dosing is associated with increased risk of cancer, cardiovascular disease and weight gain.

See Lifestyle Medicine Board Review Manual 2nd edition pp 147

Question 35

Which one of the following is incorrectly matched? Choose one.

1. Lauric acid is found in coconuts.
2. Stearic acid is found in poultry and dark chocolate
3. Stearic acid, palmitic acid and myristic acid are found in cheese
4. Myristic acid is found in dark chocolate, dairy products, coconut oil and nutmeg
5. Myristic and palmitic acid are found in (cow’s) milk.

Answer 35

D.

A is correct. Coconuts have lauric acid and coconut oils have myristic acid.

B is correct – stearic acid is found in cheese, meat poultry, dairy and dark chocolate.

C is correct. Cheese has all three saturated fats.

D is false. Dark chocolate has stearic acid.

E is correct. Myristic acid is found in dairy (cheese, butter, milk), meat, coconut oil, palm kernel oil and small amounts of nutmeg and palm oil. Palmitic acid is also found in palm oil, butter, cheese, milk and meat.

See Lifestyle Medicine Board Review Manual 2nd edition pp 131