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MSN 6204 > Notes > Flashcards

Notes Flashcards

1
Q

Changes produced in the milk when making kefir

A 
Lactose —> lactic acid
CO2 production
Increases free amino acids
Increase B vitamins + flavonoids
Produces anti microbial compounds
Produces polysaccharides
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2
Q

Therapeutic properties of kefir

A

Improve appetite, salivation, secretion of gastric acid and pancreatic enzymes

Good sources of free amino acids

Useful in travelers diarrhea and UTIs

Diuretic effect

Chol lowering effect

Normalizing effect on the bowel

Improve immune fxn (macrophages)

Improve resistance to catching URIs

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3
Q

Kefir microorganisms

A 
Lactococcus lactis
Lactobacillus brevis
Lactobacillus rhamnosus 
Leuconostoc mesenteroides 
Candida kefir 
Torulaspora delbrueckii 
Saccharomyces cerevisiae 
Streptococcus lactis
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4
Q

Microorganisms involved in sauerkraut and kimchi

A

Leuconostoc mesenteroides

Lactobacillus plantarum (can reach 1010 CFU/g)

Lactobacillus brevis

+/- Streptococcus faecalis & Pediococcus pentosaceus

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5
Q

Benefits of sauerkraut and kimchi

A

Vit C content increase 600% after 7day ferment

Final product is low glycemic index = delay gastric emptying

Decrease levels of agricultural pesticides through the ferment process

Right in strain L. plantarum

Laxative effect

Contain glutaric acid and indolent-3-carbinol which improve estrogen metab.

Contains polyamines

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6
Q

Bacteria associated with Bulgarian yogurt (2)

A

Lactobacillus delbrueckii ssp. bulgaricus

Streptococcus theramophilus

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7
Q

Most common and best researched prebiotics (3)

A

Fructooligosaccharides (FOS)

Lactulose

Galactooligosaccharides (GOS)

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8
Q

3 types of FOS

A

Insulin

Oligofructose

Neosugar

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9
Q

What are the sizes / types of the 3 FOS?

A

Insulin - largest chain, extracted from chicory roots

Oligofructose - medium chain, from inulin using enzymatic hydrolysis

Neosugar - short chain, synthesized using Funchal organism that converts sucrose to FOS

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10
Q

Define probiotic

A

Live microorganism which when administered in adequate amounts confer a health benefit on the host

Viable, microbial agents that have been demonstrated to improve health

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11
Q

Define food sources of live and active cultures

A

Contain a diverse community of microbes that are not well-defined in terms of strain composition or stability

Lack specific therapeutic qualities

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12
Q

What bacterial species are responsible for taste, consistency, and smell associated with yoghurt

A

Lactobacillus delbrueckii ssp bulgaricus

Streptococcus thermophilus

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13
Q

4 Essential characteristics of probiotics

A
  1. Gastric acid and bile salt stability (e.g. survival through upper GIT)
  2. Ability to adhere to intestinal cells
  3. Ability to temporarily colonies the gut
  4. Clinically documented and validated health effects
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14
Q

Differentiate species from strain

A

Species, like dogs

Strains, like the breeds of dogs

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15
Q

T/F actions and qualities of probiotics are strain specific

A

True

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16
Q

How do probiotics work?

A

Car park theory - they work by competing with bacteria and fungi in the GI for limited space

They are:
• Antagonists (inhibitory, secrete anti-microbial substances, bind to viruses, inhibit gene coding and thus reduce expression of pathogen factors)
• Interact with immune cells (trains and balance immune system, increase gut sIgA production, modify allergens to less allergenic forms)
• Produce beneficial compounds: SCFA (create healthy colonic environ by decreasing pH = more acidic) and polyamines (restore normal sm intestinal architecture and upregulate digestive enzyme fxn)
• Anti-inflammatory: interact with toll-like receptors
• Modify gut transit time
• Decrease visceral hypersensitivity (a problem with IBS)
• Strengthen intestinal barrier
• Alter brain chem
• Alter metabolism

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17
Q

T/F take probiotics on an empty stomach to optimize survival through upper GIT

A

FALSE

Take probiotics with food to decrease gastric acid and optimize survival

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18
Q

2 factors of a “good” probiotic supplement

A

1 - characteristics of the strains contained in supplement

2 - adequate viability

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19
Q

Minimum effective dosage for probiotic

*memorize this

A

10^9 colony forming units/dose

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20
Q

What condition occurs rarely in people with short small intestines?

A

D-lactic acidosis

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21
Q

Probiotic for viral gastroenteritis

A

L rhamnosus GG

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22
Q

T/F Don’t use probiotics during antibiotic treatment because the antibiotics
will kill all the probiotic bacteria

A

F

research clearly shows that concurrent administration not only
significantly decreases AB-related side
effects, but also attenuates AB-associated damage to the gut microbiota

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23
Q

Changes produced in kefir milk

A

Lactose —> lactic acid

CO 2 production

Increased free amino acids

‘B’ vitamins & flavonoids increase

production of antimicrobial compounds–appear to be active
against some Gram-negative bugs (e.g., E. coli)

production of a polysaccharide – kefiran
— raises activity of proteolytic enzymes in GIT (rats & in vitro)
— oral consumption has demonstrated anti-tumour activity and improvements in immune status (rats)

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24
Q

Leuconostoc mesenteroides

Lactobacillus plantarum (can reach 1010 CFU/g)

Lactobacillus brevis

+/- Streptococcus faecalis & Pediococcus pentosaceus

Those microorganisms are involved in?

A

Sauerkraut and kimchi

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25
Q 
Lactococcus lactis 
Lactobacillus brevis 
Lactobacillus rhamnosus 
Leuconostoc mesenteroides 
Candida kefir 
Torulaspora delbrueckii 
Saccharomyces cerevisiae 
Streptococcus lactis

Those microorganisms are involved in?

A

Kefir

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26
Q

Vitamin C can increase by 600% after 7 day ferment of

A

Sauerkraut/kimchi

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27
Q

Sauerkraut/kimchi is rich in strains of

A

L plantarum

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28
Q

Sauerkraut/kimchi contain what compound that helps improve estrogen metabolism

A

Glucaric acid (glucarate)

Indole-3-carbinol

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29
Q

Yeast ferment microbe

A

Saccharomyces cerevisiae

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30
Q

What are the bacteria that produce lactic acid as one of the main end-products?

A 
Leuconostoc spp.
Lactobacillus spp.
Streptococcus spp.
Pediococcus spp.
Lactococcus spp.
Bifidobacterium spp.

Involved in yoghurt, kefir, idli, sauerkraut, kimchi, dosa, olives, pickles

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31
Q

Tempeh is fermented by

A

Rhizopus oligosporus

  • not reliable probiotic food
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32
Q

Miso is fermented by

A

Aspergillus oryzae
Saccharomyces rouxii

*unlikely to have probiotic effect

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33
Q

Define PREbiotic

A

A nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon.

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34
Q

4 characteristics of prebiotics

A
  1. Neither be hydrolysed nor absorbed in the stomach or small intestine;
  2. Act as a selective substrate for one or a limited number of potentially beneficial commensal bacteria in the large intestine;
  3. Change the colonic microflora ecosystem towards a healthier composition; and
  4. Induce luminal or systemic changes that improve the health of the host.
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35
Q

What are prebiotic compounds

A

FOS
GOS
Lactulose

Lactitol
β-glucoolimers
Raffinose
Xylooligosaccharides

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36
Q

Difference between colonic foods and prebiotics?

A

PREbiotics very specific

Colonic foods lack specificity.

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37
Q

Examples of colonic food

A

Slippery elm
Pectin
Psyllium husk
Guar gum

Green tea
Dark cocoa
Almonds
Larch aabinogalactans

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38
Q

3 types of FOS, their size, and how their extracted

A

Inulin - largest; extracted from chicory roots

Oligofructose - medium; from inulin using enzymatic hydrolysis

Neosugar - short; fungal organism that converts sucrose to FOS

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39
Q

Foods that contain FOS

A 
Onion
Artichoke
Rye
Dandelion
Barley
Asparagus
Leek
Garlic
Banana
Wheat
Chicory
Salsify
Burdock
Ya on
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40
Q

Uses of FOS

A

Enhance bifidobacteria

Enhance immunity

Absorption of calcium

Improved bioavailability of phytoestrogens

Efficacy of medicinal herbs, esp post-antibiotic therapy

Hyperlipidemia

Damaged intestinal or colonic mucosa

Tx atopic eczema and prevent atopy development

Promote satiety

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41
Q

Optimal dose of FOS

* memorize

A

10g/day of FOS
(4-40g/day have been shown to have bifidogenic effect)

Dosages of <3g/day are unlikely to cause sig alterations in GIT

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42
Q

Lactulose is semi-synthetic disaccharide composed of the monosaccharides (2)

A

Fructose

Galactose

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43
Q

Uses of lactulose

A

Enhances growth of lactobacilli AND bifidobacteria

Candidiasis

Constipation

Prevention of colon cancer

Damaged Intestinal or Colonic Mucosa
- trophic and healing effects on the GIT

Alcoholic Liver disease

Lowered immunity

Colon acidifier

Endotoxemia

Prevention UTI

Tx of atopic eczema and prevent atopy

Tx UC

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44
Q

Optimal dose for lactulose

*memorize

A

10g, 2x/day

3-20g/day

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45
Q

GOS is a nondigestible carb produced from lactose using

A

β-galactosidases

β-linked glycosides are resistant to digestion by host-secreted enzymes in the small intestine

  • reach the terminal ileum & colon intact
  • become available to those members of the colonic microbiota metabolically equipped to metabolize these specific oligosaccharides
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46
Q

Uses of GOS

A

Enhances growth of lactobacilli AND bifidobacteria

Constipation

Prevent atopic disease

Increased resistance to infections

IBS

Calcium absorption

Metabolic syndrome

Prevent GIT infections

Prevent Travellers diarrhea

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47
Q

Bifidogenic effect of GOS in doses of:

*memorize

A

2.5-15g/day

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48
Q

Tx of IBS - dosage of GOS

*memorize

A

3.5G/day

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49
Q

Prevention of travellers diarrhea - dosage of GOS

*memorize

A

2.6g/day

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50
Q

Enhance calcium absorption - dose of GOS

*memorize

A

5-20g/day

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51
Q

Define colonic food

A

Foods entering the colon and serving as substrates for the endogenous colonic bacteria, thus indirectly providing the host with energy, metabolic substrates and essential micronutrients.

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52
Q

Colonic foods include (general)

A 
Resistant starch
Plant cell wall polysaccharides
Hemicelluloses
Pectins
Gums
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53
Q

Dosage of larch arabinogalactans (LA)?

*memorize

A

5-30g/day

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54
Q

What are synbiotics

A

Contain both probiotic and PREbiotic agents

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55
Q

Synbiotics are supposed to (30)

A

1) enhance the survival of the probiotic bacteria through the upper GIT,
2) improve implantation of the probiotic in the colon, and
3) have a stimulating effect on the growth and/or activities of both the exogenously provided probiotic strain(s) and the endogenous inhabitants of the bowel

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56
Q

Synbiotics must meat 4 criteria

A

1) well-characterized and researched probiotic strains
2) “prebiotic” substance meets requirements to be considered prebiotic
3) “prebiotic” demonstrates enhance growth of exact probiotic strain in the product
4) both agents included in therapeutic dose

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57
Q

Disappearing microbiota hypothesis. The reason why things are changing is:

A 
Clean drinking/bathing water
More C-sections
More pre-term and infant AB usage
Widespread AB use through life
Reduced breastfeeding rates
Increased use of antibacterial soaps, creams, sprays
Early childhood PPI use
Dysbiosis-inducing and/or restrictive diets
PPI exposure in life and pregnancy
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58
Q

Medications that induce (8)

A 
PPI
Chemotherapy
Metformin
NSAIDs
Atypical antipsychotics
Statins
Polypharmy in elderly
Radiotherapy
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59
Q

Food additives that induce dysbiosis

A

Artificial sweeteners=sucralose, saccharin
Dietary emulsifiers=carboxymethylcellulose, polysorbate-80
Environmental chemicals=glyphosate
High protein-low carb
Keto diet
SAD

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60
Q

Natural medicines capable of inducing dysbiosis

A

Citrus seed extract
High-dose and long-term berberine
Enteric-coated essential oils
Biofilm busting products

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61
Q

Strategies to improve microbiota diversity

A 
PREbiotic daily
Diversity of plants
Live on a farm/organic gardening
Raw fruits, veggies, nuts, seeds
Exercise
PRObiotic supplants, ferments
Fecal microbial transplant
Resistant starch-rich foods
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62
Q

Acacia fibre dosage

*memorize

A

At least 10 g/day

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63
Q

Lactulose (syrup) dosage

*memorize

A

at least 5ml/day

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64
Q

GOS dosage

*memorize

A

at least 3g/day

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65
Q

FOS/inulin dosage

*memorize

A

at least 3g/day

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66
Q

Partially-hydrolysed guar gum dosage

*memorize

A

• at least 5g/day

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67
Q

Polyphenol-rich foods

A

Fruit-blk elderberries, currants, blueberries, cherries, strawberries, blackberries, plums, raspberries, red apples, black grapes
Nuts and seeds-flaxseed meal, chestnuts, hazelnuts, pecans, black tahini
Vegetables-purple carrots, red carrots, purple/red potatoes, red cabbage, spinach, red onions, broccoli, carrots, red lettuce
Grains-red&black rice, quinoa, whole grain rye bread
Other-black olives, olive oil

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68
Q

FOS foods

A 
Asparagus
Banana
Barley
Burdock
Chicory
Dandelion
Garlic
Artichoke
Leek
Onion
Rye
Salsify
Wheat
Yacon
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69
Q

GOS foods

A 
Beetroot
Borlotti beans
Brocc
Chick peas
Fennel
Haricot beans
Lentils-green, red
Lima beans
Oats
Onion
Radish
Red kidney beans
Rye bread
Soy beans
Wheat
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70
Q

Prebiotic like foods

A 
Brown rice
Carrots
Black currants
Dark cocoa
Almonds
Green tea
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71
Q

4 types of resistant starch-rich foods

A

RS1 - grains, seeds, legumes

RS2 - starchy foods, raw potatoes, plantains, green bananas

RS3 - when root veggies and whole grains are cooked and cooled. Also, legumes

RS4 - human-made via chemical process

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72
Q

3 enterocytes

A

Bacteroides
- associated with diets rich in animal protein and saturated fats

Prevotella
- plant-based diet

Ruminococcus
- most prevalent now

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73
Q

benefits of colonic microflora

A 
Modulate immune system
Enhance GIT motility and function
Improved digestion and nutrient absorption
Produce B and K vitamins
Xenobiotic metabolism
Colonization resistance
Production of SCFAs
Production of polyamines
Weight management
Dysbiosis
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74
Q

3 main SCFAs

A

Butyrate
Propionate
Acetate

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75
Q

The more protein consumed the more (4) produced

A

Insoles
Phenols
Hydrogen sulphide
Ammonia

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76
Q

Diet high in fat increases (2) populations and decreases (1) population

A

Increase: E.coli.& Desulfovibrionaceae;

Decreases: Bifidobacteria

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77
Q

Diets high in milk fat increase the rare gram-negative bacterium

A

Bilophila wadsworthia

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78
Q

How to Dx dysbiosis

A

Mostly symptom based picture plus a recent history: AB, high stress, dietary risk factors, suffer from 1+ diseases

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79
Q

How to Tx dysbiosis

A

PREbiotics
Probiotics
Colonic foods
Antimicrobial herbs

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80
Q

Probiotics for dysbiosis (2)

A

Bifidobacteria lactis HN019

Lactobacillus rhamnosus GG

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81
Q

Herbs that have substantial selectivity of action GIT antimicrobials (3) for dysbiosis tx

A

Allium sativum -garlic

Pomegranate husk

Green tea extract

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82
Q

Last resort, broad-acting, potentially microflora-damaging option for dysbiosis tx (3)

A

Berberine-rich herbs
Enteric-coated essential oils
Antibiotics

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83
Q

Causes of GERD

A 
LES incompetence
Delayed gastric emptying
Impaired esophageal acid clearance
Hiatal hernia
Decreased salivation
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84
Q

Contributing factors of GERD

A 
Genetic disposition
Medications
Smoking
Pregnancy
Psychological stress
High BMI
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85
Q

What types of food/drink causes increased acid secretion in GERD (2)

A

Alcohol

Coffee

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86
Q

What types of food /drink causes reduced LES pressure in GERD (4)

A

Alcohol
Chocolate
Coffee
Fatty meals

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87
Q

What types of food /drink causes transient LES relaxation in GERD (2)

A

Alcohol

Peppermint essential oil

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88
Q

What types of food /drink causes slow gastric emptying in GERD (2)

A

Alcohol

Fatty food/meals

89
Q

What types of food /drink impairs esophageal mobility in GERD (1)

A

Alcohol

90
Q

Food/drink capable of triggering esophageal pain in GERD (4)

A

Tomato/citrus juice
Soft drinks
Spicy food
Alcohol

91
Q

Define FODMAP

A 
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols
92
Q

The presence of ___ infection in stomach plays a protective role against dev of the most severe forms and complication of GERD incl Barrett’s esophagus

A

H pylori

93
Q

TX heartburn pain in GERD

A

GI demulcents

94
Q

TX for GERD (add)

A 
D-limonene (demulcent)
Melatonin
Meadowsweet (demulcent)
Chamomile (demulcent)
Licorice (demulcent)
Comfrey leaf (demulcent)
Aloe vera (demulcent)
Calendula flowers (demulcent)
Curcumin
95
Q

TX for GERD (avoid)

A

Alcohol
Chocolate
Caffeine
Fatty foods

96
Q

TX for GERD in infants

A

Diary free diet
Carob powder
Althaea radix powder

97
Q

Vitamins to prevent esophageal cancer

A

Zinc

B-carotene

98
Q

Speed gastric emptying - probiotic

A

Lactobacillus reuteri protectis

99
Q

Etiology of peptic ulcer disease (PUD)

A

Drug use: oral corticosteroids, aspirin, NSAIDS

Lifestyle: stress, smoking, alcohol abuse, low dietary fiber

100
Q

Foods and drinks to eradicate H pylori

A 
Green tea - inhibits growth
Cranberries - goes dormant
Cranberry juice - not as good as AB
Dark grapes
Berries 90% eradication
101
Q

Probiotics to eradicate H pylori

A

Lactobacillus acidophilus NAS - 43%
Lactobacillus reuteri MM53 +omeprazole 60%
Lactobacillus acidophilus LA5 & bifidobacterium lactis Bb12 - decreased density
Saccharomyces cerevisiae var boulardii biocodex 12%

102
Q

Pre-AB therapy probiotic for H pylori

A

Lactobacillus acidophilus LA5 & bifodobacterium lactis Bb12

103
Q

With AB therapy probiotic for H pylori

A

Lactobavillus reuteri MM53

104
Q

Herbs to eradicate H pylori

A

Rheum emodi - rhubarb
Nigella sativa - ground seeds
Brocc sprouts
Mastic gum

105
Q

Vitamins for eradicating H pylori

A

Vitamin C and E
Zinc carnosine
Lactoferrin

106
Q

Promote ulcer healing

A 
Melatonin
L-tryptophan
Zinc carnosine
Cabbage juice
Mastic gum
Licorice
107
Q

What supplement decreases thickness and viscosity of mucous layer facilitating physical contact between natural anti-microbial and H pylori?

A

N-acetyl Cysteine (NAC)

108
Q

Ddx wheat allergy, celiac disease, gluten sensitivity

A

Wheat allergy - IgE antibodies
CD - autoimmune mediated
Gluten sensitivity - IgG antibodies

109
Q

Tx for wheat allergy

A

Avoid wheat only

110
Q

TX for celiac disease

A

Avoid gliadin (wheat, spelt, kamut, triticale), secalin (rye), horedin (barley), avenin (oats) peptides because they resist digestion in the upper GIT

Lifelong strict avoidance of all gluten-containing foods and drinks

111
Q

TX for gluten sensitivity

A

Gluten-free diet

Lifelong strict avoidance of all gluten-containing foods and drinks

112
Q

Skin condition possible in CD

A

Dermatitis herpetiformis
10-20% patients
Symmetrical rash on elbows, knees, back, buttocks

113
Q

Gold standard test for CD

A

Small bowel biopsy

114
Q

How much and long does patient need to consume gluten before testing?

A

4 slices bread (2 for children) per day for 6 weeks

115
Q

Tests for CD

A

Gold standards ⭐️ small bowel biopsy
Biocard celiac test
Anti-gliadin antibody (AGA) IgA
Intestinal permeability lactulose:mannitol ratio

116
Q

Other indicators of “hidden” CD

A

Unexplained raised liver enzymes: AST, ALT
Unexplained Iron deficiency
Delayed puberty
Infertility

117
Q

Dx gluten sensitivity

A

Serum zonulin
Anti-gliadin Antibody (AGA) IgG

Trial of GF diet and subsequent open/blinded challenge

118
Q

CD Tx

A

Nutritional supplementation:
‣ Fe, B12, homocysteine, serum 25-hydroxyvitamin D
‣ Zinc, selenium, calcium, magnesium, vitamin B6, vitamin e, vitamin k
‣ Hookworm infection
‣ Gluten-digesting enzymes (glutenases) e.g. germinated barley and sphingomonas capsulatum

Probiotics:
‣ Bifidobactrium lactis
‣ Bifidobacteria infantis (Natren strain)
‣ Saccaromyces cerevisiae var boulardii (Biocodex strain)

Tumeric, curcumin
L-glutamine
Prebiotics
CLA

119
Q

One of 3 major dietary monosaccharides (along with glucose and galactose) is:

A

Fructose

Ingested in 2 forms: free fructose, sucrose

120
Q

Fructose is absorbed via

A

Carrier mediated facilitated diffusion = GLUT5

121
Q

Define fructose malabsorption (FM)

A

occurs when the amount of fructose consumed is more than the small intestines can metabolise and absorb

122
Q

What is the threshold of FM?

A

15g

123
Q

DX fructose malabsorption

A

Breath hydrogen testing + methane
Blinded fructose tolerance test
Empirical trial of low-fructose diet

124
Q

2˚ fructose intolerance due to (5)

A

chemotherapy, radiotherapy, giardiasis, viral and bacterial gastroenteritis

125
Q

S&S of fructose malabsorption

A

GI, fatigue, HA, diminished concentration, myalgia, arthralgia, depression

126
Q

When ingested regularly, adaptation occurs with [this condition]

A

Lactose intolerance

NOT fructose malabsorption

127
Q

TX for fructose malabsorption

A

Reduce fructose
Eliminate sorbitol and other sugar alcohols
Avoid: fruit, dried fruit, sweeteners, drinks, sauces, others
OK food:
‣ Fruit: Papaya, avocado, banana, blackberry, blueberry, coconut, cranberry, fig, grapefruit, jackfruit, kiwifruit
‣ Sucrose in mod, glucose, maple syrup, molasses
Low FODMAP diet, which is not great, so to manage negative microbiota impact add: GOS, PHGG (5G or 10g)
Add glucose which enhances fructose absorption and upregulate GLUT2 activity
Add amino acids/protein with fruit consumption

128
Q

Fructose malabsorption is associated with decreased (3) levels/concentrations

A

Tryptophan
Folate
Zinc

129
Q

Fruit that is OK in FM

A

avocado, babaco, banana, blackberry, blueberry, coconut (grated and
dried), cranberry, fig (fresh), grapefruit, jackfruit, kiwifruit, kumquat, lemon, lime, mandarinβ, orange (Valencia is higher in fructose), passionfruit, pepino, pineappleβ, rhubarb, tamarillo, tangelo, raspberryβ, strawberry

130
Q

Problematic vegetables, grains, supplements for fructose malabsorption

A

Grains – wheat

Vegetables – asparagus, globe artichoke, garlic (small doses usually OK), Jerusalem artichoke, leek, onion, shallot, spring onion, zucchini

Other – fructooligosaccharide (FOS), lactulose, larch arabinogalactans, and inulin supplements

131
Q

Issues with low FODMAP diet

A

Eliminates many healthy foods

Negative effects on microbiota

132
Q

Attenuate negative microbiota impact from low FODMAP with:

A

GOS

PHGG

133
Q

Giardiasis is an Intestinal infection caused by the protozoan parasite

A 
Giardia lamblia (aka G. intestinalis or
G. duodenalis)
134
Q

The MC protozoan infection in humans

A

Giardiasis

135
Q

Sx of giardia

A 
Ab pain
Nausea
Lack of appetite
Diarrhea
Vomiting
Flatulence
Burping
Tiredness
136
Q

TX goals for giardiasis (3)

A
  1. inhibit G. lamblia growth, replication and/or
    attachment to enterocytes
  2. promote giardial-defence mechanisms
  3. minimise unpleasant symptoms
137
Q

2 specific TX for giardiasis

A

Wheat germ - 60% reduction

Insoluble fiber

138
Q

TX for giardiasis - probiotics (4)

A

Lactobacillus plantarum 299v

L acidophilus LA5 and L rhamnosus GG

Saccharomyces cerevisiae var boulardii (Biocodex strain)

Saccharomyces cerevisiae (Biocodex strain)

139
Q

Overall general dietary recommendations for TX Giardiasis (5)

A

Eat whole foods, high fiber

Reduce fat

Minimize lactose (<12g) and simple sugars

Consume flavonoid-rich food

Blueberries are good

140
Q

Herbs for giardiasis

A

Psidium guajava leaf - guava leaf

Garlic
Berberine

Mangifera indica leaf - mango
Plantago major leaf - plantain
Punica granatum husk - pomegranate

141
Q

Lactose is composed of (2)

A

Galactose and Glucose

142
Q

Define lactase nonpersistence

A

Indicates the brush border lactase activity is a small fraction of the infantile level

143
Q

Define lactose malabsorption

A

Indicates that a sizable fraction of a dosage of lactose in not absorbed in the small bowel and thus is delivered to the colon

144
Q

Define lactose intolerance

A

Indicates that the malabsorbed lactose produces symptoms (linked to the quantity of lactose)

145
Q

Who does lactase persistence happen in?

A

Northern European descent

Lactase persistence was rare in Northern Europeans prior to diary farming

146
Q

Humans lose their capacity to digest lactose as they age because

A

Genetically programmed reduction in lactase synth

70% of the world has lactase nonpersistence, but not all are lactose intolerant

147
Q

T/F All people who have lactose malabsorption experience lactose intolerance

A

False

Not every malabsorbed has symptoms of intolerance

148
Q

Define secondary lactose intolerance

A

Loss of lactase activity in people with lactase persistence or infants.

Occurs as a result of any trauma or illness that damages the microvilli of the small intestine

Deficiency that is usually reversible with recovery from the disease

E.g. intestinal infection, CD, giardiasis, gastroenteritis, radiotherapy, chemotherapy, rotavirus gastroenteritis

149
Q

What is the single dose of lactose that produces no or only minor Sx

*memorize

A

12g

> 80% lactose maldigesters report Sx after 50g lactose.
Single dose >18g associated with greater risk of S&S

150
Q

Labs/test of lactose intolerance (3)

A

Breath testing-analyze excreted gases

Genotyping

Lactose challenge ⭐️ may be the gold standard

151
Q

Lactose intolerance - management

A

Low lactose diet

Lactase enzymes

152
Q

What foods have high calcium?

A 
Fortified soy/rice/almond milk
Spinach
Sardines w/bones
Chinese cabbage
Tahini
Tofu
Almonds
Figs
Molasses
153
Q

Lactase enzymes derived from yeast (2)

A

Kluyveromyces lactis OR

Asperigillus oryzae

154
Q

Probiotics for lactose intolerance (3)

A

Lactobacillus casei Shirota and Bifidobacterium breve
Yakult

Lactobacillus acidophilus LA5

155
Q

T/F continued daily ingestion of lactose results in adaptation

A

True

156
Q

TX 2˚ lactose intolerance

A 
Low lactose diet
Supplemental lactase
Appropriate probiotic strain supplementation
Lactulose supplementation
Lactose colonic adaptation
157
Q

Best strain for 2˚ lactose intolerance

A

Saccharomyces cerevisiae var boulardii Biocodex

158
Q

Define SIBO

A

Small ingestion bacterial overgrowth

Heterogenous syndrome characterized by increase number and/or abnormal type of bacteria in the small bowel
>10^5 CFU of bacteria/mL

159
Q

2 types of SIBO

A

Gram-positive bacteria from upper respiratory tract and oral cavity
- failure of gastric acid barrier

Colonic/Coliform bacteria
- failure of intestinal clearance / small bowel anatomic alterations

160
Q

Risk factors for SIBO

A 
PPI
Narcotics
Opiates
Gastrectomy
Chronic pancreatitis
Dysmotility
AIDS
Diabetic neuropathy
Elderly >75yo
Small bowel intestinal disorders (causing dismobility)
Large bowel disorders
161
Q

What is 1 way to DX SIBO that has a lot of false positives/false negatives

A

Lactulose breath test

It measures hydrogen+methane after lactulose ingestion.
Poor specificity, poor sensitivity.

There is no gold standard for testing for SIBO

162
Q

What is the imperfect gold ⭐️ standard for Dx of SIBO?

A

Jenjunal aspirate and culture

163
Q

Other Dx testing for SIBO (2)

*profs prefered testing

A

Glucose breath test

Triple sugar testing * profs prefered testing

164
Q

TX of SIBO

A 
Remove contributing factors (PPI, narcotics)
Anti-microbial therapy (ABs)
Diet?
Pro/PREbiotics?
Nutritional supplements
Sm intestinal motility enhancers
Gut healing agents
165
Q

Anti-microbial herbal medicine for SIBO (1)

A

Enteric-coated Mentha piperita oil - peppermint oil

166
Q

Herbs agains streptococcus spp (6)

A 
Punica granatum (fruit rind) - pomegranate 
Allium sativum - garlic
Syzygium aromaticum oil - clove
Thymus vulgaris oil - thyme
Origanum vulgare oil - oregano
Berberine
167
Q

Herbs agains e.coli (8)

A 
Punica granatum (fruit rind)
tea polyphenols
Allium sativum (fresh best)
Origanum vulgare oil
propolis
Plantago major
Syzygium aromaticum oil
Thymus vulgaris oil
168
Q

Herbs against bacteroides spp (4)

A 
tea polyphenols
Allium sativum
Syzygium aromaticum oil
Thymus
vulgaris oil
169
Q

Herbs against clostridium spp (9)

A 
Origanum vulgare oil, 
Trachyspermum copticum oil,  
Mentha piperita oil, 
Allium sativum (fresh),  
Coptis chinensis,  
Punica granatum (fruit rind), 
tea polyphenols, 
Thymus vulgaris oil
Syzygium aromaticum oil
170
Q

Herbs against staphylococcus spp (7)

A 
Punica granatum (fruit rind)
tea polyphenols, 
Allium sativum,  
Coptis chinensis (berberine)
Thymus vulgaris oil
Syzygium aromaticum oil,
Origanum vulgare oil
171
Q

Herbs against klebsiella spp (5)

A 
Punica granatum (fruit rind), 
Allium sativum,  
Origanum vulgare oil and infusion, 
Thymus vulgaris oil, 
Syzygium aromaticum oil
172
Q

Given that you likely don’t know the species involved in SIBO, chose the herbs for the MC microbes first (3) before those less selective ones (3):

A

Punica granatum (fruit rind)
Allium sativum – fresh is best; or high allicin
Green tea polyphenols

Origanum vulgare oil
Thymus vulgaris oil
Syzygium aromaticum oil

173
Q

Diet Tx in SIBO?

A

No dietary approach is clinical prevent

174
Q

Probiotics for SIBO (3)

A

Lactobacillus rhamnosus GG

Lactobacillus plantarum 299v

Lactobacillus casei Shirota, Bifidobacterium breve Yakult,
and GOS (in combination)
175
Q

PREbiotic for SIBO (3)

A

Lactulose
PHGG (Partially-hydrolysed guar gum)
GOS

176
Q

Small intestinal motility enhancers for SIBO (6 suggestions)

A

Lactulose

Synbiotics: L. rhamnosus GG and B. lactis Bb12 with inulin

Probiotic strain:

1) Bifidobacterium lactis DN-173010
2) Bifidobacterium lactis HN019

Reduce stress

Minimise snacking

Iberogast

Ginger

177
Q

Gut healing agents for SIBO Tx (4)

A

Lactulose
PHGG
Saccharomyces cerevisiae var boulardii Biocodex
L-Glutamine

178
Q

Digestive aids for SIBO (3)

A

Betaine HCL
Digestive enzymes at meals
Herbal bitters

179
Q

Define Crohn’s disease

A

Chronic inflammatory bowel disease

180
Q

Crohn’s disease results from

A

Inappropriate inflammatory response to intestinal microbes in genetically-susceptible host

181
Q

S&S of Crohn’s disease that is different from others

A

Rectal bleeding

Abdominal tenderness or masses

182
Q

Tests to DX Crohn’s

A

Stool tests
Colonoscopy and endoscopy
Imaging (CT, barium xray)
ESR and CRP

183
Q

What is the main objective in Tx of Crohn’s disease

A

Mucosal healing

184
Q

Tx for mucosal healing for Crohn’s disease (3 total, 1 is probiotic)

A

Glutamine
Whey protein
Saccharomyces cerevisiae var boulardii CNCM I-745

185
Q

Lifestyle recommendations for crohns

A

Stop smoking

Reduce oxidative stress

186
Q

How to Reduce oxidative stress in CRohns

A 
NAC
Vit E + C
Dietary antioxidants
Eliminate alcohol
Yeast free diet
Avoid Lactose
Avoid fructose
Low FODMAP diet
Semi-vegetarian
187
Q

What are Dietary antioxidants?

A

Proacthocyanidins: dark-coloured grapes, red rice

Anthocyanins: blueberries, bilberries, black currants, raspberries, black rice, cranberries, purple/blue corn

Chlorophyll: leafy greens (silver beet, English spinach, watercress, lettuce), celery

Carotenoids: Butternut pumpkin (squash), carrots, sweet potatoes, tomatoes, red capsicums (peppers)

188
Q

Nutritional supplementation for crohns

A

Zinc

Vit D

189
Q

Probiotics with negative results in crohns

A

Lactobacillus rhamnosus GG

Lactobacillus johnsonii LA1

190
Q

PREbiotics in crohns

A

FOS and lactulose didn’t provide significant improvement

191
Q

Omega-3 FA for crohns?

A

Yes

192
Q

Herbal medicine for crohns (4)

A

Wormwood
Turmeric
Boswellia
Mastic gum

193
Q

MC cause of severe, dehydrating gastroenteritis among children worldwide

A

Rotavirus gastroenteritis

194
Q

Prevention of rotavirus - probiotics (2)

A

Lactobacillus rhamnosus GG

Lactobacillus reuteri MM53

195
Q

Prevention of rotavirus - food (4)

A

Carob powder
Cooked green bananas
Avoid gluten
Avoid juices and soft drinks

196
Q

Prevention of rotavirus - herbs

A

Potentilla tormentil - rose family

Tannin-rich herbs (cinn, blackberry/raspberry)

Nutmeg

197
Q

Post-gastroenteritis probiotic (1)

A

Saccharomyces cerevisiae var boulardii Biocodex

198
Q

Define IBS

A

Functional GI disorder characterized by altered bowel habit and ab pain

199
Q

How to DX IBS

A

Dx of exclusion

200
Q

Rome IV criteria

A

Recurrent ab pain 1 day per week in the last 3 months associated with 2+ of the following:

  1. Related to defecation
  2. Change in freq of stool
  3. Change in form of stool
201
Q

PREbiotics for IBS (1)

A

GOS

202
Q

Probiotics for IBS (1)

A

Lactobacillus plantarum 299v

203
Q

In C-IBS, Tx to normalize bowel habit (3)

A

Fiber
Fluid
Exercise

204
Q

Fiber for C-IBS (6)

A 
Ground flaxseed
Slippery elm powder
Psyllium husk
Oat bran
Chia seeds
Pectin
205
Q

C-IBS probiotic that speeds colonic transit time

A

Bifidobacterium animalis DN-173 010

Bifidobacterium lactis HN019

206
Q

3 GI Sx that have neg impact on quality of life for IBS

A

Straining at stool
Abdominal pain
Abdominal bloating

207
Q

Manage GIT Sx for IBS - abdominal pain and bloating

A 
Cardamom
Caraway seeds
Peppermint
Spearmint
Dill seeds
Fennel seeds
Mandarin peel
Ginger
Chamomile
Lemon balm cramp bark
208
Q

Manage GIT Sx for IBS - decrease gut inflammation and visceral hypersensitivity

A

Licorice root
Chamomile
Turmeric
Melatonin

209
Q

These are SX not part of IBS

A

Bloody stools
Weight loss
Fever
Family Fx colon cancer

210
Q

MC form of IBD

A

UC

211
Q

Lifestyle factors that increase risk of UC

A 
Cigarette smoking
Med use (AB)
Insufficient duration breastfeeding
SAD diet
Vitamin D deficiency
Stress
NSAID use
Alcohol intake
212
Q

Primary Sx for US

A

Diarrhea with blood

213
Q

Dx tests for UC

A

Colonoscopy and biopsy

Supportive: elevated CRP, ESR, fecal lactoferrin and calprotectin

214
Q

Dietary advice for UC

A 
Decrease n-6 fats
Increase n-3 fats
Antioxidant rich diet
Wheatgrass juice
Psyllium seeds - increase butyrate

Eliminate alcohol, dietary emulsifiers, packaged junk foods, white bread, sulphuric dried fruits, dehydrated veggies, packaged fruit juices, animal protein (putrefaction), dairy, potato-family

215
Q

N-6 fats

A 
Margarine
Sunflower
Corn 
Safflower
Soybean
Cottonseed
Sesame
Peanut oils
216
Q

N-3 fats

A 
Sardines
Salmon
Herring
Ocean trout
Mackerel
Mullet
True all a
Arctic char
Tuna
Tailor
Flaxseed oil, ground chia seeds, ground flaxseed
Walnuts, hemp seeds
217
Q

PREbiotic for UC (2)

A

Lactulose

FOS

218
Q

UC Tx - supplements

A 
Vitamin D
Aloe vera gel
Boswellia Serratus
Turmeric
Silymarin -extracted milk thistle
Andrographis
Bilberry

MSN 6204 (2 decks)

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