nutrition review Flashcards
AGE “the burnt stuff”
thin crust pizza , most AGE
IBS would like to enjoy sweet beverage, what is LowFODMAP
FODMAP (fructo, oligo, di,..)
sweetner is important.
Opposite of low glucose/high glucose is fine. Want low fructose.
***Table sugar is the lowest FODMAP.
Treating SIBO, IBS, IBD with lowfodmap
REduce gas, bloating, and loose stools. Low fiber diet.
Client with IBS would like to prep meals.
Tofu, White rice, carrots, kale, and kale
lowfodmap sweetners
Maple syrup, table sugar, brown sugar, stevia, Rice Malt syrup, raw sugar (lowest)
High fodmap: (highest) Honey, agave, molasses, coconut syrup.
stage 4 kidney disease which of the following would like Not be an appropriate nutrition diagnosis:
a. imbalance of nutrients
b. food and nutrition related knowledge deficit
c. inadequate fluid intake
d. impaired nutrient utilization
inadequate fluid intake would not be correct.
when on hemodialysis: fluid restriction to -750 mL/d (fluids liquid at room temperature included-not liquids in solid foods)
To maintain oncotic pressure and prevent hypertension
-monitor bp
-monitor edema
peritoneal dialysis: not as restrictive for fluid.
intake/Regulation of what plays a role in kidney disease
Protein, minerals - Na+, Ca+, P, vitamins-vitD, Fluids- too much or too little
Diabetic patient whi is pregnant with poor glucose control is at increased risk for:
pre-eclampsia
Metabolic labs
HbA1c Pre-d: 5.7-6.3
Fasting Glucose: 70-100(normal), 100-125 (pre-diabetic), >125 Type II diabetes.
Insulin : fasting: 5-15 (normal), above 15 need alot of insulin to flush (prediabetic),
What are the normal ranges?
what are the prediabetic ranges?
what are the diabetic ranges
Which conditions would be of concern in a patient with ANorexia nervosa who has been under consuming calories for several months and is at risk of refeeding.
Hypophosphatemia
Hypophosphatemia is a condition characterized by low levels of phosphorus in the blood123. It can be caused by decreased intestinal absorption, increased urinary excretion, or movement of phosphate into cells1. Symptoms include muscle weakness, respiratory failure, heart failure, seizures, and coma
brush border enzyme review
- starch glycogen>salivary enzyme>
A Disaccharides (maltose, sucrose, lactose)
B Monosaccharides (2 glucose; 1 glucose +1 fructose; 1 glucose + 1 galactose) - Maltose –Maltase–2 glucose
- sucrose–sucrase–1 glucose, 1 fructose
- lactose-lactase- 1 glucose +1 galactose
brush border enzymes
a. aminopeptidase> proteins/peptide chains
b. lipase> fats/lipids
c. maltase> carbohydrates/breaks down maltose and maltotriose into two and three molecules of glucose, respectively.
what is an snp? (mutations)
Very specific mutations that are inheritable may or may not have consquences.
A single nucleotide base substitution in a gene may result in significant phenotypic alteration.
Over one million such substitutions (single nucleotide polymorphisms) have been identified. Alterations of greates interest are those that cenfer a significantly increased or decreased risk for the development of a disease condition.
Inheritable. expressive alterations. snps that increase or decrease disease risk.
what is methylation
what is one carbon metabolism
heterozygous vs homozygous
Homozygous : tow idenitical versions (alleles) of that gene. Wild type homozygous “normal” Homozygous polymorphism- 2 copies of the genetic variant Ex: CC TT
two recessive genes, homozygous recessive gene. Wild type is better.
Heterozygous: an individual for a gene when they have two different alleles for that gene, potentially only 1 copy of the genetic variant. These do not penetrate the phenotype as much as a homozygous mutation. CT, AG
celiac or MTHFR
methyltransferases
purpose of pathways
Glutathione obsessed
Genes
SNPS to study (LOOK UP IN PRACTICE BETTER)
MCM6 (lactase)
LCT
VDR (vitamin D)
CYP1A2
APOE (1-4) (fats, cholesterol)
BHMT
CBS
COMT (reduce catacolamines, and nerve synapse (dopamine, norepinephrine)
FTO
GAD1
MAOA
MTHFR-C677T VS A1298C
MTR
PEMT
SOD2
SOD3
FUT2
ADORA2
VDR
Vitamin D receptor
FUT2
B12 metabolism
SOD enzymes
SOD1- CU/Zn
SOD2- Manganese (chocolate, nuts, broccoli, honey)
-scavenge o2
-handle reactive oxygen species ROS in the mitochondrial matrix
-SOD deficiency contributes to several neurological diseases, including amytrophic lateral sclerosis (ALS), Alzheimers disease (AD), Parkinson’s disease (PD), and stroke
LCT
lactase, lactose
lactose intolerance
MCM6
milk (lactose)
Caffeine snps
ADORA2A - worse anxiety after consuming
CYP1A2- fast vs slow metabolizer, increased risk w >200 mg caffeine per day
client has chief complaint of fatigue and has a MCM6 and ADORA2 snp, what should consume at breakfast
chai latte with coconut milk
no milk and lower caffeine
Pathways
Folate cycle- glycine and serine fuel mitochondrial enzymes through purine production
Methionine cycle- s-adenosylmethionine (SAM) serves both hydrocarbons and polyamines.
Transsulfuration pathway-synthesis of glutathione, which is involved in the production of reactive oxygen species (ROS).
Amine and catecholamine pathway- Neurotransmitter synthesis and metabolism
BMI
should only be used as a directional heuristic and combined with other factors in considering an individuals health.
Underweight: BMI is less than 18.5
Healthy weight: 18.5 to <25
overweight: 25.0 to <30
Obese: 30 or higher.
Methyltransferase
eclectic mix of enzymes of which the majority, over 95 %, uses s-adenosyl -l-methionine ( Ado-Met) as the methyl donor.
The basic methyl tranfer reaction is the catalytic attack of a nucleophile (carbon, oxygen, nitrogen, or sulfur) on a methyl group to form methylated derivatives of proteins, lipids, polysaccharides, nucleic acids, and various small molecules.
Such Methyl conjugation is an important pathway in the metabolism of many drugs and xenobiotic compounds, in addition to endogenous neurotransmitters and hormones; methylation is fundamental to the conrtol of gene transcription.
Moving methyls around putting on proteins and lipids wherever they need to go.
MEthylation turns genes on or off.
Phase II detoxification (conjugation pathways) : Glucuronidation
Location: phase 2 pathway
Processes: alcohol, phenols, and carboxylic acids (hormones/steroids, bile acids, salicylates).
Cofactors: B12, P5P (B6), Folate, Mg+
MEtabolizes: Phenobarbital, warfarin, nicotine, marijuana, naproxen, estradiol, salicylates, menthol, vanilla, chlorine, aspirin…Dopamine, serotonin.
Enemies: BPA is metabolized via UGT//B-Glucoronidase (cleaves glucuronic acid)
B-Glucoronidase (produced as an enzyme by gut bacteria)
UDP- glucuronosyltransferases (aka UGT)
Essential in enhancing the elmination of toxins in feces and urine, as well as metabolizing bilirubin and steroids hormones.
UDP polymorphisms are associated with hereditary unconjugated hyperbilirubinermias: Crigler-Najjar syndrome type I, Type II and Gilberts syndrome.
Bioactive compounds, cruciferous vegetables, citrus and resveratrol induce UGT enzymes.
UGT supporters
Magnesium
B1
Resveratrol
calcium D Glucarate
L-glutamine, spartic acid, iron, B3, B6
Cruciferous vegetables
Glutathione production
Phase II detox
Glutamic acid, glycine and cysteine (mash up of three)
Process: Electrophilic compounds, alkylhalides, epoxides
Raw materials needed: Glutamic acid, glycine, cysteine
Enzymes: GST, GSS, GSR
Co Factors: NAC, vit C, Vit E
MEtabolizes: Heavy metals, solvents, herbicides.
GST (p or M)
-Main function is the conjugation of the sulfur group on glutathione (GSH) to produce a water soluble compound excreted via bile or urine.
-They play an important role in antioxidant defense and detoxification
-Foods such as alliums, cruciferous vegetables, and resveratrol have been shown to induce GSTs in humans.
-GST, GSR, GSS
What are some nutrition related snps that may impact diseases? what is our scope
PKU: autosomal recessive disorder (homozygous) casued by mutations in both alleles of the gene for PHENYLALANINE hydroxylase (PAH) but what if someone is heterozygous and only has 1 copy of the mutation gene?
Celiac Disease: HLA DQ2 and HLA DQ8
But these do not “guarantee” that someone has celiac disease
35 year old individual has been working night shifts for an extended period. digestive issues, dry skin, thinning eyebrows, weight gain. What nutrient assessment tools,
24 hour recall, analysis, along with CBC, CMP, and hormone profile test to assess melatonin, and cortisol levels, and thyroid function
Short chain fatty acids are made in the gut by processing what type of food?
carbohydrates (Fiber)
Types of short chain fatty acids:
1. Butyrate (commonly found in butter)
2. acetate
3. Proprionate
important for microbiome stability. Give first. Needing to get PH down in gut. Helps create stable environment for good bacteria to go.
If SFA are low. Supplement first before giving probiotics.
Essential fatty acids
Omega 6 (linoleic acid) : vegetable oils, safflower oils, meat, poultry, eggs, corn oil pecans, brazil nuts, Sunflower seeds, sesame oil.
Omega 3 (a-linoleic) Green leafy vegetables, flax, chia seeds, canola, walnuts, soybeans, oily fish, algae oil, krill oil, walnuts, flaxseeds, walnuts, canola oil, mustard, tofu, soybean oil,
Functional tests on a stool panel
Betaglucaronadase
calprotectin
epx
Iga
Buterates
SCFA
zonulins/ocludin (proteins that keep tight junctions connected)
staph
current guidelines for increasing intake in non-acute diverticulosis
Fiber
client needs berberine to help blood sugar balance and overgrowth situation in gut.
Goldenseal (berberine)
uva ursi (microbial) UTI bladder infection
ashwaghanda and ginseng (adaptogenic)
Client is miserable ths allergy season what is likely to help
Quercetin (mast cell stabilizer)
-zinc in high doses inside cell will inhibit viral replication. Quercetin works the same. Give Quercetin to get zinc in cell.
Bromelain (makes quercetin work better) also breaks mast cells down.
Nettles
Your client with A1c of 6.0 and a ferritin of 75. According to CDC guidelines
Prediabetic
Thalassemia ?
what are different types?
who is most at risk?
Thalassemias are inherited blood disorders that result in abnormal hemoglobin.
MEditeranean countries
Thalassemias are genetic disorders.There are two main types, alpha thalassemia and beta thalassemia.The severity of alpha and beta thalassemia depends on how many of the four genes for alpha globin or two genes for beta globin are missing.
hemolytic anemia : avoid fava beans
It is most common among people of Greek, Italian, Middle Eastern, South Asian, and African descent.
Lactose intolerant: geographic regian most likely to be intolerant.
East Asian decent. west africa, arab, jewish, greek, italian
SNP (LCT, McM6)
Dyshphagia: aspirating due to parkinsons
- adaptive eating
- chin tuck
- texture modification (thickener)
- chopped diet
- pureed foods
- repeated swallow
POTS ?
What are common food approaches to take with someone with POTS?
Postural orthostatic tachycardia:
A condition where the heart rate increases on changing the posture, such as lying to sitting up or standing. This will cause dizziness or fainting.
How common is condition?
Common (More than 200,000 cases per year in US)
Is condition treatable?
Treatments can help manage condition, no known cure
Does diagnosis require lab test or imaging?
Rarely requires lab test or imaging
Time taken for recovery
Can last several years or be lifelong
Condition Highlight
Common for ages 15-50
More common in females
Family history may increase likelihood for some types
- Increase sodium in your diet to 3000 mg to 10000 mg per day.
-Drink 2-2.5 liters per day of fluids. water is a good choice. sports drinks ok.
-small and frequent meals are better tolerated and reduce POTS symptoms.
-Diet with high fiber and complex carbohydrates may help reduce blood glucose (sugar) spikes and lessen POTS symptoms. - Celiac is often comorbid. Also, frequent with anorexia, SJorgens.
- Be careful with potassium.
-sometimes can tolerate fruits. sometimes you have to take the fruits out.
what is FPIES?
How long does it take for Sx to begin after eating?
what are the most common trugger foods?
food protein induced Entercolitis syndrome
-food allergy that affects GI tract
-Sx appear several hours after eating- vomiting, diarrhea, dehydration
-cows milk, soy, rice and oats are the most common trigger foods, but any food can cause sxs.
