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Clinical Nutrition I (BECK) > Midterm 1 > Flashcards

Midterm 1 Flashcards

1
Q

Example of adaptogen

A

Ginseng

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2
Q

Example of astringent

A

Witch hazel

Horse chestnut

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3
Q

Example of bitter tonic

A

Gentian root

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4
Q

Example of carminative

A

Peppermint

Chamomile

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5
Q

Example of cholagogue

A

Dandelion

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6
Q

Example of demulcent

A

Slippery elm

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7
Q

Describe powder

A

Dried and ground plant part used in tablets and capsules

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8
Q

Describe infusion

A

Brewed briefly as a tea

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9
Q

Describe decoction

A

Boiled for a longer time

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10
Q

Describe tincture

A

Extract with solvent e.g. alcohol

1: 5
herb: alcohol

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11
Q

Describe fluid extract

A

Solvent partially distilled off

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12
Q

Describe solid extract

A

All solvent removed
5:1 concentration
Herb:alcohol

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13
Q

Describe standardized extract

A

Produced to deliver consistent amount of one or more active or marker compounds

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14
Q

What are the 4 therapeutic programs?

A

Longevity
Functional restoration
Allergy elimination
Prostaglandin modification

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15
Q

What is the basics of a longevity therapeutic program? 3

A

Diet/exercise
Mental health (stress & depression)
Environmental health: minimize environmental exposure

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16
Q

What is predicted to become the #2 cause of death?

A

Depression

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17
Q

What are the effects of stress and depression?

A
  • Contributes to multiple diseases e.g. heart disease, chronic pain
  • Reduces QOL and work productivity
  • predicted to become #2 cause of death
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18
Q

What is the main idea/goal of functional restoration program?

A

Correct underlying disturbances of body system that is thought to be the root of disease

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19
Q

What are the 2 parts of functional restoration program?

A

GI rehab

Detoxification support

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20
Q

What are the 4 Rs to restore GI integrity and function?

A

Remove
Replace
Re-inoculate
Repair

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21
Q

What is the only detox program with published research?

A

Hubbard program

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22
Q

What is the goal of allergy elimination program?

A

Remove sx-producing sources in the diet or environment

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23
Q

What are elimination options?

A 
Water fast
Hypoallergenic formula
Hypoallergenic diet
Combined formula and diet
Remove sus foods only
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24
Q

What program was set up for ground zero workers after 9/11?

A

Hubbard program

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25
Q

What are the 3 main parts of Hubbard program?

A

Lipolytic exercise
Low-heat saunas
Nutritional support

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26
Q

What is a timeline to eliminate allergens?

A

Take food out
Observe for Sx reduction 1-3 weeks
If Sx clear, challenge with 1 eliminated food per 24-48 hours
- If sx provoked, remove and rechallenge 3 months later
- if sx not provoked, eat in mod but never daily

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27
Q

What is the basis of prostaglandin modification?

A

Eicosanoids mediate many pathological states

Influenced by: diet, lifestyle, supplements, environ factors

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28
Q

What are the key players for prostaglandin modification

A

AA (Arachidonic acid)
GLA (gamma-linolenic acid)
Fish oil; omega-3 FA

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29
Q

What does AA do?

A

Arachidonic acid (AA) are metabolites implicated in many disease including asthma, HTN, atherosclerosis, menstrual cramps, chronic inflammatory disease

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30
Q

What is GLA?

A

Precursor to beneficial eicosanoids, may not be produced in adequate amts under certain conditions

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31
Q

How much GLA/day?

A

500-2800 mg/day

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32
Q

Examples of GLA from least concentrated to most concentrated

A

Evening primrose oil
Black currant seed oil
Borage oil *1200mg/day for anti-inflammation effects

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33
Q

What does fish oil/omega-3 FA do?

A

Inhibit arachidonic acid production

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34
Q

Plant sources with omega-3 FA?

A

Flaxseed
Walnuts
Canola oil

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35
Q

How much EPA+DHA/day?

A

1-10 grams per day of EPA+DHA

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36
Q

What does a prostaglandin modification program look like?

A

Removed unfriendly AA
Remove known inhibitors of normal prostaglandin metabolism
Provide cofactors for prostaglandin metab
Provide FA that are precursors of friendly prostaglandin and/or inhibit production of unfriendly prostaglandin

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37
Q

What are dietary sources of undfriendy AA?

A

Animal meat
Dairy fat
Shellfish

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38
Q

What are inhibitors of normal prostaglandin metab?

A

Trans fat

Alcohol

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39
Q

What are cofactors for optimal prostaglandin metab

A

Vit B6
Magnesium
Zinc

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40
Q

What is a low arachidonic acid “anti inflammatory diet”

A

Dietary fat from plant sources
Low-nonfat dairy only
Minimal-no animal flesh
No egg yolks

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41
Q

What is a botanical for depression?

A

St. John’s wort

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42
Q

Scientific name for St. John’s wort?

A

Hypericum perforatum

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43
Q

What parts of Hypericum perforatum / St. John’s wort do you use?

A

Above ground parts

Harvest when flowering

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44
Q

What are Hypericum perforatum/ St. John’s wort active consituents? Which one is 1st important standard and 2nd important?

A

Hypericin *1st
Hyperforin **2nd
Flavonoids

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45
Q

What are the 2 physiologic effects of Hypericum perforatum/ St. John’s wort?

A
  1. Neurotransmitter fxn modifications: serotonin, norepi, dopamine

Inhibits synaptic reuptake, similar to common antidepressant drugs

  1. Affects neuroendocrine system (HPA axis)
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46
Q

What is Hypericum perforatum /St. John’s wort used for?

A
  • Mild-moderate major depression
  • Helps mood, sleep, body symptoms
  • Possibly effective for “somatoform disorders” e.g. chronic pain patients, physical sx w/o physical pathology
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47
Q

How much Hypericum perforatum /St. John’s wort/day and what kind of preparation is done?

A

300 mg TID dried alcoholic extract of flowering aerial parts containing

0.3% hypericin OR
1-3% hyperforin

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48
Q

In Hypericum perforatum /St. John’s wort, how much of each constituent is necessary?

A

0.3% hypericin OR
1-3% hyperforin

In 300 mg TID dried alcoholic extract of flowering aerial parts

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49
Q

Contraindications for Hypericum perforatum/ St. John’s wort?

A

Bipolar disorder

Antidepressant drugs

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50
Q

Side effects for Hypericum perforatum/ St. John’s wort?

A 
Upset stomach
Fatigue
Itching
HA
Sleep disturbance
Skin rash
Skin photosensitivity at high doses
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51
Q

At high doses, what side effect might show up with Hypericum perforatum /St. John’s wort

A

Skin photosensitivity

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52
Q

What is ASCVD

A

Atherosclerotic Cardiovascular Disease

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53
Q

What disease does ASCVD encompass

A

Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease

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54
Q

What are risk components of atherosclerotic vascular disease? (8)

A 
Dyslipidemia
HTN
Insulin resistance
Platelet dysfxn
LDL oxidation
Hyperhomocysteinemia
Arterial dysfxn
Inflammation
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55
Q

What is dyslipidemia characterized by?

A

Elevated LDL
Low HDL
Elevated Tg

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56
Q

What factors help evaluate risks for vascular disease?

A 
Age
Genetics
Lifestyle
Adiposity
Lipids
BP
Other
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57
Q

What is the prevention principle of ASCVD?

A

Give diet, exercise, lifestyle advice to all

Measure ASCVD risk routinely in older adults and younger with suspected risk

Tx risk factors when indicated: HTN, obesity, metabolic syndrome

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58
Q

What is the 10 year ASCVD risk calculator used for?

A

Predict risk in currently healthy people

Calculated from age, gender, race, HDL, total cholesterol, systolic BP, smoking status, presence of diabetes

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59
Q

What is a low risk number in US and Canada for an ASCVD risk?

A

<7.5 US

<10 Canada

60
Q

What is high risk LDL US vs canada?

A

> 70 mg/dL US

> 135 mg/dL Canada
PLUS >70 mg/dl with additional risk factors
PLUS >70 with 10 year risk fo 20% or more

61
Q

ASCVD high risk indicators: (5) AKA you don’t need to evaluate if they have these diagnoses/history/disease processes/lab results

A 
Current ASCVD dx
LDL cholesterol >190 mg/dl
Diabetes
CKD in >50yo
Hx of AAA
62
Q

What is the lifestyle recommendation for prevention of ASCVD? (6)

A
  • Mediterranean or DASH diet
  • Regular mod/vigorous physical activity
    = Healthy weight
  • Tobacco smoke avoidance
  • Moderate alcohol usually ok
  • Stress management
63
Q

What supplements can people with ASCVD take?

A

Phytosterols
Viscous fibers
Standardized fresh garlic powder

64
Q

How much Phytosterols/day?

A

2 grams/day with meals

65
Q

How much viscous fibers/day? (Range)

A

3-15 grams/day

Beta-glucagon 3
Glucomannan 4
Psyllium husk 10
Guar gum 15

66
Q

How much garlic /day?

A

4000 mcg allicin per daily dose

67
Q

What are high intensity interventions? (5)

A
  • R/o 2˚ causes hyperlipidemia (thyroid issues)
  • Refer for intensive lifestyle coaching
  • Chinese red yeast rice 1200-1400/day
  • Statin therapy
  • Niacin therapy 1500 mg/day
68
Q

How much niacin/day?

A

1500 mg/day

69
Q

How much Chinese red yeast rice?

A

1200-1400 mg/day

70
Q

Therapy if High TG and/or low HDL

A
  • Healthy weight
  • Moderate-intense exercise
  • Avoid unhealthy carbs
  • Niacin therapy
71
Q

Therapy if High TG only

A
  • Rule out secondary causes
  • Reduce alcohol
  • Fish and fish oils: At least 2000 mg/day EPA+DHA
72
Q

Low HDL only

A
  • Smoking cessation

- Alcohol ok

73
Q

what is a good HTN Tx?

A
  • Control weight
  • Control salt: Reduction to <2400 mg/day
  • Aerobic exercise
  • Control alcohol
  • Fiber and mineral-dense semi-vegetarian diet → DASH Diet
74
Q

What is the benefits of fiber and mineral-dense semi-vegetarian diet e.g. DASH Diet

A

Heart healthy
High in minerals associated with BP control
Works w/ or w/o salt restriction

75
Q

What are minerals and quantities/day are associated with BP control?

A

Potassium: 2000+ mg/day
Magnesium: 350 mg/day
Calcium: 1000-1200 mg/day

76
Q

How much coenzyme Q needed /day for vascular disease?

A

100-200 mg/day

77
Q

What are supplements/special foods for vascular disease/ASCVD?

A 
Coenzyme Q10 (non essential)
K+, Ca, Mg
Garlic powder
Fish and fish oils
Dark chocolate
78
Q

How much garlic /day?

A

4-5 mg/day allicin potential

79
Q

What is garlic’s scientific name?

A

Allium sativum

80
Q

What part of allium sativum is used?

A

Bulb containing individual cloves

81
Q

What are active constituents of FRESH allium sativum chemistry?

A

Alliin and enzyme allinase

Alliin + allinase → allicin which may further transformt to other active compounds in vivo

82
Q

What are active constituents of AGED allium sativum / garlic chemistry?

A

Complex sulfur compounds (S-ally cysteine aka SAC)

83
Q

What are the cardiovascular physiologic effects of allium sativum / garlic

A
  • Antioxidant
  • Hypolipidemic
  • Antihypertensive
  • Antithrombotic/antiplatelet
  • Possible other anti-plaque mechanisms
84
Q

How much FRESH allium sativum/garlic should you take per day?

A

1.3 alliin precursor, 0.6% allicin yield

600-900 mg/day (3.6-5.4 mg/day allicin)

85
Q

How much AGED allium sativum/garlic should you take per day?

A

2.4-7.2 grams Powder or 4-5ml liquid

If standardized, 1.2-3.6 mg/day S-alkyl cysteine SAC

86
Q

Is allium sativum/garlic oil effective?

A

No

87
Q

Contraindications for allium sativum/garlic

A

Bleeding risks

Drug interactions

88
Q

What drug interactions might occur with allium sativum/garlic?

A

Anticoagulants
BP meds
Diabetes

89
Q

What are side effects of allium sativum/garlic

A

GI Sx in some
Breath/body odor
Can be secreted to baby in breast milk and alter flavor and affect nursing behavior

90
Q

What are the Healing phases of MSK trauma?

A

Inflammatory phase: days

Proliferation phase: weeks-months

91
Q

Challenge for trauma research?

A

Almost all patients improve with time

Patient healing varies based on severity, tissues, areas involved

92
Q

What do proteolytic enzymes do?

A
  1. Augment natural tissue proteases:
    - Degrade inflammatory protein to reduce pain and edema
    - Degrade fibrin and cellular debris (from phase 1 inflamm phase of healing) to improve lymphatic drainage and restoration of normal circulation
  2. Possible prostaglandin modification effect as anti-inflammatory and anti-thrombotic mediators
  3. GI absorption up to 40%
93
Q

What are 2 pharmaceutical products that are proteolytic enzymes?

A

Bovine pancreatin extract = trypsin and chymotrypsin
Note: In athletic player soft tissue trauma, 70% of trypsin/chymotrypsin group was fit to play in 6 days compared to 30% of placebo group

Pineapple stem extract = bromelain
Note: In bruised boxers, bruising disappeared by day 4 compared to natural progression of placebo group. Also In hospital patients with inflammation and edema from trauma, surgery, or skin infection, 75% recovered faster than similar cases not treated with bromelain

94
Q

Bovine pancreatin extract

A

Trypsin and chymotrypsin

95
Q

Pineapple stem extract

A

Bromelain

96
Q

When choosing multiple enzyme ingredient formulas, they should only contain proteolytic enzymes such as (5)

List dosage too

A

Pancreatin​ (from porcine), 100mg

Bromelain, 50mg

Papain, 50mg

Trypsin and chymotrypsin, 100mg

SOD 10mcg

Catalase 10mcg

97
Q

Most research suggests ____ enzymes on an empty stomach for better absorption

A

Enteric coated

98
Q

Potency of an enzyme produce depends on

A

Total enzyme activity

99
Q

How do you measure total enzyme activity?

A

Depends on ​mg of enzyme per dose​ (typically 100-500mg)

Depends on ​activity of enzyme per gram​ (diff units of enzyme activity make comparison tricky)

100
Q

What is a common way to measure enzyme?

A

Milk-clotting units (mcu)

Less common:

  • gelatin-digesting units (gdu)
  • USP
  • FIP
101
Q

What are 2 important numbers for choosing enzyme produce?

A

A) Enzyme activity per gram of enzyme concentrate

B) Total weight of concentrate per dose

A * B = total enzyme activity per dose

102
Q

Recommendation for daily dose of enzyme produce?

A

3000 mcu 3X/day on empty stomach

3-4 enteric coated pills, 3-4X/day

103
Q

Caution for enzymes

A

Generally save and free of side effects

R/o allergies

It has blood thinning effect

Avoid during peptic ulcer or other serious infections

104
Q

What are flavonoids?

A

Plant substances with molecular similarities that

  • reduce vascular permeability to limit trauma-related swelling
  • inhibit production o inflammation eicosanoids to reduce p and local congestion
105
Q

When can you start patient on flavonoids?

A

Immediately after trauma or before high-risk activities

106
Q

What are some clinically-investigated flavonoids? (4)

A

Citrus bioflavonoids: reduction of recovery time

Curcumin: reduction of edema and wound tenderness

Bilberry anthocyanosides: reduction of postoperative complications

Grape seed OPCs: shortened postoperative edema

107
Q

Name example of proteolytic enzyme and flavonoid combo?

A

Wobenzyme or Phlogenzyme

108
Q

What are Wobenzyme and Phlogenzyme and what is it used for?

A

Enteric coated proteolytic enzymes of pancreatic and plant origin plus flavonoid Rubin

Used for traumatic inflamm

109
Q

How much Wobenzyme and Phlogenzyme do you dare per day?

A

9 tablets for athlete or postoperative surgical trauma

110
Q

How do you best manage muscle involvement in trauma?

A

Manipulation and physical modalities

111
Q

What about minerals and botanicals for muscle involvement in trauma?

A

No research has been done

Theoretically reduces neuromuscular irritability during acute phase of healing and may provide anti anxiety effects and/or aid sleep. Which is good.

112
Q

What are typical natural muscle relaxants? (4) And quantities

A

Magnesium 100mg
Calcium 50mg
Passion flower 180mg
Valerian root 90mg

113
Q

What does valarian show in CNS and smooth muscle?

A

CNS depressant activity
Antispasmodic properties in smooth muscle

But herbal tranquilizers have other clinical uses: insomnia (valerian) and anxiety (kava)

114
Q

What supplement can be taken before and after unaccustomed exercise to reduce DOMS severity?

A

Vit C

NO BENEFIT: bromelain, fish oils, homeopathic arnica

115
Q

What contains flavonoids that have anti inflammatory activity and may benefit DOMS? And how much do you take

A

Tart cherry juice

12oz 2X/day starting 5 days before exercise

116
Q

What are 3 reasons why non-traumatic muscle cramps happen and what can you do about it?

A
  1. During activity: mm shortening d/t dehydration or electrolyte disturbance
  2. Poor circulation may respond to vit E 600-1600 IU/day or ginkgo extract 120 mg/day
  3. Magnesium insufficiencies 300mg/day or during pregnancy 365 mg/day
117
Q

If taking vitamin E for poor circulation, how much/day?

A

600-1600 IU/day

118
Q

If taking ginkgo extract for poor circulation, how much per day?

A

120 mg/day

119
Q

If taking magnesium for leg cramps, how much per day (2)

A

Night leg cramps 300mg/day

During pregnancy 365 mg/day

120
Q

What are important micronutrients for fracture healing? (4)

A

Ca
Vit D
Mg
Zn

121
Q

What is microcrystalline hydroxyapatite and what is it used for?

A

It’s a specially processed bone meal
Contains minerals, proteins, GAGs
Good Ca absorption according to some research

122
Q

How much microcrystalline hydroxyapatite/day?

A

6-9 grams/day resolved delayed union in one study of fracture healing

123
Q

What is the scientific name of valerian

A

Valeriana officinalis

124
Q

What part of Valeriana officinalis/valerian is used?

A

Root

125
Q

What are the active constituents of Valeriana officinalis/valerian?

A

Valerenic acid**
Valepotriates
Flavonoid (linarin)

126
Q

What are the physiologic effects of Valeriana officinalis/valerian seen in non human studies?

A

GABA related activities similar to sedative drugs

  • sedative/hypnotic
  • anxiolytic
  • anticonvulsant/antispasmodic
127
Q

What are the physiologic effects of Valeriana officinalis/valerian seen in human studies?

A

EEG wave pattern suggests mental relaxation

Counteracts caffeine effects

128
Q

How is Valeriana officinalis/valerian used in clinical research?

A

Insomnia/anxiety/sleep

129
Q

Valerian vs melatonin for insomnia?

A

Melatonin is more consistently effective

130
Q

What is the evidence about valerian and kava in regards to anxiety and stress?

A

Suggests valerian or combined with kava is stronger

131
Q

How much Valeriana officinalis/valerian of standardized extract per day VS dried root powder/day?

A

2-5 mg valerenic acid per day dose of 500 mg

(Can include extract of hops, lemon balm, Passion flower)

Dried root powder: larger amounts needed

132
Q

Contraindications for Valeriana officinalis/valerian

A

Sedatives, narcotics, general anesthesia

Alcohol

133
Q

Side effects of Valeriana officinalis/valerian

A

Altered mental function

134
Q

Scientific name of kava?

A

Piper methysticum

135
Q

Parts of Piper methysticum/kava used?

A

Rhizome

136
Q

What are the active constituents of Piper methysticum/kava

A

Kava lactones (aka pyrones)

137
Q

What is the physiologic effect of Piper methysticum/kava in non-human studies? Human studies?

A

Non-human studies: GABA related activities similar to valerian

Human studies: EEG changes similar to anti-anxiety drugs w/o excessive sedation

138
Q

How is Piper methysticum/kava used in clinical research?

A

Anxiety and stress

But low quality evidence for stress relief

139
Q

Dosage of Piper methysticum/kava ?

A

35-70 mg lactones TID to Tx anxiety or chronic stress

140
Q

Contraindications for Piper methysticum/kava

A

CNS depressants, surgical anesthesia
Use caution with alcohol and anti anxiety drugs
Caution w/ drugs with potential hepatotoxicity (this led to kava ban in several countries)

141
Q

Side effects Piper methysticum/kava

A

Acute mental impairment similar to alcohol at high intakes

142
Q

Is Piper methysticum/kava associated with cognitive impairment?

A

No

143
Q

Chronic excessive use of Piper methysticum/kava leads to ?

A

Dermopathy

144
Q

Piper methysticum/kava recommended during pregnancy and lactation?

A

No

145
Q

St. John’s wort / hypericum perforatum recommended during pregnancy and lactation?

A

Safety not established

146
Q

Valerian / valeriana officinalis recommended during pregnancy?

A

Too little research to ensure safety

Clinical Nutrition I (BECK) (2 decks)

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