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Clinical Nutrition > Midterm 2 > Flashcards

Midterm 2 Flashcards

1
Q

How do glucosamine and chondrotin compare as options for treating osteroarthritis?

A

Final trials are yet to be done but both seem moderately effective for reducing symptoms and slowing the progression of OA (primarily of the knee) as well as reducing the need for NSAIDs.
Glucosamine has better bioavailability and dosages recommended are different.
Glucosamine may affect blood insulin levels (Watch with diabetics) and is made with shellfish (watch for allergies)

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2
Q

How does MSM compare to glucosamine and chondroitin?

A

MSM does not have as much information and research behind it as GS and CS do. It has not been shown to be an efficient replacement for CS or GS. GS and CS are both proteoglycan precursors while MSM may facilitate proteoglycan synthesis as it is an organic sulfur compound (plankton and the sky)

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3
Q

Besides glucosamine and chondroitin, which supplements have the best scientific support for treating osteoarthritis? Which popular treatments have relatively little support?

A

Supplements associated with helping OA-
Niacinamide: improved symptoms and joint motion
Vitamin C: less cartilage damage is noted with VitC is high
Vitamin D: Slows progression
Vitamin E: may improve symptoms and delay progression
SAMe: expensive but natural methyl donor and is comparable to a Cox-2 inhibitor

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4
Q

What is the rationale for the nightshade free diet? What foods must be eliminated?

A

Nightshades contain a natural toxin called SOLANINE that is capable of causing joint symptoms
Nightshades: tomatoes, white potatoes, peppers, eggplant, tobacco

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5
Q

Distinguish between vitamins that may be useful in the management of osteoarthritis symptoms and those that may be useful for preventing progression of osteoarthritis. Which seem to be necessary to take in megadose amounts?

A

Improve symptoms: Niacinamide & SAMe
Preventing progression: Vit C&D (vit E is inconsistent)
Megadoses: Vit E? C&D also higher than normal intake

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6
Q

What is the mechanism for the effects of DL-phenylalanine on chronic pain?

A

x

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7
Q

What botanicals appear most effective for treating osteoathritis according to published evidence?

A 
Capsaicin ointment, 
Curcumin
Devil's claw
Ginger
Willow Bark
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8
Q

Of all the supplements studied for treating osteoarthritis, which is the only one with evidence for reducing the need for total joint replacement?

A

Glucosamine

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9
Q

How many times per day should capsaicin ointment be applied to duplicate succsessful protocols used in clinical trails?

A

Four times daily (0.025%-0.075%)

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10
Q

What is the evidence for nutritional and botanical treatment options for chronic low back pain?

A

x

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11
Q

What type of preparation of Devil’s claw appears to be most effective?

A

x

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12
Q

Most important known modifiable risk factor for OA

A

Weight loss.

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13
Q

Capsaicin: Common and Scientific Names

A

Common name: Cayenne

Scientific name: Capsicum annuum, C. frutescens

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14
Q

Capsaicin: Parts of the plant used

A

Fruit (the hot pepper)

Active constituents: Capsaicinoids

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15
Q

Capsaicin: Physiological Effects

A

Need purified capsaicin
Stimulates C-nociceptors through canilloid receptor.
Desensitization of C nociceptors by depleting substance P (makes it hard for the nociceptor to fire because the substance P leaks out of the neuron)
May have indirect effects on inflammation

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16
Q

Capsaicin: Clinical evidence of effectiveness for indicated uses

A

Most helpful for OA, small effects for fibromyalgia, chronic neck pain & chronic low back pain
May also be beneficial for neuropathy in diabetes, shingles (post herpetic neuralgia), postsurgical pain, psoriasis and migraine or cluster headaches.

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17
Q

Capsaicin: Extraction and standardization criteria for effective preparations

A

creams and ointments must contain at least 0.025% capsaicin. 4 times daily, may take 2-3 weeks of therapy to respond
Plasters should have at least 11mg per lumbar spine plaster and should be applied for 4-12hrs/day

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18
Q

Capsaicin: Necessary cautions and precautions

A

wash hands, avoid breathing it in, some people may be too sensitive to handle it.\contraindications: open skin lesions
transient burning, some inflame skin conditions

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19
Q

Willow: Common and Scientific Names

A

Salix alba aka Willow bark, white willow

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20
Q

Willow: Parts of the plant used

A

Bark used

Actives: salicylates including salicin (half life=2.5hrs)

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21
Q

Willow: Physiological Effect

A 
Anti inflammatory (cox-1&2 inhibitor)
Analgesic (slower onset but longer lasting that aspirin)
Antipyretic
22
Q

Willow: Clinical evidence of effectiveness for indicated uses

A

Willow bark is used to treat OA and RA (pain reduced but not always better than placebo)
Low back pain (Better than placebo-reduces pain about 33%)
rated A for OA and B for LBP

23
Q

Willow: Extraction and standardization criteria for effective preparations

A

need 40-80mg salicin TID

24
Q

Willow: Necessary cautions and precautions

A

Similar to those of aspirin: hypersensitivity, anticoagulation drugs, Reye’s syndrome (kids-no info on this but may be concern), no info on pregnancy

25
Q

Devil’s Claw: Common and Scientific Names

A

Common: Devil’s claw
Scientific: Harpagophytum procumbens

26
Q

Devil’s Claw: Parts of the plant used

A

Tubers

27
Q

Devil’s Claw: Physiological Effects

A

Proposed activities: iridoid glycosides: harpagoside, harpagide and procumbide
anti inflame (cox-2)
Analgesic
Chondroprotective (maybe)

28
Q

Devil’s Claw: Clinical evidence of effectiveness for indicated uses

A

Evidence of B for both OA and LBP
OA-spine hip/knee
Chronic and specific LBP

29
Q

Devil’s Claw: Extraction and standardization criteria for effective preparations

A

preparations tested: crude powdered herb, extract using water or extract using ethanol
Best when use at least 50mg/day of harpagoside (aqueous extracts have the most concentrated harpgoside)

30
Q

Devil’s Claw: Necessary cautions and precautions

A

Possible interaction with anticoagulants, possible exacerbation of peptic ulcer,
Safety unknown in pregnancy and lactation.
infrequent and mild GI symptoms may be a side effect

31
Q

What kind of benefits has exercise been shown to have on fibromyalgia patients? Which type of exercise has the most evidence?

A

Exercise has been shown to reduce pain and improve fitness, function and well being. Aerobic exercise has shown to be the most effective but other activities may help as well. Some people may have to start very gradually to avoid worsening symptoms.

32
Q

(Fibromyalgia) What issues should educational and counseling interventions address?

A

Teach life skills, address fears, address stress and mood disturbances.

33
Q

Which formal counseling technique has the best evidence (fibromyalgia)?

A

x

34
Q

Describe the evidence for mind-body therapies and other alternative therapies for treating fibromyalgia and related symptoms?

A 
Massage therapy- pain and mood
stress reduction awareness and relaxation, 
acupuncture may be beneficial, 
electro acupuncture may be better
moist heat can be beneficial
35
Q

What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improved pain?

A

SAMe (improved disease activity pain, fatigue, mood) also used to treat depression and OA
Melatonin (improves sleep and therefore improves pain, fatigue, sleep, mood and other symptoms)
Capsaicin (improves pain and may help treat OA and LBP)

36
Q

What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improving sleep?

A

5-HTP and melatonin

Valerian root extract or tryptophan may also help

37
Q

What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improving mood?

A

SAMe, 5HTP (also known to help with mood disorders, sleep disturbances and migrane headaches) and melatonin

St. John’s Wort and kava kava may also help

38
Q

What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improving cognitive function?

A 
improve sleep (5 HTP, melatonin) and fatigue (CoQ10) pain/fatigue/mood (SAMe)
ginko biloba
39
Q

List and describe the types of diets that have been shown to help patients with fibromyalgia

A

Weight loss is important, it improves pain and other symptoms/quality of life. Elimanation diets may help (gluten, MSG, NutraSweet, typical allergies)
Strict plant based diets have helped, although may be due to weight loss/reduced allergens or placebo

40
Q

What types of interventions are typically included in multidisciplinary/multicomponent programs for treating fibromyalgia patients?

A

Support groups, information and mind body resources

41
Q

What is RA?

A

Rheumatoid arthritis is an autoimmune inflammatory disorder that has a younger onset than OA

42
Q

Dietary approaches to RA (diets and supplements)

A

It has been shown that 5-40% of patients with RA have food intolerances, including a possible elevated amount of antibodies to milk and/or wheat.
Allergy elimination diet, gluten free diet, or nightshade free diet may help some people
prostaglandin-modifying diet may also help some people (vegan, low arachidonic acid or Mediterranean diet)
Supplements: Fish oil and borage oil (prostaglandin modification)
Vit E (antioxidant effects)
Curcumin (botanical)
maybe selenium, copper or zinc & iron only if they are low

43
Q

Dietary recommendations for Lupus

A

Avoid milk and other food allergens
Low fat diet plus 6 grams omega 3
flaxseed
and DHEA

44
Q

Dietary recommendations for Psoriatic arthritis

A

Zinc 150mg/day

Gluten sensitivity common and elimination may help

45
Q

Ankylosing Spondylitis & dietary recommendations

A

Dairy product elimination may be effective

46
Q

Ginko Biloba: Common and scientific names

A

Common name: Maidenhair tree

47
Q

Ginko Biloba: Parts of the plant used

A

Leaf
Active constituents: Falvone glycosides & Terpene lactones. It is highly concentrated so must remove harmful constituents. Activity may not persist for more than half a day.

48
Q

Ginko Biloba: physiological effects

A

Affects neurotransmitter and blood flow characteristics. It is neuroprotective (it inhibits neuronal damage from some pathological mechanisms).
It changes brain wave activity and increases blood flow to some tissues

49
Q

Ginko Biloba: Clinical effectiveness for indicated uses

A

Improves cognitive function in alzheimers disease (shows stabilization for up to a year), age related cognitive decline (fairly consistent results), “cerebral insufficiency” (good results, bad research design) and in healthy people (in some studies).
Others: increases pain-free walking distance in people who suffer with intermittent claudication.

50
Q

Ginko Biloba: extraction and standardization criteria for effective preparations

A

Standardized leaf extracts: 6% terpene lactones and 24% flavone glycosides
180-240 mg/day in divided doses
may need up to 6 weeks to see cognitive improvement

51
Q

Ginko Biloba: Necessary cautions and precautions

A

contraindications: kids under 12
Side effects: transient headach, occasional GI upset, occasion skin reaction
May increase bleeding, may react with drugs

Clinical Nutrition (3 decks)

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