N1 Sample Paper 2

Question 1

Explain the Migrating Motor Complex (MMC) is in relation to digestion (2 marks)

Answer 1

The migrating Motor Complex is a distinct pattern of electoromechanical activity in the smooth muscle between the stomach and distal ileum during the periods between meals

Digestion L5 slide 34 (2 marks)

Question 2

Explain the difference between Louis Pasteur’s and Antoine Bechamp’s
theories of disease (2 marks)

Answer 2

Pasteur: founder of ‘germ’ theory
Germ Theory: Disease occurs from outside of the body i.e. bacteria, viruses, fungi,
cause diseases from outside.
Bechamp: maintained that disease occurs from within the body (changes of the
terrain, opposite to Pasteur).
* “Bacteria and viruses are the ‘after-effects’ rather than the cause of disease”.
* “Most diseases are the result of an acidic, low oxygenated terrain” (environment)
where the
diseased tissue spawns the growth of microorganisms which develop into different
forms.

1/2 marks for each above, must mention ‘germ theory’ and ‘terrain’
All in History L1 - slides 31-32 (2 marks)

Question 3

Name FOUR symptoms of subclinical thiamine deficiency (2 marks)

Answer 3

– Fatigue
– Depression
– Headaches
– Memory loss
– Confusion
– Muscle weakness
– Gastrointestinal disorders

(½ mark for a max of FOUR)
Vitamins; slide 52. Symptoms of subclinical thiamine deficiency

Question 4

Describe THREE enzymes involved in carbohydrate digestion.
Explain the function of each? (3 marks)

Answer 4

• Salivary amylase
• Pancreatic amylase
• Brush boarder enzymes
• salivary amylase starts working on the end of the long glucose chains in starches (hence if you chew starch for a long period, you will start to taste sweetness)
• Salivary amylase works well at a fairly neutral pH but is deactivated by stomach acid.
• In the small intestine, the pancreas releases pancreatic amylase which continues carbohydrate digestion but this time into disacharide units.
• The last stage of carbohydrate digestion involves brush border enzymes in the small intestine (lactase, maltase and sucrase).

Chem & BIochem 1; slide 64. (1 mark each) each enzyme mentioned and explain in
terms of function.

Question 5

List TWO nutrients found in squash and TWO therapeutic uses of
squash (2 marks)

Answer 5

Vitamin B1, B2, B3, B5, B6, folate, C, E, K, calcium, copper, iron, magnesium,
potassium, phosphorus, zinc, alpha & beta-carotene, lutein.
Uses: vision (vitamin A for formation of photopigments in the retina), skin health (e.g.
acne, eczema – due to vitamin A’s role in skin barrier), cardiovascular health (high
antioxidant content)

Foundations of Nutrition – slide 40(0.5 mark for each nutrient max 1 mark and 0.5
per use)

Question 6

Name TWO adverse effects of eating food containing thickeners and
emulsifier additives, eg: E407Carrageenan? What food sources are
these commonly found? (2 marks)

Answer 6

1 mark for any of the following: Condensed milks and dairy products, jelly, nut milks,
organic products, Cosmetics, medications, supplements.

Food labelling; slide 38. (I mark for 2 of the following) GI inflammation, bloating and
bowel disease.

Question 7

Name FOUR nutrients involved in The Kerbs Cycle. What is something
that might block or stop this pathway from being efficient, give ONE
example of such? (4 marks)

Answer 7

Magnesium, Manganese, Iron, B1, B2, B3.
1 mark heavy metals, 1 mark example: eg: Aluminum (total marks 2)

Chem & Biochem 2; slide 62. ½ mark for any 4 of the following (total marks 2)

Question 8

Corrugated cardboard lines across the forehead may indicate what in
facial diagnosis? (1 mark)

Answer 8

Large intestine toxicity (the deeper the line, the longer the toxicity has been present)

Digestion lecture; slide 93

Question 9

Compare and contrast fat and water-soluble vitamins with regard to
absorption and storage (2marks)

Answer 9

Fat soluble vitamins are absorbed within the small intestine into lymphatic capillaries
then the blood (1/2 mark) and are readily stored (1/2 mark).
Water soluble vitamins are absorbed in the small intestine directly into the blood (1/2
mark); storage is minimal, and they are easily excreted (1/2 mark).

Vitamins – slide 7

Question 10

Name TWO key signs or symptoms that would indicate an excess dry
condition? (1mark)

Answer 10

E½ mark for any 2 of the following Constipation, dry skin, stiff
joints, anxiety.

nergetics; slide 20.

Question 11

Supplements of which vitamin have the most drug interactions of all? (1
mark)

Answer 11

Folic acid

Vitamins; slide 77.

Question 12

Name THREE natural therapeutic agents that work by inhibiting the
Cyclooxygenase-1 and -2 (COX) and Lipoxygenase-5 (LOX) enzymes (3marks)

Answer 12

Boswellia, curcumin/turmeric and ginger (1 mark per point, max 3 points)

Chem & Biochem 2; slide 42

Question 13

What are FOUR metabolic functions of phosphorus? (2marks)

Answer 13

Energy * Phosphorus is a part of ATP
* Structural * About 85% of P is found in bones and teeth (contributes to
hardness) * It is a structural component of DNA
* Muscle contraction * Creatine phosphate is a storage unit of energy in
muscles.
* Cell membrane integrity * Phospholipids support cell membrane integrity and
aid fluidity. * Phosphatidylserine and phosphatidylcholine (types of
phospholipid) are abundant in the brain and important for cognition

Minerals; slide 33. Phosphorus is involved in: (½ mark for each answer – max TWO
marks)

Question 14

Describe how Bisphenol A (BPA) can cause hormonal imbalance (2marks)

Answer 14

BPA and other compounds found in plastics are called xenoestrogens (chemicals
that mimic oestrogen in the body).
Xenoestrogens can bind to oestrogen receptors, disrupting normal function

Food labelling; slide 48

Question 15

.List two key functions of minerals within the body (2marks)

Answer 15

• Building tissues; e.g. skeletal system, teeth
• Nerve and muscle function –
• Thyroid health (supporting metabolism)
• Supporting immune health
• Components of enzymes

Minerals; slide 6

Question 16

How do herbal bitters stimulate digestion? (2marks)

Answer 16

• Stimulate the production of digestive enzymes. They should be taken 15-20
  minutes before meals.
• Bitters are thought to work by stimulating the Vagus nerve
• Also trigger the release of Cholecystokinin (CCK).

Chem and Biochem 2; slide 36 (1 mark each, max 2 marks)

Question 17

.Describe the role of mucosal Ferritin and mucosal Transferrin in iron (2marks)
absorption

Answer 17

Mucosal Ferritin receives iron from food and stores it in the small intestinal mucosal
cells. – 1 mark
Mucosal Transferrin transfers the iron to Blood Transferrin which transports the iron
to the rest of the body – 1 mark.

Minerals, slide 53

Question 18

Answer ALL THREE of the following questions:

Answer 18

Energetics; Slide 50 to 53

Question 19

Discuss the role of energetics in relation to seasonal diets. For each
season name TWO foods or food preparation methods that will help
bring balance, and TWO foods or food preparation methods that will be
aggravating (15 marks)

Answer 19

1 mark per point unless indicated

• Energetic qualities change across the seasons. Therefore, diet needs to
  adjust across the year to keep us in balance.
• Seasonal products are usually ideal from an energetic perspective. *
• Spring is dominated by moisture. *
• Productive cough, runny nose, watering eyes, allergies, hay fever. * (0.5 per
  point max 2 marks)
• Reduce: dairy, high water content fruit and vegetables, gluten, refined sugars
  and carbs. * (0.5 per point max 2 marks)
• Increase: light, crunchy, dry food, whole grains, vegetables, spices. (0.5 per
  point max 2 marks)
• This is an ideal time to detox using the fresh green leaves that emerge in
  early spring such as nettles and cleavers.
• Summer is dominated by heat. *
• Inflammation, prickly heat, sun-burn, irritability. * (at least 2 points to get full mark)
• Reduce: red meat, oily foods, stimulants. * (at least 2 points to get full mark)
• Increase: salads, raw foods, green smoothies, bitter vegetables and
  detoxifying herbs. (0.5 per point max 2 marks)
• In the summer nature provides abundant greens, berries, fruit and veg -
  perfect cooling foods. *
• Although the summer diet should be generally raw and cool, warm teas and
  spices can be used to promote sweating which has a ‘cooling’ effect. (2
  marks)
• Autumn is dominated by dryness.
• Dry skin, joint stiffness, decreased energy, anxiety.
• Reduce: light, dry foods such as biscuits, gas forming legumes, ‘astringent’
  green tea, ‘hot’ spices. (0.5 per point max 2 marks)
• Increase: warm and ‘hearty’ soups, stews, broths, root veg, high water content
  fruit and veg, sweet herbs such as liquorice, herbal teas. (0.5 per point max 2
  marks)
• In Autumn nature provides its harvest of nuts, seeds, grains and root veg.
  Perfect for building energy, weight and warmth in time for winter (2 marks)
• Winter is dominated by cold.
• Poor circulation, weight gain, sleepiness, low mood, seasonal affective
  disorder (SAD). (0.5 per point max 2 marks)
• Reduce: refrigerated & frozen foods, iced drinks, cold, raw food, leafy foods,
  sushi. (0.5 per food max 2 marks)
• Increase: warm cooked, spiced food and drinks to raise temperature,
  digestive power and circulation.
• Winter provides cruciferous vegetables which are warming and help clear
  respiratory mucus.
• Aside from this we should stay warm, rest, relax and enjoy warm and
  luxurious ‘soul’ food and ‘spices’.

Question 20

Helena has been diagnosed with low vitamin B12. Describe the
functions and therapeutic uses of vitamin B12. Provide THREE good
dietary sources and outline THREE signs or symptoms associated with
low levels (15 marks)

Answer 20

Vitamins 78-85
1 mark per point unless indicated

Answer 21

Max 7 marks:
Functions: Therapeutic Uses:
Nervous System
- Myelin production
- Neurotransmitter production (dopamine, serotonin)
- Choline – key for brain function
- Therapeutic Uses: MS * Tingling / Pins and Needles * Sciatica
Erythropoiesis
- B12 is required for erythropoiesis.
- Therapeutic Uses: Megaloblastic anaemia
Methylation
- Homocysteine cycle (conversion of the amino acid homocysteine to
methionine)
- Therapeutic Uses: Cardiovascular disease, Alzheimer’s
Energy Production
- Energy production from fats and proteins
- Therapeutic Uses: Fatigue
Deficiency Signs and Symptoms: Max 5 marks – must mention 3 signs/symptoms.
- Megaloblastic anaemia
- presenting as fatigue, breathlessness, pallor, etc.
- Supplementation with B9 will alleviate the anaemia, however other symptoms
of vitamin B12 deficiency progress.
- Neurological abnormalities: tingling, numbness, loss of balance, burning
sensations, weakness, confusion and decreased reflexes. (0.5 per point, max
3 marks)
- Anaemia typically develops first, but not always if the person is consuming
lots of folate. Changes occur slowly, and once the patient experiences
neurological symptoms, they may be irreversible

Must mention 3 sources for 3 marks:
- Vegan B12 Food Sources: *
- Chlorella pyrenoidosa (e.g. 9g per day) *
- A substantial amount (133.8 μg/100 g) of vitamin B12 has also been found in
dried Korean purple laver (Porphyra sp.). *
- Nutritional yeast, nori and kombu sea vegetables (nori, kombu, kelp and
dulse), shiitake & Lions mane mushrooms. Animal B12 Food Sources: *
- Meat, liver, milk, cottage and feta cheese, organic eggs, fish (esp. sardines,
mackerel and wild salmon).

Question 22

Discuss the therapeutics uses of FOUR different types of nuts and/or
seeds, in your answer include a list of the key nutrients they contain (15
marks)

Answer 22

Foundations of Nutrition; Slide 58/59/60/61/62
1 mark per point unless indicated

Almonds:
- Vitamin A, B1, 2, 3, 5, 6, folate, C, E, calcium, copper, iron, magnesium,
manganese, phosphorus, potassium, selenium, zinc, beta-carotene, lutein.
(0.5 per point, max 2 marks)
- More calcium than any other nut.
- High fibre content.
Macadamia nuts:
- Vitamin A, B1, 2, 3, 5, 6, folate, C, E, calcium, copper, iron, magnesium,
manganese, phosphorus, potassium, selenium, zinc, complete protein
(contain all the essential amino acids). (0.5 per pint, max 2 marks)
- Uses: anti cancer and cardiovascular health (antioxidants), skin health
(vitamin E, zinc), digestive health (fibre), bone health (calcium). (0.5 per point,
max 2 marks)
Brazil nuts:
- Vitamin A, B1, B2, B3, B5, B6, folate, C, E, calcium, copper, iron, magnesium,
manganese, phosphorus, potassium, selenium, zinc. (0.5 per point, max 2
marks)
- More selenium in one nut than the RNI (although this is dependent on soil
quality).
- Uses: Cardiovascular health (antioxidant), liver (required for glutathione
peroxidase), reproductive health (antioxidant), thyroid support (selenium aids
conversion of T4 to T3). (0.5 per point, max 2 marks)
Walnuts:
- Vitamin A, B1, B2, B3, B5, B6, folate, C, E, K, calcium, copper, iron,magnesium, manganese, phosphorus, potassium, zinc selenium, betacarotene, phospholipids, omega-3 (highest in nuts). (0.5 per point, max 2
marks)
- Uses: Brain health including memory (due to the phospholipids).
- Pumpkin, Sesame, Chia, Flaxseed (linseed), Hemp, Sunflower. Benefits: *
- Highly nutritious – a rich source of protein, healthy fats and fibre. *
- Have a higher omega 6:3 ratio, but healthy omega-6. *
- High fibre content slows the release of sugars in the blood (preventing a sugar
spike) and is important for transit time. *
- When soaked Chia and Flaxseeds are an excellent source of soluble fibre.
- The polysaccharides form a mucilage which helps to soothe irritated mucosal
membranes.
Pumpkin:
- Vitamin A, B1, B2, B3, B5, B6, folate, C, E, copper, iron, magnesium,
manganese, phosphorus, potassium, selenium, zinc, beta-carotene, lutein.
(0.5 per point, max 2 marks)
- Uses: anti-parasitic (due to an amino acid in the seeds - cucurbitacin),
nervous system (B vitamins), cardiovascular and immune health
(antioxidants). (0.5 per point, max 2 marks)
Chia:
- Vitamin A, B1, B2, B3, folate, C, E, copper, iron, magnesium, manganese,
phosphorus, potassium, zinc, mucilage, phenolic compounds, omega-3. (0.5
per pint, max 2 marks)
- Uses: anti-cancer and skin health (antioxidants), digestive support (mucilage
nourishes mucous membranes), cardiovascular health (high omega-3). (0.5
per point, max 2 marks)
Flaxseed:
- Vitamin A, B1, B2, B3, B5, B6, folate, C, E, K, calcium, copper, iron,
magnesium, manganese, potassium, zinc, mucilage, lignans, beta-carotene,
lutein. (0.5 per pint, max 2 marks)
- Uses: soothing inflamed mucous membranes due to the mucilage content
(mucilage is derived from polysaccharides which swell in water, and produce
a gel-like substance)(2 marks), anti-cancer (antioxidant content), skin (fatty
acids, minerals and vitamins). (0.5 per point)
- To regulate oestrogen levels in the first half of the cycle (follicular phase)
consume 1 tbsp flaxseeds and 1 tbsp pumpkin seeds daily.
- In the second half of the menstrual cycle (luteal phase) consume 1 tbsp
sesame and 1 tbsp sunflower seeds to boost progesterone levels.
- Ensure the seeds are freshly ground, as they oxidise quickly

Question 23

SECTION C – Case Study (20 marks)
Case Study: Jasmine
Sex: Female
Age: 32
Height: 175cm
Weight: 70kg
Occupation: Marketing Manager

Answer 23

Prescription medication: Antibiotics for recurrent cystitis and fluconazole (antifungal) when needed for thrush.
Supplements: None currently but was previously taking Vitamin D from Boots over
winter.
Presenting symptoms: Jasmine has irritable bowel syndrome (IBS). Her stools will
alternate between constipation and diarrhoea particularly during the week before her period. She experiences urgency and flatulence and occasionally has blood and
mucus in her stool. She feels tired a lot of the time and experiences symptoms of
cystitis including burning and stinging which requires her to take antibiotics (about 5
times per year).
Medical history: Recurrent cystitis and some candida (thrush). Was a fairly healthy
child but would get a cold/’flu every year and athletes foot (tinea) over summer. She
had acne in her early teens and gets the occasional spot now, usually due to her
menstrual cycle.
Family history: Mother also suffers with IBS. Father is on medication for cholesterol
and has high blood pressure.
Diet: She likes salty fatty foods like cheese although it makes her feel bloated.
Doesn’t often feel hungry in the morning and frequently skips a proper breakfast.
Has 3 large glasses of water a day, knows she should have more, but she gets
annoyed having to go to the bathroom to urinate when she drinks a lot.
Breakfast: Large glass of store-bought fruit juice. Sometimes a boiled egg on brown
toast. Black coffee with 1 artificial sweetener at 10am
Lunch: Spinach and feta roll, or mushroom quiche and black coffee with 1 artificial
sweetener. Eaten at her desk.
Snacks: Crisps, salt and vinegar or cheese and onion.
Dinner: White rice or mashed potatoes with fish or chicken, steamed vegetables
(cauliflower, carrots, corn) with a white sauce.
Dessert: Two large (250ml) glasses of red wine with cheese – 2 chunks each about
the size of a box of matches.
Lifestyle: Goes to bed at 10pm and gets up at 6:30am, five days per week. Finds it
difficult to fall asleep and might not drift off properly until midnight. She usually plays
online scrabble in bed on her phone or checks social media to relax as she finds
work stressful. She plays tennis twice a week with her partner.

Question 24

What are the likely triggers, and mediators in this case? (5 marks)

Answer 24

Triggers: Inflammatory diet, stress from work, antibiotic use, caffeine intake. (1
mark for any must have at least one Trigger and one Mediator to gain full marks)
Mediators: Work stress, Inflammatory diet, high dairy IGF-1, sweetener intake
causes gut irritation leading to IBS symptoms, antibiotic use impacting gut
microbiome, alcohol intake impacting detoxification and gut microbiome,
dehydration leading to constipation

Question 25

State any red flags in the case (1 mark)

Answer 25

Blood and mucus in stool (must mention both for full mark)

Question 26

Formulate THREE therapeutic aims based on your naturopathic summary (3
marks)
Aims must be clear on what system they are supporting (½ mark) and why (½
mark)

Answer 26

To support the immune system to reduce inflammation and improve reactive
symptoms.
Support the digestive system to improve pathways of detoxification and
elimination.
Support kidney and urinary system to improve cystitis symptoms.
To help restore optimal digestion and enable healthy elimination.
Support gastrointestinal health to improve bowel motions, nutrient absorption and
removal of excess toxins.

Question 27

List TWO nutrients you would initially recommend. Provide a rationale for
your answer (2 marks)
Any sensible nutrient (½ mark) with sound rationale (½ mark) maximum total of 2
marks.

Answer 27

• Omega 3 – anti inflammatory
• Magnesium – stress/anxiety, blood sugar control, energy- stress and quivering
  tongue
• B vitamins – stress and OCP use depletes them
• Fibre- stools etc.
• Probiotics – to support gut dysbiosis and antibiotic use
• D-Mannose – help with cystitis
• Gut repair: Liquorice,Glutamine, Zn, Slippery Elm
• Milk Thistle antioxidants, and B vits- liver etc.

Question 28

List THREE positive things about the client’s diet (3 marks)

Answer 28

• Breakfast: a boiled egg on brown toast.
• Lunch: Spinach and mushroom in quiche
• Protein at dinner
• Steamed vegetables (cauliflower, carrots, corn) etc

Question 29

List THREE negative things about the client’s diet (3 marks)

Answer 29

• Only 3 glasses of water
• High amount of sweeteners
• High refined carbs
• High GI
• Low protein
• Little variety
• Low fibre
• High dairy intake
• High alcohol intake etc.
• Anything sensible

Question 30

What three dietary changes could you suggest to Jasmine? (3 marks)

Answer 30

• Incorporate protein with every meal.
• Increase vegetable intake to a minimum of 5 portions.
• Increase hydration to 2L a day.
• Reduce alcohol consumption, ultimately eliminating it.
• Remove refined carbohydrates and replace with unrefined carbohydrates.
• Increase legumes and wholegrains.
• Include oily fish.
• Remove dairy.
• Remove sweeteners. Etc.
• Anything sensible.