Midterm 1 Flashcards
Clinically useful botanicals for migraine prevention
Butterbur (petasite hybridus)
Feverfew (Tanacetum parthenium)
Clinically useful botanicals for musculoskeletal health
Cayenne (capsaicin) Willow bark Devils claw Bromelian and flavonoid containing botanicals Botanical oils high is GLA
Clinically useful botanicals for cardiovascular health
Garlic
Hawthorn
Horse chestnut
Clinically useful botanicals for Respiratory health
Echinacea purpurea andrographis panniculata Sambucus nigra (black elderberry) Pelargonium sidoides (Umcka) Hedera helix (Ivy Leaf)
Clinically useful botanicals for Cognitive Health
ginkgo biloba
Clinically useful botanicals for psychological health
St. John’s Wort
Valerian
Kava
Clinically useful botanicals for Liver Health
Milk thistle
Clinically useful botanicals for Prostate Health
Saw Palmetto
Pygeum
Clincally useful botanicals for Gynecological health
Vitex agnus (Chaste tree) Black cohosh (Cimicifuga racemosa)
Horse Chestnut
Cardiovascular health
Sambucus nigra (Black elderberry)
Respiratory Health
Pelargonium Sidoides (Umcka)
Respiratory Health
Feverfew (Tanacetum Parthenium)
Migraine prevention
Saw Palmetto
Prostate Health
Vitex angus
Gynecological Health
Black cohosh (Cimicifuga racemosa)
Gynecological Health
Adaptogen
generally strengthens the body system (also called tonic)
asian ginseng, siberian ginseng
Analgesic
reduces or relieves pain
Anodyne
pain relieving, not as potent as anesthetic or narcotic
Antihelmintic
expels or distroys intestinal worms (also called Vermifuge)
Antipyretic
reduces or prevents fever (also Fibrifuge)
Antispasmodic
relieves spasms or cramps
Aphrodisiac
increases sexual desire or potency
Astringent
contracts or shrinks tissue, used to decrease secretions or control bleeding
witch hazel, horse chestnut
Bitter tonic
possesses an acrid, astringent or disagreeable taste that stimulates flow of saliva and gastric juices
gentian root
calmative
mild sedative or hypnotic properties
Carminative
stops the formation of intestinal gas and helps expel gas that has already formed
peppermint, chamomile
Cathartic
powerfully activates intestinal peristalsis, used to relieve severe constipation (also purgative, compare laxative)
Cholegogue
stimulates secretion and release of bile (also called Choleretic)
Cholerectic
cholegoge- stimulates secretion and release of bile
Counterirritant
causes a distracting irritation intended to relieve another irritation
Demulcent
soothes irritates tissue, especially mucous membranes
slippery elm, aloe leaf
Diaphoretic
promotes sweating
Diuretic
promotes urine production and flow
Emetic
induces vomiting
Emollient
softens or soothes skin
Expectorant
increases bronchial secretion and facilitates their expulsion through coughing spitting or sneezing
Fibrifuge
see antipyretic
Galactogogue
increase secretion of milk
Hepatic
affects the liver
Laxative
generally promotes bowel movements
Senna, cascara, psyllium
Nervine
calms nervousness, tension or excitement
Pectoral
relieves aliments of the chest and lungs
Purgative
see cathartic (strong laxitive)
Sedative
reduced nervous tension; usually stronger than a calmative
valerian
Soporific
induces sleeo
Stimulant
excited or quickens a process or activity of the body
Stomachic
gives strength and tone to the stomach or stimulates the appetite by promoting digestive secretions
Tonic
see adaptogen- to strengthen
Vermifuge
see antihelmintic- to get rid of worms
Powder
dried and ground plant part used in tablets and capsules
Infusions
weak extractions using brief exposures to hot water as in making tea
Decoction
stronger extraction than infusions by boiling water for longer periods
Tincture
fliud extractions (usually alcohol) with longer exposure time (up to weeks) concentration is usually 1herb:5-10parts fluid
Fluid extract
fluid extracted after which some of the fluid is distilled away
typically 1:1 concentration
Solid extract
Most concentrated extract produced by evaporating all fluid
typically 2:1 to 8:1 concentration
Standardized extract
extract produced to contain a constant amount of one or more known active ingredients
concentration of active ingredient(s) appears on lable
BID
2x/day
TID
3x/day
QID
4x/day
Q4H
every four hours
PRN
as needed
St John’s Wort scientific name
Hypericum perforatum
St John’s Wort: Part of the plant used
Aerial (above ground) harvested during the flowering season
St John’s Wort: Physiological effects
Inhibition of monoamine oxidase (MAO inhibitor)
inhibition of neurotransmitter reuptake, including serotonin, norepinephrine, and dopamine
possibly modification to receptor and the hypothalmic-pituatary-adrenal axis
induces cytochrome P450 activity- this can affect the metabolism of several drugs
St John’s Wort: Active constituents
Hypericin and other dianthrones (benchmark for standardization)
Hyperforin (becoming an additional standardization benchmark)
Hypericin
St John’s Wort- original standardization
Hyperforin
St John’s Wort- additional constituent for antidepression
St John’s Wort: Clinical evidence of effectiveness for indicated uses
Consistently effective for mild, moderate and severe depression in adults (know more about adults)
studies have shown that SJW is equivalent to antidepressant drugs
Study showed once daily 900mg in adults and children 600-900mg to be effective. One of two supplements safe and effective for depression-the other one is S-adenosylmethionine-SAMe
St John’s Wort: Extraction and standardization criteria for effective preparations
standardized alcohol extract containing 0.3% hypericin
300mg TID is most common- up to 1200mg BID for major depression. doses as low as 500mg/day may be effective.
studies have shown that 5% hyperforin was more effective that 0.5% hyperforin
St John’s Wort: Necessary cautions and precautions (containdications, side effects, pregnancy/lactation issues, drug interaction issues)
Contraindications: Current antidepression medication, bipolar disorder or current treatment with drugs (watch the P450)
Side Effects: better tolerated than antidepressant medications but may include upset stomach, fatigue, itching, sleep disturbances, skin rash and increased skin photosensitivity.
Interactions: if hyperforin content is high it may increase the catabolism of other drugs
may increase the activity of other drugs
may cause irregular bleeding or decreased effectiveness of oral contraceptives
Pregnancy/Lactation: No restrictions known but unknown risks suggest caution
Somatoform disorder
features symptoms such as chronic pain than cannot be explained physically but can be attributed to psychological factors- your emotions inflate your physical symptoms- SJW was rates a B in treating this disorder
Dysthymic Disorder
minor depression
The longevity program makes several recommendations for achieving an optimal diet. On which dietary patterns are these recommendations based?
Mediterranean diet, dash diet, USDA/Harvard Healthy Eating Index
What foods and food components would be emphasized on the longevity diet? Which ones would be restricted of avoided?
Focused on fresh fruit, veggies, healthy protein, limited red meat and processed meats, whole grains over refined grains, lower fat dairy, healthy oils, limited sweets and sweetened beverages
Which supplement is recommended in the Longevity Program? Which supplement recommendations are more speculative?
Multivitamin-mineral with iron for premonopausal women
- additional vitamin D/antioxidants/fish oil?
What are the non-nutrtional recommendations of the longevity program, and why are they important?
Mental health management (stress and depression effects)
environmental health management
Four main therapeutic programs
Longevity
Functional Restoration of Body Systems (detox/xenobiotics)
Allergy Elimination
Prostaglandin Modification
The detoxification program assumes that exposure to xenobiotics may occur from which parts of the external environment
Air food water
How are exercise and heat used in detoxification strategies
Used to mobilize and remove toxins
Describe the detoxification methods used in the Hubbard program
Daily immediate release niacin supplementation to induce lipolysis
Moderate aerobic exercise to increase circulation and lipolysis
Intermittent moderate heat saunas
Fatty acid and multivitamin mineral support for improved nutritional status.
As reported in the scientific literature, what types of health problems and toxic exposures has the Hubbard program been successful to treat
Firefighters- ground zero
Name the five organs of detoxification
Intestine, liver, kidneys, skin, lungs
Explain the basic purpose of each of the two phases of liver detoxification
Phase/Step 1- Cytochrome P450 toxic chemical to less toxic
Required: B vitamins, folic acid, glutathione, antioxidants, carotenoids, vit E&C
Phase/Step 2- conjugation pathway the liver cells add another substance to a toxic chemical or drug to render it less harmful so that it can be excreted from the body
Required: Amino acids, sulphurated-phytochemicals found in garlic & cruciferous vegetables
What is the relationship between intestinal dysbiosis and systemic disease
There are a lot of connections, even between types of arthritis- dysbiosis= unbalanced microbiome
What is meant by the “leaky gut”
The gut is supposed to be semipermeable and selective, there is evidence that this barrier doesn’t work well sometimes and lets things in that shouldn’t be let in. Things like alcohol and NSAIDs can make this worse.
Describe four methods for restoring optimal function of the intestine
REMOVE- stressors from the environment, antigenic foods, additives, drugs, chemical agents, bacteria, fungi, parasites
REPLACE digestive secretions as needed, HCL, digestive enzymes, bile acids
RE-INOCULATE with beneficial bacteria-pre or probiotics
REPAIR (above 3 +) key nutrients include zinc and glutamine
How could a patient have an allergy that is provoking symptoms without knowing they have an allergy?
delayed hypersensitivity response, may not be able to put two and two together. You may have a chronic symptom because you do not know it is triggering it. “hidden allergies.”
For some disease that are known to have certain allergies attached to them, it might be worth taking that food out of their diet. ie- Rheumatoid arthritis
What are the pros and cons of laboratory testing for food allergies?
No one test is perfect, allergy testing is never complete.
costly and unreliable- there are several possible mechanisms for allergic responses and lab tests are usually only specific for one mechanism such as IgE or IgG
What foods are almost always eliminated in a food allergy elimination diet?
Dairy and wheat. Should really do this with the top 10 or 20 allergic foods.
Describe how you would explain the method of the allergy elimination and challenge program to a patient
Remove it for 1-3 weeks to see if you start feeling better
What is the purpose of the rotation diet and how is it used?
To slowly add those foods back in to try prevent re development of an allergy
What health problems or risks may be helped by the prostaglandin-modification program
Chronic inflammatory conditions; conditions relating to platelet function, smooth muscle irritability; other prostaglandin functions
List the strategies that make up the prostaglandin-modification program
Remove the bad AA, provide cofactors, provide good fatty acids
What food sources or arachidonic acid should be limited in the prostaglandin-modification program
limit- animal flesh, dairy fats, egg yolk, hydrogenated (trans) fats and alcohol.
only mammals make AA
What foods can be eaten frequently to improve the balance between friendly and unfriendly prostaglandins?
Fish oil omega 3 fatty acids helps inhibit arachidonic acid production + anti inflam agents
Gamma linolenic acid- can be a precursor to beneficial eicosanoids, and may not be produced in adequate amounts under certain conditions. -these are plant based and omega 6.
What are the sources for gamma linolenic acid supplementation? For omega-3 fatty acid supplementation? Which are the most potent sources for each? What precautions should be taken when using them?
Gamma linolenic acid is not in food but it is in some seeds that we can process it from. theraputic amounts start at 500mg/day. Goes to 2800mg/day. 2-6 borage oil capsules per day Evening Primrose oil
Omega 3- certain fish (mackerel, herring, chinook/king/atlantic/sockey, oysters, albacore, tuna, rainbow trout) flaxseed and walnuts and their oils, canola oil.
Omega 3 supplements: Omega 3 better than flaxseed oil. theraputic starts at 1000mg/day of EPA+DHA. 1-10g/day. prevention or intervene? 1g/day=heart disease prevention
3g/day= already have heart disease
3-8g/day= artritis
3-10g/day=kidney disease
What are three mechanisms behind the concept of an antiinflam diet? What foods would typically appear in these diets and which foods would be limited or removed?
Close to the Mediterranean diet
- Lots of fruits and veggies
- minimize saturated and trans fat
- good sources of omega 3
- watch intake of refined carbs like pasta or white rice
- lots of whole grains
- lean protein
- no processed food
- spice it up: ginger, curry
Unfriendly arachidonic acid sources
animal flesh, dairy fats, egg yolk. AA itself is not inflammatory but these have precursors to other nasty things (ecosonoids)
Dietary inhibitors of normal prostaglandin metabolism
hydrogenated (trans) fat
alcohol
Cofactors for optimal prostaglandin metabolism
Vitamin B6, magnesium, zinc
How do recent US guidelines for assessing and treating Atherosclerotic Vascular Disease ASCVD risk depart from Canadian and earlier US guidelines?
Stroke is added to CAD in risk predicton calculations
race is added to reflect risk
Cholesterol lowering goals have been changed
moderate short term risk for ASCVD has been changed so more people qualify for treatment
statins are used more immediately now. less initial non pharmacological therapy treatment used.
What ASCVD prevention interventions should be used for all individuals regardless of their personal risk for ASCVD?
Diet, exercise and lifestyle to reduce ASCVD
What risk assessment should be done in all adults 40 years of age and older and in younger adults in whom elevated risk is suspected?
10 year risk of ASCVD calculated every 4-6 years
How are moderate and high ASCVD risk defined?
People with moderate risk should recieve additional treatment. modified risk is defined as a elevated 10-year risk of ASCVD, US guidelines state about 7.5% or higher, Canadian state 10% or higher.
What clinical measurements are needed to assess whether the metabolic syndrome is present?
Metabolic syndrome is present when three of any of the following is present:
Abdominal obesity
Triglyeride levels 150mg/dl or over or medication treated
HDL cholesterol less than 40 in men, 50 in women or medically treated
Blood pressure 130/85 or medically treated
Fasting glucose 100mg/dl or medically treated
Blood cholesterol intervention decisions are aimed at improving which specific blood laboratory value?
LDL
Describe the general dietary pattern recommended for ASCVD prevention
Rich in fruits, vegetables, whole grains, fatty fish, low fat dairy, lean poultry, nuts, legumes,
Like the mediterranean diet or dash diet. Plant based with low processed foods
What four characteristics define the food recommendation in the dietary portfolio of cholesterol lowering foods?
Plant sterols, soy protein, nuts and/or viscous fiber
What foods or food components increase the Mediterranean Diet Score? Which ones lower the score?
see page C14. Basically just eating lots of veggies, fruits, nuts, fish, legumes, if you eat enough you get a point, if you dont you do not get the point. Need at least 6 points for highest benefit and less than 4 means there is little or no protection. There are 9 questions.
When is moderate alcohol consumption not recommended for a patient with elevated ASCVD risk?
Elevated triglyceride levels or other contraindications
Describe the benefits of phytosterols (plant steroids) and how their consumption can be increased.
lowers concentrations of serum total and LDL cholesterol
Plant sterols can be added to low fat yogurt, low fat milk, low fat cheese, dark chocolate. However are found to be more effective when in margarines, mayonnaises, vegetable oils, salad dressings
Which viscous fiber supplements are available as blood cholesterol treatment options?
Beta-glucan
Glucomannan
Psyllium hust
Guar gum
Describe an appropriate garlic supplement for treating blood cholesterol
Fresh garlic powder yielding at least 4000mcg allicin per daily dose
Describe an appropriate red yeast rice supplement for treating blood cholesterol. What precautions should be taken when using this supplement?
Chinease red yeast rice extract, at least 1200mg daily supplying at least 7mg total lovastatins per day.
Precautions: consider cotreatment with coenzyme C10
measure CK if muscle symptoms develop
Measure hepatic functions is symptoms develop
What intervention options are available for treating high ASCVD risk patients or for intensifying treatment of moderate ASCVD risk patients?
You want to achieve at least 50% reduction in LDL cholesterol levels.
- Rule out secondary causes of hyperlipidemia
- Refer for intensive diet, exercise and or lifestyle interventions in a 1 on 1 setting
- Chinese red yeast extract up to maximum tolerated dose
- Refer for statin therapy
- Niacin: immediate release up to 3000mg/day or extended release up to 2000mg/day
What precautions should be taken when using niacin for blood lipids?
Monitor transaminases, glucose tolerance, uric acid
To minimize flushing start doses low and build up, take with food or pre medicate with aspirin 30 minutes prior
What treatment options are available for elevated blood triglycerides? What treatment options are available for low blood HDL?
blood triglycerides: all of the normal ones- rule out 2ndary cause, healthy weight, diet and exercise, limit alcohol, fish oil and niacin
low blood HDL: stop smoking, moderate drinking ok, niacin
What is considered high risk for ASCVD
High risk should receive intensive treatment. High risk is any of the following
- clinical evidence of current ASCVD (CAD, cerebrovascular or peripheral arterial disease)
- LDL cholesterol over 190mg/dl or higher
- Over age 40 with type 1 or 2 diabetes AND elevated 10 year risk
- Canadian guidelines define high risk as 10-year risk of 20% or greater
Which diet, exercise, and other lifestyle factors specifically impact blood pressure?
Weight loss if overweight reduce salt intake increase physical activity diet similar to DASH limit alcohol
What are the six food categories of the DASH diet? What minerals is the DASH diet designed to provide in generous amounts?
Grains and grain products, vegetables, fruits, low fat or non fat dairy, meats poultry and fish, nuts seeds and legumes.
Potassium (need grams, problem prescribing, can use salt substitutes, watch for kidney disorders), Magnesium (350mg), Calcium (1000-1200mg)
Which supplements are treatment options for lowering blood pressure?
Coenzyme Q10, fresh garlic powder (at least 4000 mcg allicin per daily dose), fish oil (delivering at least 3000mg daily)
Describe an appropriate form of chocolate for treating blood pressure
high polyphenol content, at least one ounce containing at least 50% cocoa content
What foods are the top sources of sodium in the American diet?
Meat pizza White bread Processed cheese hot dogs spaghetti sauce Ham catsup cooked rice white rolls flour tortillas
What treatment options are available for insulin resistance?
Low carb/low glycemic diet
re emphasize diet, exercise and lifestyle
recommend multi, want 100% vit D, magnesium, zinc, and chromium (consider chromium supplement-500 mcg)
Alpha-lipoic acid 600mg daily
Dark chocolate 3.5oz
refer for pharmacological therapy
What treatment options are available for homocysteinemia?
Folic acid, B12, B6
they are controversial
consider measuring plasma homocysteine to detect elevated levels and treat with folic acid & vit B12 (400mg each/day)
multivitamin with B vitamins in it
What treatment options are available for prothrombotic state?
Low dose aspirin therapy is routine
- fish/fish oil (at least 1000mg/day of EPA+DHA)
- garlic, ginko biloba and vit E have anticoagulant activity
What treatment options are available for endothelial dysfunction?
Occurs early in the pathogenesis of artherosclerosis, reduces availability of NO
increase intake of polyphenols from tea, fruit, wine, dark chocolate
increase intake of fish and fish oils
What treatment options are available for chronic systemic inflammation?
increase plant sterols, soy protein, nuts and or viscous fiber
multivitamins-mineral (want 100% B6, C, E, magnesium)
Chinease red yeast rice extract (1200mg daily- 7mg lovastatins)
referral for statin therapy
Garlic: common and scientific names
Allium sativum
Garlic: Parts of the plant used:
Bulb, containing individual cloves
Garlic: Active constituents
Allicin and related sulphur compounds
Garlic: physiological effects
antimicrobial hypocholesterolemic antithrombotic/fibrinolytic antioxidant tumor inhibiting, anti carcinogenic
Garlic: clinical evidence of effectiveness for indicated uses
hyperlipidemia- all by itself it is not as strong as statins but combined with other things could be as significant
hypertension- reduces BP
atherosclerotic disease- good
Garlic: Nessasary cautions and precautions
contraindications, side effects, pregnancy/lactation, drug interaction issues
contraindications: pre surgical status: bleeding
known allergies
Side effects:body ordor, heartburn and flatulence
Interacts with anticoagulents-icrease bleeding time and alters drug metabolism- may decrease HIV meds
Babies may get upset stomachs
Valerian: Common and scientific name
Valeriana officinalis
Valerian: Parts of the plant used
Root
Valerian: Active constituents
Volatile oils
sesquiterpenes such as valerenic acid
iridoid esters such as valepotraites
flavonoids such a linarin
Valerian: physiological effects
acts on CNS- mood and sleep disorders- INSOMNIA AND ANXIETY
sedative-hipnotic, anxiolytic, antidepressant, anticonvulsant, antispasmotic
binds to gaba- sedative
changes EEG wave patterns
counteracts caffeine
Valerian: Clinical evidence of effectiveness for indicated uses
sleep: mixed results-better when mixed with other things and at high doses. mixed with lemon balm or hops
as muscle relaxant- unknown
anxiety- varied results
Valerian: Nessasary cautions and precautions
contraindications, side effects, pregnancy/lactation, drug interactions
Should not be combined with sedative, barbiturate therapy or general surgical anaesthesia without medical consent.
does not appear to reduce reaction time etc.
does not seem to react with other drugs
no research on human pregnancies
Kava: Name and scientific name
Common Kava kava
Scientific Piper methysticum
Kava: part of the plant used
Rhizome
Kava: active constituents
Kava-lactones aka kava-pyrones
Kava: physiological effects
Analgesic, centrally mediated muscle relaxing, and anticovulsant effects
may bind to GABA receptors, maybe also dopamine, opioid and histamine.
possibly antidepressant, hippocampal and limbic system effects
smooth muscle relaxant
Kava: Clinical evidence of effectiveness for indicated uses
Known to be good with anxiety, anxiety in menopausal women, anxiety with depression, , good with mental stress/insomnia
Kava: Nessasary cautions and precautions
contraindications, side effects, pregnancy/lactation, drug interaction
contraindicated if on sedative, antidepressant or anti-psychotic therapy. or going under general anaesthesia.
Excess causes intoxication, some cases of hepatotoxicity
occasional GI distress, possible allergies, may turn skin yellow, driving and memory not impaired
not recommended during pregnancy, may increase your memory when drunk
Garlic: effective forms
garlic powder 600-900mg daily
garlic oil may not be as effective as the powder
fresh garlic 1 clove/day
aged garlic extract
Valerian dosage and administration
Dried root powder, Root extracts (5:1 or 8:1)
Dosage and administration of Kava
50-100mg (35-70 mg kava lactones TID for anxiety
120-200 mg/day for stress related insomnia
