N1 Sample Paper 3

Question 1

List THREE foods, dominated by dryness, which should be reduced during the
autumn months (3 marks)

Answer 1

(1 mark per point to max 3 marks) Light, dry foods such as biscuits, gas forming legumes, ‘astringent’
green tea, ‘hot’ spices.

Question 2

Provide the chemical symbol for potassium (1 mark)

Answer 2

K (1 mark)

Question 3

Name TWO natural food additives and what food they are derived from (2 marks)

Answer 3

((0.5 for number and 0.5 for food to max 2 marks)
E100 Curcumin (Turmeric).
E162 Beetroot.
E101 & E106 riboflavin, E160a carotenes

Question 4

What are the FOUR principles of Traditional Chinese Medicine? (2 marks)

Answer 4

(0.5 marks per point to max 2 marks)
Based on centuries of clinical observation
Individualised (patient-centred)
Emphasises stimulating the body’s self-healing mechanisms
Holistic - looks at the person as a whole
Primary aim – Maintain health.

Question 5

Describe TWO therapeutic uses of tomatoes (2 marks)

Answer 5

(0.5 marks for use and 0.5 marks for explanation for 2 of the following)
Uses: cancer prevention (high antioxidant content), prostate health (lycopene decreases cell damage
and is thought to suppress the proliferation of androgen-dependent cancerous prostate cells),
cardiovascular health (antioxidants and lycopene lower cholesterol), anti-inflammatory (lycopene
modulates LOX and COX expression), vision (lutein and vitamin A content)

Question 6

Name TWO metalloenzymes that zinc is a component of (2 marks)

Answer 6

. (1 mark each, max 2 marks)
Superoxide Dismutase (SOD), Alcohol Dehydrogenase, Carboxypeptidase, Alkaline phosphatase,
Metallothionein, Carbonic anhydrase B, Other enzymes involved in Haem synthesis, folate absorption
and DNA/RNA synthesis.

Question 7

List FOUR functions of proteins in the body (2 marks)

Answer 7

(0.5 marks for any of the following up to 2 marks)
Structure of body tissues, eg Collagen.
Movement eg Actin and myosin fibres (in muscles).
Carrier molecules, eg Haemoglobin.
Storage molecule, eg Ferritin (iron).
Fluid balance in the blood, eg Albumin.
Enzymes (for reactions in the body).
Hormones, eg Insulin.
Immune function, eg Antibodies.
Clotting mechanisms, eg clotting factors.
Alternative energy source – Much less efficient than carbohydrate or fat so only used during dietary
deficiency.
Cell membrane proteins, eg receptors.

Question 8

Name FOUR symptoms of subclinical thiamine deficiency (2 marks)

Answer 8

(0.5 marks for any of the following up to 2 marks)
Fatigue
Depression
Headaches
Memory loss
Confusion
Muscle weakness
Gastrointestinal disorders

Question 9

List FOUR accessory organs of the digestive system (2 marks)

Answer 9

(0.5 per point) Accessory organs: * Salivary glands * Pancreas * Liver * Gall bladder & biliary tract

Question 10

Name the FOUR possible nucleotide bases (amino acids) of DNA (2 marks)

Answer 10

(0.5 per point) Adenine (A) - a ‘purine’ – Cytosine (C) – Guanine (G) - a ‘purine’ – Thymine (T)
2

Question 11

According to TCM, 4PM correlates with which organ? (1 mark)

Answer 11

Bladder (1 mark)

Question 12

List TWO foods that are associated with the ‘Pungent’ flavours and name the organ
that has an affinity to it (2 marks)

Answer 12

Lungs (1 mark). Ginger, black pepper, mustard, cayenne, horseradish, onion (0.5 per 2 foods)

Question 13

Name THREE therapeutic uses of rosemary (Rosmarinus officinalis) (3 marks)

Answer 13

(1 mark per point to max 3 marks) Weak digestion, liver support, poor memory, concentration,
circulation, depression.

Question 14

Nucleotides consist of what three components? (3 marks)

Answer 14

A phosphate group, sugar and a nitrogenous base. (1 mark each)

Question 15

A butterfly rash around the nose may indicate what in facial diagnosis? (2 marks)

Answer 15

Possible rosacea (linked to H pylori and hence the stomach) (1 mark) or B3 deficiency (1 mark)

Question 16

A key function of vitamin D is to maintain serum homeostasis of which TWO
minerals? (2 marks)

Answer 16

Calcium and phosphorus. (1 mark each)

Question 17

List TWO organic and TWO inorganics mineral carriers (2 marks)

Answer 17

(0.5 per point, to max 2 marks)
Organic: Citrate, Ascorbate, Gluconate, Glycinate
Inorganic: Oxide, Carbonate, Sulphide, Chloride

Question 18

SECTION B (45 marks)
Please answer ALL THREE of the following questions:

Answer 18

to follow

Question 19

1. Introduce phosphorus, including the best food sources. Outline its functions and
   therapeutic uses. Discuss the problems associated with using phosphorus as a
   preservative (15 marks)

Answer 19

Section B – 45 marks
1. (1 mark per point made unless stated otherwise to max 4 marks)
* Phosphorus (P) is the body’s second most abundant mineral.
* About 85% of P is found combined with Ca in hydroxyapatite crystals of bones and teeth.
* In nature P is rarely free; it’s almost always bound to oxygen as ‘phosphate’ (PO4 3- ).
* Phosphate is an essential constituent of all plant and animal tissues and thus is widely distributed in all
foods, especially: – Seeds, nuts, beans, legumes. – Meat, poultry, fish, dairy. – Soft drinks (not a
recommended source)! (0.5 per food source to max 2 marks)

Phosphorus toxicity: (1 mark per point made to max 4 marks)
* Phosphorus intake from natural foods will never lead to toxicity.
* However, phosphorus as a preservative (inorganic phosphorus) as used in carbonated soft drinks,
processed food, fast food, enhanced meats) can lead to hyperphosphataemia (high P in the blood)
* as well as hyperactivity in children.
* This could result in decreased Ca absorption, as P can form a complex with Ca in chyme.
* Polyphosphates from food additives can also interfere with Zn, Cu and Fe absorption.

Question 20

2. Explain why junk foods are unable to maintain health and growth, discuss why they
   are detrimental to health and well-being and explain how they are implicated in a
   wide range of diseases (15 marks)

Answer 20

2. Health and growth (1 mark per point, max 5 marks) Junk foods are chemically-altered food substances
   that provide no nutrients and are, therefore, not able to maintain health and growth. They are: * Highly
   processed and generally contain GM ingredients, artificial colourings, sweeteners, pesticides and other
   chemical additives. * High in calories, sugar, salt, refined carbohydrates and trans fats. * Low in fibre and nutrients. * Designed to make one overeat because of the unique combination of chemicals they contain
   which increase desire to eat. Often much cheaper which is what mainly justifies their consumption.
   Detrimental to health and wellbeing. (1 mark per point, max 5 marks) Cellular poison * Hinders the electrical
   flow between cells. * Doesn’t nourish cells or tissues. * Robs the body of essential nutrients. * Destroys cells
   and impairs body functions. * Reduces life expectancy and performance (athletic, cognitive, sexual). *
   Absorbs energy from the body. Accelerates ageing. * Addictive — leads to overeating, malnutrition,
   disease, early death.
   Implicated in a wide range of diseases and disruption of physiological processes / pathways, including: (1
   mark per point, max 5 marks) * Atopic conditions — asthma, eczema. * Hormonal disturbances — Type 2
   diabetes, PCOS, PMS, infertility, menopause. * Skeletal disorders — osteoarthritis, rheumatoid arthritis,
   osteoporosis. * Cardiovascular disease — atherosclerosis (creating endothelial damage)  strokes, angina,
   etc. * Neurological diseases — migraines, Parkinson’s, Alzheimer’s. * Contribution to cancer pathogenesis
   (carcinogenicity).

Question 21

3. Explain in detail how fats can be utilised for energy in the absence of carbohydrates.
   Explain specifically the process by which fats are used to make energy, including the
   role of essential co-factors. Describe how the brain can utilise fats for energy
   production (15 marks)

Answer 21

3. (1 mark per point unless indicated, max 15 marks)
   - In the absence of sufficient carbohydrates, fats can also be used for energy production.
   - Lipases split triglycerides from adipose tissue into fatty acids and glycerol.
   - The fatty acids are transported to the liver (1 mark), where the body uses a process called betaoxidation to convert them into molecules of Acetyl CoA (1 mark).
   - The acetyl CoA can then enter the Krebs cycle, just like carbohydrates.
   - Fats yield a lot more energy than carbohydrates.
   - So whilst burning carbohydrates is easier, burning fats is more efficient.
   Getting Into The Mitochondria:
   - In order to get into the mitochondria and be used for energy, fatty acids must first combine with
   coenzyme A (from vitamin B5).
   - This process requires ATP and, therefore, magnesium.
   - A carnitine-dependent enzyme is then needed to ferry the fatty acid into the mitochondria.
   - L-carnitine is, therefore, required to transport fatty acids into the mitochondria.
   - This explains why L-carnitine is often found in weight loss formulas, to help the fatty acids enter the
   mitochondria and be “burned“ for energy.
   Beta-Oxidation:
   - The aim of beta-oxidation is to gradually chop the fatty acid chain into acetyl CoAs, ready to go into
   the Krebs cycle.
   - This process occurs in the mitochondria.
   - Beta-oxidation requires Vitamin B2, Vitamin B3 and Sulphur. (1 mark for each)
   - This produces energy.
   - The process repeats until the entire fatty acid chain is broken down into acetyl CoA units, which can
   then enter the Krebs cycle.
   - The amount of energy produced depends on the length of the fatty acid chain.
   - Ketone Bodies
   - Most body tissues can use fatty acids for energy directly when carbohydrates are in short supply,
   but the brain cannot!
   - The brain gets its energy from ketone bodies when sufficient glucose is not available, e.g. fasting.
   - The mitochondria of liver cells can convert acetyl CoA into ketone bodies – acetone, acetoacetic
   acid and -hydroxybutyrate. (2 marks)
   - These can cross the blood brain barrier and be used as a source of energy.
   - Ketone bodies can also be formed when protein is used for energy.
   - The production of ketones is called ‘ketogenesis’.
   - The body state of forming ketones is known as ‘ketosis’.
   - Ketosis can occur during high fat (and low carbohydrate) diets and whilst fasting. This state is
   highly beneficial for the body.
   - Ketosis is never harmful from diet alone. Although, in some pathological states, ketone bodies form
   in excessively high quantities; this creates a state known as ‘ketoacidosis’.
   - This dangerous state can occur in diabetes mellitus and alcoholism.
   - Both acetoacetic acid and beta-hydroxybutyrate are acidic, so if levels of these ketone bodies are
   extremely high, the pH of the blood drops. This is dangerous in that it affects the blood pH.
   - Ketoacidosis can be smelled on a person’s breath. This is due to acetone (smells like nail varnish
   remove.

Question 22

SECTION C - Case study (20 marks)
Name: Eleanor
Sex: Female
Age: 36 years
Height: 160cm
Weight: 49kg
Occupation: Creative Director

Answer 22

Prescription medication: GP has recommended an antidepressant, but Eleanor has
declined and wants to focus on her nutrition instead. She was recommended this
medication as it’s been 6 months since she and her husband suffered 2 failed IVF
attempts.
Supplements: Pharmacy brand Pre Natal multinutrient
Presenting Symptoms:
Low mood due to unsuccessful IVF attempts, and poor sleep. She suffers with an
urgency to pass stools, which are often loose. She will go three times a day sometimes,
particularly when stressed, this has been a recent change. Very occasionally she sees
blood around her stool. She reports experiencing frequent urination, which she
describes as “annoying”. Eleanor would also like to develop a better sleep pattern.
Observation: Eleanor is very thin and pale. Has a pale tongue. Nails remain pale when
you press on them.
Medical history:
Suffered some anxiety through high school; she was bullied and ended up changing
schools. Her menstrual cycle has always been irregular and she can have months
without a period. Eleanor has not given up on her wish to conceive, although she does
not wish to go through IVF again. She would like to support her body to potentially
conceive naturally.
Diet: Eleanor is quite rigid in her diet and likes to be slim, but she has said that she is
open to some changes.
Breakfast: 2 cups of strong black coffee. A boiled egg and 1 piece of plain whole wheat
toast.
Morning snack: Celery and carrot sticks. A cup of green tea with artificial sweetener.
Lunch: Piece of poached fish or chicken with steamed greens and soy sauce. Can of
diet cola.
Afternoon snack: A ccup of black coffee. When she is tired or succumbs to craving
(about 3-5 times per week) she will have a chocolate bar or sometimes a regular cola.
Evening meal: Baked chicken breast or Cod with no skin, green salad with lemon and
½ cup of quinoa or brown rice. Two cups of green tea with artificial sweetener.
Pudding: 2 squares of dark chocolate.
Cravings: Sugar/sweetener, coffee, chocolate and sometimes salty foods.
Water: Drinks 3-3.5L of water per day.
Alcohol: Rarely.
Lifestyle: Eleanor goes to the gym three days per week and runs for 45 minutes every
morning. She reports being slow to recover from exercise – her muscles ache for days
after strenuous workouts or if she does a different class at the gym.
Eleanor is happily married. She finds it very difficult to get to sleep at night, often not
feeling sleepy until around midnight- watching movies and youtube until falls asleep.
She wakes at 6am to run before work and feels tired on waking but feels the run and
her morning coffee wakes her up.

Question 23

1. What are the likely triggers, and mediators in this case? Please explain your
   rationale (5 marks)

Answer 23

Markers: Please accept any reasonable answer based on your own knowledge
1. What are the likely triggers, and mediators in this case? (5 marks)
Trigger: Failed IVF; caffeine/sugar (up to 2 marks)
Mediators: (up to 3 marks- ½ mark each). Excessive caffeine and stimulants in the diet – must mention:
irritating the urinary and GIT system; causing wakefulness/poor quality sleep ie cortisol and melatonin>
affecting serotonin; high exercise- low calorie; excessive hydration
Possible iron deficiency – low dietary intake, tiredness, pale, nail and tongue signs
Possible magnesium insufficiency – high urinary output, poor exercise tolerance, nervous agitation, poor
sleep
Lack of omegas in the diet and low body weight impacting fertility and mood etc.

Question 24

2. State any red flags in the case (1 mark)

Answer 24

2. State any red flags in the case (1 mark)
   Blood in stool (1/5 mark)- must mention
   Urgency and Frequency of Stools (1/2 mark)
   Frequent urination, high water/fluids and sugar craving to be investigated – could also gain ½ but only to
   max 1 mark

Question 25

3. Formulate THREE therapeutic aims based on your naturopathic summary (3 marks)

Answer 25

3. Formulate THREE therapeutic aims based on your naturopathic summary (3 marks)
   Support natural fertility to improve chance of conception.
   Support Nervous system to reduce the effects of stress on the body and improve mood and sleep
   Support the Digestive system to improve absorption and assimilation of nutrients and regulate transit time
   Support the Endocrine system to improve blood glucose balance, improve mood and stamina/energy levels
   etc.

Question 26

4. List TWO nutrients you would initially recommend. Provide a rationale for your
   answer (2 marks)

Answer 26

4. List TWO nutrients you would initially recommend. Provide a rationale for your answer (2 marks)
   Magnesium – stress/anxiety, blood sugar control, energy, sleep
   B vitamins – stress, anxiety, high sugar, mood and blood sugar balance
   Iron – after testing – pale, dietary lack
   Omega 3- lack in diet, mood, energy, stamina
   Protein etc

Question 27

5. List TWO positive things about the client’s diet (2 marks)

Answer 27

5. List TWO positive things about the client’s diet (2 marks)
   Vegetables and Fruit daily. Has fish and white meats instead of red. Steamed veg. Drinks water. Whole
   grains. No alcohol etc

Question 28

6. List TWO negative things about client’s diet (2 marks)

Answer 28

6. List TWO negative things about the client’s diet (2 marks)
   Excessive caffeine – must mention. Artificial sweetener – must mention. Calorie deficient. Not satiating
   enough. Low iron. Low zinc. Little variety. Limited EFAs. Limited energy etc

Question 29

7. What THREE dietary changes could you suggest to Eleanor? Please explain your
   reason for these recommendations (3 marks)

Answer 29

7. What THREE dietary changes could you suggest to Eleanor? Please explain your reason for these
   recommendations. (3 marks)
   Incorporate protein with every meal and snack to balance blood sugar levels and reduce cravings.
   Increase leafy green vegetables, especially those high in folate for fertility, and magnesium to support the
   NS- 2 cups per day
   Include bitter foods such rocket, chicory, endive before meals, ACV to stimulate digestion and appetite
   5
   Reduce caffeine – too stimulating for NS and increases cortisol levels. Will help with sleep
   Choose protein rich snacks to balance blood sugar levels and reduce cravings.
   Include oily fish 3 times a week to improve mood, energy, stamina and fertility
   Remove artificial sweeteners – disrupt the normal hormonal and neurological signals that control hunger
   and satiety. Can lead to cravings.
   Decrease hydration to 2 L per day. Etc.

Question 30

8. What TWO lifestyle changes would you suggest to help support your client, provide
   your rationale? (2 marks)

Answer 30

8. What TWO lifestyle changes would you suggest to help support your client, provide your rationale (2
   marks)
   Epsom Salt baths for magnesium and relaxation. No screens after 8:30pm, to help wind down for restful
   sleep- sleep hygiene/Epsom salts. Take up an arts/crafts or other self esteem boosting class. Replace
   stimulants (coffee/tea) with herbal teas- not green, try lemon balm for eg. Try yoga and other less
   strenuous classes at the gym etc.