Nutri Theraputics Flashcards by Paige Snyder

Know how to interpret folate, B12, and iron deficiency anemias on blood chemistries and nutrient support for anemia.
• decreased transferrin saturation – in those with?

Hemolytic anemia
iron deficiency anemia
macrocytic anemia

iron deficiency anemia

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• megaloblastic anemia resulting from _____ deficiency is identical to the megaloblastic anemia resulting from _____ ___ deficiency, and further clinical testing is required to diagnose the true cause of megaloblastic anemia

B12, B6
B6, iron
folate, B12
folate, iron

folate, B12

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Signs of what?

fatigue, poor balance memory loss, pallor (paleness), reduced sensation of touch, shortness of breath, or tingling feet

anemia

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Megaloblastic or macrocytic anemia: can be classified by what kind of cells? what nutrients?

B12, B6
B6, iron
folate, B12
folate, iron
enlarged, immature red blood cells
enlarged, immature white blood cells
shrunken, immature red blood cells
sickle shaped cells

enlarged, immature red blood cells.

B12, or folate

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Recommendations for:
• the DASH, Mediterranean or a full plant-based diet3 in order to help balance out his blood chemistry.
• Lower dietary sodium
• Increase water
• Increase plant based protein (pg112)
• Omega -3’s (pg114)
• Fiber, Alpha Lipoic Acid, CoQ10, garlic etc

Know dietary and nutritional support for hypertension pg 105 - Week 2 Discussion Board A

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What condition do these test for?
•	Homocysteine, 
•	CoQ10, 
•	alpha-tocopherol, 
•	gamma- tocopherol, 
•	lipid peroxieds  
•	low vitamin C 
•	CRP

cardiovascular health

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two heavy metals associated with poor cardiovascular health

aluminum, cadmium
cadmium, lead
lead, aluminum

cadmium, lead

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T or F: RBC potassium is a better indicator of total body stores than serum potassium

True

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Numerous research has demonstrated a significant reduction of blood pressure with increased dietary intake of ____. At ___ g per day

biotin, 5.7
folate, 5.7
magnesium, 4.7
potassium, 4.7

potassium, 4.7

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A high dietary intake of 500 – 1000 mg per day of ____ reduces blood pressure in most of the clinical trials.

calcium
magnesium
potassium
sodium

magnesium

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T or F: Body magnesium is more accurate in assessing total RBC magnesium

False , opposite

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Adding 1000 – 2000 mg/d of _____ will enhance the anti-hypertensive effects of magnesium.

Glycine
Lysine
Serine
Taurine

taurine

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T or F: High serum zinc levels have been associated with hypertension as well as cardiovascular disease

false, low

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______ mcg of allicin (four cloves) is the required amount to have a significant effect on lowering blood pressure

100
1000
10,000
100,000

10,000

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____ : decrease potassium, magnesium, phosphorus, sodium, chloride, folate, vitamin B6, zinc, iodine, and CoQ10.

Beta blockers
Diuretics
PPI
SSRI

Diuretics

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_____ reduce CoQ10 and zinc

Beta blockers
Diuretics
PPI
SSRI

Beta Blockers:

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5 statements required to be on dietary supplement labels

Name of the dietary supplement
Amount
Nutrition labeling
Ingredient list
The name and place of business of the manufacturer, packer, or distributor

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Vital for brain and organ function

25% of total _______ in the body is in the brain
Required for the synthesis of steroid hormones
Required to synthesize vitamin D
Required to produce bile salts
Cholesterol
Chylomicron
LDL
Lipids
VLDL

cholesterol

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Mechanisms in which _____ induce vascular damage

Inflammation
Oxidative stress
Autoimmune dysfunction
None
All
A and B only

all

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_____ and ____ have a positive effect on serum lipids and CHD risk.

Monounsaturated and PUFAs
Monounsaturated and Saturated
PUFAs and n-3s
PUFAs and saturated

Monounsaturated and PUFAs

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\_\_\_\_\_ \_\_\_\_\_ contribute to:
–Insulin resistance
–Artherogenic LDL
–LDL particle number
–VLDL
–Triglycerides
–Total HDL and HDL subfractions

Refined carbohydrates

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___ Particles Cause Plaque
•Cholesterol cannot float freely in the body
•Cholesterol is carried inside ___ particles through your blood.

Cholesterol
Chylomicron
LDL
Lipids
VLDL

LDL

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Expanded Lipid Panels looks at what 4 things?

LDL particle number
LDL small
LDL medium
LDL Large

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How to Change Small ___ to Large ___

Exercise
–4-5 days per week for at least 30 minutes
–2 days per week, do weight training
•Nutrition
–Consume fish 2-3 times per week or take a fish oil supplement
–Plant Sterols (2,000 mg/day)

Small LDL to Large LDL

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How to improve ____? –Body fat loss –Exercise –Consume fish 2-3 times per week or take a fish oil supplement (3 - 5 g/d) –Niacin (500 mg to 4000 mg in divided doses) –Quit smoking * Apo A * Apo B * Cholesterol * HDL2B * LDL * VLDL

HDL2b

____ is a true measurement direct measurement of amount of LDL particles •A high number of ____ increase your risk of heart disease •____ is a direct measurement whereas LDL is a calculated number, so ____ is a better marker for disease risk * Apo A * Apo B * Cholesterol * HDL2B * LDL * VLDL

Apo B

How to improve ____? Increase foods with plant sterols –Decrease foods high in saturated and eliminate trans fat –Increase soluble fiber –Exercise * Apo A * Apo B * Cholesterol * HDL2B * LDL * VLDL

Apo B

____ fiber binds fatty acids, cholesterol and bile acids and prevents their absorption or reabsorption during circulation. •____ fiber increases bile acid synthesis, creating a pathway for cholesterol excretion. •Since insulin stimulates cholesterol and triglyceride synthesis, lowering insulin with fiber may lower blood lipids.

soluble fiber

most of the cholesterol found in serum is derived from intestinal reuptake of cholesterol that has been deposited into the intestine from the ____ and ____ * Gall bladder and kidney * Liver and gall bladder. * Liver and kidney

liver and gall bladder.

* High levels can increase your risk for heart attacks and strokes * Diet and exercise have no significant affect on lowering abnormal values * A high level of ___ can be genetic -- Family members may consider testing to see if they are at risk * Niacin * High dose vitamin C * Apo B * HDL * LDL * Lp(a)

Lp(a)

3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG CoA reductase inhibitors) •_____ is synthesized in the same pathway as cholesterol; therefore also involves the HMG CoA reductase enzyme. •Research suggests that some statin drugs decrease serum _____ levels by as much as 40%

CoQ10

``` ____ induced nutrient depletions: –CoQ10 –Carnitine –Vitamin E –Vitamin D –Omega-3 fatty acids –Selenium ```

Statin

Nutrients to Improve__________ (9) * Fish Oil * Niacin * Tocotrienols * Red Yeast Rice * CoQ10 * Green Tea (EGCg) * Garlic * Plant Sterols * Fiber

Dyslipdemia

It has a positive impact on all lipid fractions –Lowers LDL, Lp(a), and triglycerides –Raises HDL and increase the ratio of large/small particle LDL * Biotin * Folate * Niacin * Pantothenic acid

niacin

Research indicates that the two most potent forms of tocotrienols are ____ and ____ * alpha and delta * delta and gamma * gamma and alpha

delta and gamma

Benefits: * Reduce oxidation of unsaturated lipids in cell membranes and lipoprotein particles. * Reduce foam cell formation by reducing oxidation of LDL particles and reducing the surface expression of cellular adhesion molecules. * Reduce the translation of HMG-CoA reductase mRNA as well as increasing the degradation of the enzyme post-transcriptionally Recommended dose: 250 mg of gamma and delta ____ at night with food. •The dosage is very important because increased dosing will induce its own metabolism and effectiveness •Lower doses are not as effective * Tocotrienols * Garlic * Green Tea (EGCG)

Tocotrienols

* Reduces intestinal cholesterol absorption * Inhibits enzymes involved in cholesterol synthesis * Deactivates HMG CoA reductase * Fibrinolytic and anti-platelet activity * Lowers blood pressure * Reduces LDL * Decreases coronary calcification * Tocotrienols * Garlic * Green Tea (EGCG)

Garlic

What botanical? * Protects LDL cholesterol from oxidation * EpiGallo-Catechin-3-Gallate- one of the more extensively studied green tea polyphenols * Can cause a small decrease in LDL levels and reduce platelet aggregation * Reduces fatty acid gene expression * Inhibits HMG CoA reductase * Decreases APO B lipoprotein secretion from cells * Dosage: 500 – 700 mg/d * Tocotrienols * Garlic * Green Tea (EGCG)

Green Tea (EGCg)

``` Dietary Recommendations for _____ •Reduce or eliminate refined carbohydrate intake •Anti-inflammatory diet •Avoid hydrogenated vegetable oils •Increase dietary fiber •Eat garlic often •Cook with coconut oil •Add olive oil to cooked foods and raw vegetables ```

dislyipidemia

Congestive heart failure. Issue with ____ ____. Restrict intake to _ _____ a day .

fluid retention, 2 quarts

• ____ foods further increase fluid retention, may lead to increased blood pressure * Processed * Whole * Raw * Macrobiotic

Processed

CHF patients are commonly deficient in what two minerals? * calcium and sodium * chloride and magnesium * magnesium and potassium

magnesium and potassium

diuretic mediation often deplete what two minerals? * calcium and sodium * chloride and magnesium * magnesium and potassium

magnesium and potassium

three non mineral nutrients often needed in CHF. * d-ribose, CoQ10, L – carnitine * d-ribose, CoQ10, L – lysine * d-ribose, CoQ10, L – phenylalanine * d-ribose, CoQ10, L – serine

d-ribose, CoQ10, L - carnitine

• GI – 4Rs

o Remove food sensitivities or allergies, alcohol, aspirin, NSAIDS from the diet. Use antimicrobials for dysbiosis or GI infection o Replace digestive enzymes and HCL if necessary. o Reinoculate the bowel with pre- and probiotics. o Repair the GI mucosa

What supplement ? • Protects the intestinal epithelial cells and supports intestinal barrier function. • Increases sIgA secretion • Directly inhibits colonization of harmful bacteria • protects gastrointestinal tract during antibiotic therapy • Restores normal intestinal function in children and adults with diarrhea • Prevents traveler’s diarrhea • C. difficile • Inflammatory Bowel Disease • Use with GERD • A nonpathogenic, probiotic yeast. * Bifidobacterium breve * Bifidobacterium infantis * Lactobacillus * Saccharomyces boulardii

• Saccharomyces boulardii

Know underlying causes of ___ Visceral hypersensitivity, disordered cortical pain processing, small bowel bacterial overgrowth, increased intestinal permeability

IBS

* A chronic illness that is unremitting intestinal in cfhlaamramctaetriiozend w bityh tissue sdtarmesasge caused by increased oxidative metabolic * Iennfelarmgym, mataiocrno annudtr iinetnets, tainnadl mdaicmroanguet irniecrneta ses requirements. * eDsieset n(atinatli oroxlied ainn thse, aolminegg, aim-3m fautntye afucindcst)i opnla, yasn adn downregulating inflammation What disease? * IBS * IBD * GERD * Leaky gut

Inflammatory Bowel Disease

• CMP-14 • Lipid Panel • HA1c • Insulin • Homocysteine • Hs-CRP/CRP • Sed rate • Iron Panel • Vitamin D 25-OH; 1,25 dihydroxyvitaminD labs to run for ? * IBS * IBD * GERD * Leaky gut

Inflammatory Bowel Disease

* Gluten * Food Sensitivity * Nutrient Deficiency * Stress and Hormone Imbalance * Dysbiosis * Infections * Toxins Potential triggers for ___ * IBS * IBD * GERD * Leaky gut

IBD

_______ is a stool (fecal) test that is used to detect inflammation in the intestines. a marker of neutrophil activity and inflammation * Calprotectin * elastase * sIgA * Eosinophil Protein X

Calprotectin

* a marker of eosinophil activity * and inflammatory, allergic, and parasitic influences which test? * Calprotectin * elastase * sIgA * Eosinophil Protein X

Eosinophil Protein X • Eosinophil : are a variety of white blood cells and one of the immune system components responsible for combating multicellular parasites and certain infections in vertebrates.

* a marker of secretory * immune function, GI mucosal defense, and the * maintenance of gut barrier function which test? * Calprotectin * elastase * sIgA * Eosinophil Protein X

sIgA

test for microbiome (3)

n-butyrate Acetate Propionate

benzoate, hipurate, phenylacetate, phenylpropionate, p-hydroxybenzoate, p-hydroxyphenylacetate, indican, tricarballyate, d- lactate, 3,4 dihydroxyphenylapropionate, d- arabintol markers for?

Bacterial or yeast/fungal over growth

* CBC w/diff * CMP-14 * Lipid Panel * HA1c * Insulin * Homocysteine * Cardio CRP * Iron Panel * Vitamin D 25-OH; 1,25 dihydroxyvitamin D Test for? (2) * IBS * IBD * GERD * Leaky gut * Autoimmune

Autoimmune, IBS

A comprehensive metabolic panel is a blood test that measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function. Glucose is a type of sugar your body uses for energy. Electrolytes keep your body's fluids in balance. * CBC w/diff * CMP-14 * Lipid Panel * HA1c

CMP-14

• GI – 4Rs

Remove gluten, egg, alcohol, aspirin, NSAIDS from the diet. o Replace digestive enzymes and HCL if necessary. o Reinoculate the bowel with pre- and probiotics. o Repair the GI mucosa with L-Glutamine and GI Repair Nutrients

* Gluten * Food Sensitivity * Nutrient Deficiency * Stress and Hormone Imbalance * Dysbiosis * Infections * Toxins environmental _____ triggers * IBS * IBD * GERD * Leaky gut * Autoimmune

autoimmune

- basophil or mast cell histimine release. - IgG or IgE. - Type I allergic reaction Describes what? * food allergy * food intolerance * food sensitivity * IgE

food allergy

- immune system mediated response. - forms immune complexes that can stimulate complement cascade and local inflammation - delayed hours to 7 days after - Type III Allergic reaction Describes what? * food allergy * food intolerance * food sensitivity * IgE

food sensitivity

- non immunological mechanisms - lactotose and MSG sensitivity Describes what? * food allergy * food intolerance * food sensitivity * IgE

food intolerance

Elevated levels of food specific ___ can cause allergic reactions to food involving the anaphylactic response Describes what? * food allergy * food intolerance * food sensitivity * IgE

IgE

Physical Exam for _______ patient – Waist circumference – Waist to hip ratio – Body Mass Index = Weight Kg/Height (m)2 – Bioimpedence (BIA)

Physical Exam for diabetes patient (4)

labs for suspicion of _______ ``` – CBC – CMP – Lipid Profile – Fatty acid profile – HbA1c – TSH – Homocysteine – CRP – Vitamin D ```

labs for suspicion of diabetes (9)

``` MEN, metabolic syndrome: • Waist Circumference > • Triglycerides > • HDL Cholesterol < • Blood Pressure > • Fasting Glucose > ```

* Waist Circumference > 40 in. * Triglycerides > 150 mg/dL * HDL Cholesterol < 40 mg/dL * Blood Pressure > 130/85 mm Hg * Fasting Glucose > 100 mg/dL

``` WOMEN metabolic syndrome:: • Waist Circumference > • Triglycerides > • HDL Cholesterol < • Blood Pressure > • Fasting Glucose > ```

``` Waist Circumference > 35 in. • Triglycerides > 150 mg/dL • HDL Cholesterol < 50 mg/dL • Blood Pressure > 130/85 mm Hg • Fasting Glucose > 100 mg/dL ```

Excess sugar in your bloodstream can react with proteins and lipids (fatty substances) in your body, leading to the formation of highly toxic product called?

– Advanced Glycation End products (AGEs).

A key reason why diabetics are at a high risk of nerve, artery and kidney damage - because the high blood sugar levels in their bodies significantly accelerate the formation of ____

AGEs

• In your body, AGEs cause ___________ and ________ stress, and contribute to the progression of atherosclerosis, particularly among people with diabetes.

inflammation | oxidation

How to Avoid A.G.E.s in Your Diet • Foods that are high in AGEs are those that are? (5 methods of cooking) • Any food that is "______," particularly highfat, high-protein food, is also likely to be high in AGEs.

grilled, fried, broiled, roasted, pasteurized or sterilized. browned

Use "___" cooking methods, such as stewing, boiling, braising, crock pot or steaming, often because dry-heat cooking methods create more AGEs than moist ones

wet

When you do grill, use _____ marinades including lemon juice and vinegar, which are thought to help to fight AGEs. Also, trim the fat off the meat beforehand. * Acidic * Sugary * Spicy * Oily

acidic

what test correlates with AGE's? – Fatty acid profile – HbA1c – TSH – Homocysteine

HbA1C

what does GLUT stand for?

Glucose transport protein

* Body weight in kg/m2 . * Take body weight in pounds and divide by 2.2 = kg. * Take height in inches and multiply by .0254 then square it.

how to calculate BMI

BMI: | Underweight

Below 18.5 Underweight

BMI: | Normal or Healthy Weight

18.5 – 24.9 Normal or Healthy Weight

BMI: | Overweight

25.0 – 29.9 Overweight

BMI: | Obese

30.0 and Above Obese

mannitol/lactulose zonulin Lipopolysacchairdes (LPS) Actomyosin IgA ``` tests for? • IBS • IBD • GERD • Leaky gut ```

leaky gut

If lower esophageal sphincter fails to close stomach acids enter esophagus & cause heartburn * IBS * IBD * GERD * Leaky gut

GERD

* Endoscopy * Food antibody testing * Test for H. Pylori * Stool testing ``` Tests for? tests for? • IBS • IBD • GERD • Leaky gu ```

GERD

•Reduce animal protein •8 glasses water daily •Juicing (especially cabbage) –Methymethionine sulfonium can be a substitute for cabbage juice •Deglycyrrhizinated Licorice (DGL) chewable tablets 400mg TID between meals. •Zinc carnosine 75 mg BID •Plant based digestive enzymes (before meals) •Calcium glycerophosphate- acid-reducing properties in the gut ____ Lifestyle Recommendations * IBS * IBD * GERD * Leaky gut

GERD

Functions of ___ •Reduce stomach pH to about 2.0 •Kills bacteria in food •Inactivates amylase (starch digestion stops). •Converts (activates) pepsinogen to pepsin. •Starts protein breakdown (denature)

HCL

_____ ______ Repair nutrients - Zinc Carnosine - L-Glutamine- - Mucin-Intestinal lining support via a glycoprotein, - N-Acetyl Glucosamine- GI tissue support - DGL, Slippery Elm, Marshmallow, Chamomile, Okra, and Cat’s Claw GI soothing - Reduction of inflammation- Omega-3 fatty acids and Polyphenols - curcumin, boswellia, ginger, quercetin, rutin, rosemary, resveratrol, EGCg -

* Alcohol * Smoking * Carbonated beverages * Coffee * Chocolate * Tomatoes * Fatty foods * Onions * Peppermint * Junk food to avoid with? * IBS * IBD * GERD * Leaky gut

GERD

* Calcium channel blockers * Beta blockers * Alpha-adrenergic agonists * Theophyline * Nitrates * Progesterone * Aspirin * NSAIDS Can cause ____: * IBS * IBD * GERD * Leaky gut

GERD

_____ _______ and food allergy are frequently herald conditions for other manifestations of 'the allergic march'. They commonly co-exist, particularly in those with early onset, severe and persistent atopic eczema. Filaggrin gene defects substantially increase the risk of ______ _______.

Atopic dermatitis | atopic eczema

Regarding kidney stones: Elevated serum uric acid suggest: * increase Ca uptake * primary hyperparathyroidism associated with Ca-phosphate stones. ~5% of people with nephrolithiasis have elevated parathyroid hormone levels * secondary hyperparathyroidism; * uric acid stones, especially when combined with a history of gout and fructose ingestion

• uric acid stones, especially when combined with a history of gout and fructose ingestion

Regarding kidney stones: Elevated serum Ca can suggest: * increase Ca uptake * primary hyperparathyroidism associated with Ca-phosphate stones. ~5% of people with nephrolithiasis have elevated parathyroid hormone levels * secondary hyperparathyroidism; * uric acid stones, especially when combined with a history of gout and fructose ingestion

primary hyperparathyroidism associated with Ca-phosphate stones. ~5% of people with nephrolithiasis have elevated parathyroid hormone levels

Regarding kidney stones: Serum 25-hydroxy Vit D is valuable as both high and low levels promote stone formation. Low is associated with: * increase Ca uptake * primary hyperparathyroidism associated with Ca-phosphate stones. ~5% of people with nephrolithiasis have elevated parathyroid hormone levels * secondary hyperparathyroidism; * uric acid stones, especially when combined with a history of gout and fructose ingestion

secondary hyperparathyroidism;

Regarding kidney stones: Serum 25-hydroxy Vit D is valuable as both high and low levels promote stone formation. High levels: * increase Ca uptake * primary hyperparathyroidism associated with Ca-phosphate stones. ~5% of people with nephrolithiasis have elevated parathyroid hormone levels * secondary hyperparathyroidism; * uric acid stones, especially when combined with a history of gout and fructose ingestion

increase Ca uptake

Regarding kidney stones: Urine Ph is an important biochemical factor in the prod of kidney stones; cysteine, and Ca oxalate stones tend to form in ____ urine, while struvite and calcium phosphate stones form in ______ urine * acidic * alkaline * Ca, phosphorus, Mg, uric acid, oxalate * Calcium * Creatinine * increase Ca uptake

acidic, alkaline

Regarding kidney stones: A 24- hour collection can be analyzed for ____, and the stone-inhibiting factors citrate and phytate. In the absence of the actual stone analysis, these 24-hour urine parameters help indicate potentially abnormal or treatable conditions such as low urinary citrate. * acidic, alkaline * Ca, phosphorus, Mg, uric acid, oxalate * Calcium * Creatinine * increase Ca uptake

Ca, phosphorus, Mg, uric acid, oxalate

Regarding kidney stones: 24-hour urine ______ should be measured to evaluate the adequacy of the collection * Ca, phosphorus, Mg, uric acid, oxalate * Calcium * Creatinine * increase Ca uptake

creatinine

An elevated urine _______ excretion is another important stone-forming risk factor. Elevation can occur with increased diet acid loads, increased salt intake, and both inadequate and excessive vitamin D levels. * acidic, alkaline * Ca, phosphorus, Mg, uric acid, oxalate * Calcium * Creatinine * increase Ca uptake * primary hyperparathyroidism associated with Ca-phosphate stones. ~5% of people with nephrolithiasis have elevated parathyroid hormone levels * secondary hyperparathyroidism; * uric acid stones, especially when combined with a history of gout and fructose ingestion Regarding kidney stones:

calcium

AGEs have also been associated with a number of chronic diseases such as _____. (choose all that apply) * Diabetes * Heart disease * Kidney * Metabolic syndrome * Renal disease

diabetes, | heart disease, and renal disease.

* Hs-CRP/CRP * Sed rate * Vitamin D 25-OH; 1,25 * dihydroxyvitamin D IBD, to test for? * Anemia * Hydration * Inflammation and disease activity

• Inflammation and disease activity

CBC w/diff Iron Panel Vtiamin B12 or MMA, Folate IBD, to test for? * Anemia * Hydration * Inflammation and disease activity

• Anemia

- Vital signs, - CBC w/diff, - CMP-14 IBD, to test for? * Anemia * Hydration * Inflammation and disease activity

• Hydration

What nutrient recommendations would you make for someone on a proton pump inhibitor (PPI)? Betaine HCL Goldenseal Vitamin B12 and Magnesium Ginger

Vitamin B12 and Magnesium

o Interstitial deposits containing calcium oxalate are also known as Randall’s plaques and are visible on uroscopy as whitish deposits) o Plaque formation increase with increased urinary calcium excretion and decreased urine pH. o Stones may also form in the tubules at sites of luminal injury such as the opening of the ducts of Bellini What kind of kidney stone? * Calcium Oxalate * Calcium Phosphate * Cystine * Struvite * Uric Acid * Other

Calcium Oxalate

o Often seen in those with renal tubular acidifying abnormalities are found protruding from the ducts of Bellini What kind of kidney stone? * Calcium Oxalate * Calcium Phosphate * Cystine * Struvite * Uric Acid * Other

Calcium Phosphate

Regarding kidney stones, children vs adults: • Calcium Oxalate * (2-4%; 9-17%) * (24-30%; 8-18% - up to 75% incidence in prego women) * (4%; 2%) * (45-65%; 56-61%) * (5-8%; 1%) * (7-13%; 2-4%)

• Calcium Oxalate (45-65%; 56-61%)

Regarding kidney stones, children vs adults: • Calcium Phosphate * (2-4%; 9-17%) * (24-30%; 8-18% - up to 75% incidence in prego women) * (4%; 2%) * (45-65%; 56-61%) * (5-8%; 1%) * (7-13%; 2-4%)

• Calcium Phosphate (24-30%; 8-18% - up to 75% incidence in prego women)

Regarding kidney stones, children vs adults: • Cystine * (2-4%; 9-17%) * (24-30%; 8-18% - up to 75% incidence in prego women) * (4%; 2%) * (45-65%; 56-61%) * (5-8%; 1%) * (7-13%; 2-4%)

• Cystine (5-8%; 1%)

Regarding kidney stones, children vs adults: • Struvite * (2-4%; 9-17%) * (24-30%; 8-18% - up to 75% incidence in prego women) * (4%; 2%) * (45-65%; 56-61%) * (5-8%; 1%) * (7-13%; 2-4%)

• Struvite (7-13%; 2-4%)

Regarding kidney stones, children vs adults: • Uric Acid * (2-4%; 9-17%) * (24-30%; 8-18% - up to 75% incidence in prego women) * (4%; 2%) * (45-65%; 56-61%) * (5-8%; 1%) * (7-13%; 2-4%)

• Uric Acid (2-4%; 9-17%)

Regarding kidney stones, children vs adults: • Other * (2-4%; 9-17%) * (24-30%; 8-18% - up to 75% incidence in prego women) * (4%; 2%) * (45-65%; 56-61%) * (5-8%; 1%) * (7-13%; 2-4%)

• Other (4%; 2%)

* Melatonin * L-tryptophan and 5-HTP * Chamomile * Kava * Hops * Lemon Balm * Valerian Root * Magnesium nutrients for what issue?

sleep disturbance

* Alcohol * Most frequent food triggers: Wheat; orange; egg; tea and coffee; chocolate; milk; beef; corn and cane sugar; yeast; mushrooms; peas triggers for what?

migraines

• Pathophysiology – primary hypogonadism, y chromosome defect, altered sperm transport, secondary hypogonadism, developmental or physiological, immunological, unknown o Other considerations: obesity, increased scrotal temperature, radiation, smoking, marijuana potential causes of what?

male infertility

``` o avoid environmental exposures o detoxification  glutathione o l-arginine o l – carnitine o antioxidants o zinc o CoQ10 o Vitamin C, A, E, D, B12, folate o Alpha lipoic acid ``` nutritional support for?

male infertility

health screen and fertility work up, hormone profile and semen analysis o Environmental – PCBs, chlorinated pesticides, volatiles solvents, phthalates, parabens, nutrient and toxic element screening (heavy metals), other toxins Evaluation for?

male infertility