next level Flashcards
What does NfKB do?
NFkB activates telomerase, cytokines, adhesion molecules, VEGF and TNF. Also results in macrophage recruitment.
The Very Angry Tabby Cat
4 positive epigenetic influences:
Positives: Polyphenols and B vits Exercise Low stress Maternal and paternal diet
TOFU and it’s nutrition… incomplete so far
TOFU
High in -
Less high in - magnesium
AUD - the numbers: How many in US? % of adults exceeding NIH daily limits at least once a year? % at-risk or mild? %mod %severe
17 million 30% 26% 3% 1%
Alcohol use effects:
% of cancers
% of intentinoal injuries
% of deaths - and top three
10%
20%
7% - RTA, cancer, suicide
AUD and health
number of attributable deaths a year?
years of life lost?
88000
(8 servings exceeds the 7/week for women, 8+8 would exceed the male serving too)
- 5million per year among US adults
(2. 5 is a serving of 8 proof spirits)
AUD
Regions most at risk - 4 areas
What are they most likely to do?
Region least likely?
upper midwest, northeast, alaska, hawaii - most likely to binge drink at least once a year
South US are least likely
AUD highest risk groups:
8 RFs
Age 18-34 Higher income White Men 23% vs Women 11% Smokers Psych Trauma Family history
AUD and PCP - what proportion received proper mx?
10% only
AUD:
What two treatments are equivalent?
What is chronic care management?
ARM + medical management is as effective as addiction counselling for mild-moderate
CCM is effective for AUD and alcohol related serious medical illness
Heavy alcohol use (book definition)
Binge drinking on more than 5 days in the past month
At risk drinking (book definition)
Exceeding levels for any day or week, binge drinking at least once a month, or drinking that increases the risk of future problems
AUD - what % continue despite external consequence?
What most severe % are over-represented in rehabs, jails and hospitals?
10% - includes jail, marital, job etc.
10%
DSM 5 12 month prevalence of AUD:
Men and women, mild or mod-severe:
Mild - 10/5%
Mod-severe 6/2%
From other numbers 26%/3%/1%
Mod - 3% and severe 1% - = 4% 6-4-2
AUDIT scores:
How many items, rated 0-what?
Severity groups and importance?
10 items, 0-4
5-10 - 20% have AUD
11-15 - 40%
16+ - 90%+
AUDIT C postivie
4+ in men
3+ in women
‘more than 5 - in the book’
Symptoms of impaired control include: 4 things
going over limits
desire to cut down
use despite internal consequences
tolerance
Lets Tolerate Cutting Insects
Limits, tolerance, Down down, Internal consequences
In severe AUD, 4 reasons to consider ARMs:
- impairment may mean lifestyle intervention is difficult
- medications are comparable to AA and counseling
- medications are as good as SSRIs for depression
- ARMs improve proportion of long-term recovery
AUD - tracking outcomes
3 data sources
1 lab test
Number of heavy drinking days (5+) in past month
AUDIT/AUDIT-C
yGT - if initially elevated
ARMS:
Name - MODA - effects (stats)
2 first line - 3 others
ALWAYS NALTREXONE
Naltrexone - 50mg prior to drinking - u opioid - reduces heavy drinking by 83%, all drinking by 4%
Acamprosate - moderates glutamate transmission - abstinence increased by 11 days, all drinking RR 0.86/NNT 9, no effect on heavy drinking
Disulfuram - aldehyde dehydrogenase inhibitor, leads to acetaldehyde build up - poor tolerance - no more effective than placebo
Gabapenting - addictive/street value - abstinence higher in 900mg a day 11%, 1800mg 17%, than placebo (4%) over 12 weeks
Topiramate - off-label - decreased percentage of heavy drinking days vs placebo (43.8% vs 51.8%)
Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:
n=
Intervention=
609 adults without DM, BMI 28-40
Either low-fat or low-carb diet, with 500-600 calorie deficit on average (not specifically instructed)
Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:
Key findings: Macro-nutrient distribution Weight change Diet interactions Adverse events
48% vs 30% for carbs, 29% vs 45% for fats, 21% vs 23% for protein
Remember45/30/20 for each
-5.3kg and -6.0kg
No genotype or INS-30 interaction
18 adverse events, equal distribution
Exercise and depression - how does it compare to other treatments?
Does it work with other treatments?
What about old and young?
Exercise slightly better than no or control treatment, not better than psycho or pharmacotherapy
Slightly synergistic with pharma
Effective treatment in elderly, protective if done as children
Mood and nutrients:
Higher mood disorders if these nutrients are low:
Folate, B12, calcium ,iron, selenium, zinc, omega-3 FAs
Do fish oils/omega-3 fatty acids help mood?
Some studies say yes, others say no.
Better evidence in depression or bipolar - longer bipolar remission with FA treatment.
Mood scores and diet - what happened after how long with omnivores became vegetarians?
2 weeks, mood scores improved
What nutrients may improve mood?
Can Some White Flowers Prevent Tears
Carb rich evening meals, Saffron, Walnuts, Flax, Probiotics, Turmeric
Health promotion and positive emotions:
Direct and indirect impacts?
Direct - body physiology, well-being, disease prevention or treatment
Indirect - maintenance of behaviours
Eudaimonia protects against?
strokes, alz/CI, heart attacks
Eudamonia and epigenetic?
Associatied with down regulated pro-inflammatory genes, and unregulated antibody synthesis.
The opposite for hedonic.
Eudaimonia and brain activation?
less activation of amygdala
more higher cortical function when confronted by negative stimuli
sustained reward circuit with positive stiuli
greater insular cortex volume
The boston and harvard study showed?
What physiological effects do social connections cause?
happiness and longevity - from social connections
social connections increased PNS activation, lower heart rate
Highest quartile of social media AOR of depression is…
2.47
5 protective effects of WFPB on B cells:
Stabilises immune system Avoids hypreglycaemia Anti-inflammatory Lipids normalise Leptin/adiponectin pathway normalised