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Fun Med Review Quiz > Quiz > Flashcards

Quiz Flashcards

0
Q

Which combination of lifestyle and nutraceuticals would be most useful in treating a patient with insulin resistance
A chromium, magnesium , aerobic exercise
B calcium, vanadium, gluten free diet
C pyridoxine , cinnamon, elimination diet
D biotin , hypericum , resistance training

A

A

They all help with insulin sensitivity

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1
Q 
Hyperinsulinemia can result in
A increased free thyroxine
B decreased  EPA 
C increased free estradiol 
D increased total cholesterol
A

C

Insulin can stimulate ovarian estrogen , androgen , and progesterone secretions in vitro

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2
Q

Insulin resistance and hyperinsulinemia is and example of
A a single factor can often result in multiple symptoms
B multiple factors can underlie a single condition
C multiple conditions can be caused by a single dysfunctional process
D multiple dysfunctions can lead to multiple factors

A

C
insulin resistance at the receptors leads to hyperglycemia , hyperinsulinemia which leads to a host of other physiological responses

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3
Q

What three factors tend to underlie CVD
A ox stress , inflammation, immunological reactions
B high sens CRP , dysbiosis, autoimmune disease
C hormonal dysfunction , low antiox, MIT insufficiency
D communication, transport, defense and, repair

A

A
The three factors that tend to underlie CVD are: ox stress, inflammation, immunological factors . 5 finite vascular responses to the infinite number of vascular insults are:
1. Inflammation
2 ox stress
3 auto immune rx
4 after gene expression
5 endothelial , vascular smooth muscle & cardiac dysfunction

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4
Q

Non alcoholic fatty liver disease and pcos are two conditions that may be associated with
A subcutaneous adiposity and inflammation
B visceral adiposity and inflammation
C osteoporosis and gluten sensitivity
D uterine fibroids and hs CRP

A

B

Visceral fat accumulation and adipose tissue dysfunction have been implicated in here pathogenesis of NAFLD in PCOS

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5
Q 
A 53 yo has BMI of 29 and fmh DM, elevated waist circumference and normal waist to hip ratio, Norma BMI you suspect 
A diabetes
B met syn
C metabolic obesity
D increased muscle mass
A

D
BMI and waist circumference are both very non specific measures that can wrongly classify healthy high muscle mass patients

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6
Q

Which of the following lab tests is more useful for assessing vulnerable plague
A triglyceride HDL ratio
B lipoprotein associated phospholipase A2 (Lp-PLA2)
C 8 hydroxydeoxyguanosine (8 -OHdG)
D serum iron

A

B
Lp-PLA2 generates two proinflammatory mediators , lysophatidylcholine and oxidized non esterified fatty acids , which play a role in the development of atherosclerotic lesions and formation of necrotic core, leading to more vulnerable plaques

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7
Q 
In a patient with met syn the earliest changes you would expect to see are
A elevated 2 hr pp glucose 
B elevated fasting insulin
C elevated 2 hr pp insulin
D elevated FBG
A

C elevated 2 hr pp insulin

2 hr post glucose insulin levels are usually the earliest detectable change indicating met syn

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8
Q

Medium chain triglycerides
A are found in coconut and Palm oils and convert into ketones
B are found in ground flax seeds and convert in cell to alpha linolenic acid
C are found in grass fed and dairy products and convert in liver to omega 9 fatty acids
D are found in deep water fish and convert into the cell into eicosapentaenoic and DHA fatty acids

A

A

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9
Q 
Which of the following are critical for ATP synthesis via electron transport 
A thiamine and Pantethine 
B folate and fibrates
C vit d and mag
D b2 and b3
A

D riboflavin and niacin

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10
Q 
A 68 yo male patient with concerns about a fmh of alzehimers disease based on recent research which of the following nutrients would be most important to test
A mag
B vit d
C iron
D vit b6
A

B iron

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11
Q 
Transport of fatty acids into the mitochondria is facilitated by which nutrient
A B 5 
B taurine
C co enzyme q
D Carnatine
A

D carnatine

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12
Q 
Which of the following if prescribed in excess is most likely associated with peripheral neuropathy 
A folic acid
B vitamin B6
C vitamin D
D iron
A

B vitamin b6

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13
Q

Which of the following interventions have been shown to help prevent neurodgenerative disease and improve cognitive function
A copper supplements and grounded conductive bed sheets
B DHA and nuclear regulatory factor erythroid derived 2 like 2 NFK2 activators
C adequate sat fat and rem sleep
D high protein diets and phase III sleep

A

B?

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14
Q 
Which of the following is known to increase levels of brain derived neurotrophic factor BDNF 
A caloric restriction and DHA
B exercise and diets high in calcium
C low calorie high protein diets 
D higher calorie diets and  vitamin B1
A

A

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15
Q

Natural killer cell activity is decreased in which of the following conditions
A RA
B chronic fatigue syndrome

A

Evidence from studies on chronic fatigue patients suggest a correlation between low levels of NK cell activity and severity of CFIDS

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16
Q

A 22 month old girl presents with peri oral and perianal dermatitis sharply demarcated . She has diarrhea. The mother notes the child’s hair is falling out . The child was weaned off breast milk at six months. He older sibling had the same symptom at two. Which is the most accurate statements about the condition

A

A low serum alkaline phosphates helps with the diagnosis

Zn deficiency negative affects the bone related enzyme alk phos

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17
Q

What would be the best for supporting the endogenous production of nitric oxide

A

L arginine and tetrahydrobioterin BH4
Arginine is the ultimate source of nitric oxide produced by nitric oxide synthase while BH4 is an essential cofactor for all NOS isoforms

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18
Q

What describes the effect of insulin on beta oxidation

A

Insulin promotes glucose uptake and fatty acid synthesis . It does this in part by slowing the process of fatty acid metabolism (beta oxidation )

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19
Q

A 76 year old female comes to your office with a recent dx of osteopenia by dexa scan. You want to follow her on a more frequent basis to assess the efficacy of your therapies on bone health. You would order a

A

Urinary n teleopeptide
N terminal teleopeptide NTx molecules are mobilized from bone by osteoclasts and subsequently excreted in the urine. Elevated levels. Of NTx indicate increased bond reabsorption

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20
Q

Two botanicals to decease inflammation through activity on cox enzymes

A

Tumeric and ginger contain potent cox 2 inhibitors

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21
Q

What can cause periferal neuropathy if prescribed in excess

A

Vitamin B6

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22
Q

By what mechanism are IgG mediated antibody interactions cause GI symptoms

A

Circulating immune complexes

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23
Q

What up regulates ketone production

A

Medium chain triglycerides they increase production of ketone bodies

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24
Q

Fun med uses the model of s multi directional web to understand the complexity of the body and develop a comprehensive assessment of the patient. This web like interconnection is best described by

A

Multiple factors can underlie a single condition and multiple conditions can be caused by a single dysfunctional process

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25
Q

The initial phase of gathering oneself in the go to it the core elements for transforming encounter into an environment where insights emerge

A

Intension and centering

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26
Q

Genetic polymorphisms in the MTHFR gene have been most notably positivity linked to CAD and

A

Depression: ploymorphisms of genes involved in B vitamin absorption , metabolism, and function such as mthfr are indirectly involved in the synthesis of neurotransmitters including dopamine and serotonin and have been linked to increased incidence of psychiatric and cognitive disorders including schizophrenia , bipolar , and depression

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27
Q

How do you describe the control of adrenaline and or cortisol release during the stress response

A

ACTH from the anterior pituitary is the signal for the adrenal gland cortex to release glucocorticoids including cortisol

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28
Q

Nebulized glutathione is most indicated in

A

Emphysema: nebulized glutathione can lead to rapid resolution of emphacemic crises as well as improvement in the chronic course of the disease

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29
Q

What supplement would be good for microscopic colitis

A

OM3FA curcumin quercetin : both N- 3 fats and curcumin have antiinflammatory effects and quercetin enhances epithelial barrier function

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30
Q

Mitochondropathies have the greatest effect on what type of tissue

A

Brain and skeletal : Brain and skeletal muscle have both large and dynamic energy requirements and thus are preferentially affected by problems with mitochondria

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31
Q

Arachidonic acid

A

Is a direct precursor to many proinflammatory prostaglandins and leukotrienes
AA is an omega 6 FA that is upstream to many pro inflammatory FA metabolites including Eicosanoids ( prostaglandins and leukotrienes )

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32
Q

What does DIGIN stand for

A

Digestion, intestinal permeability , gut microbiota, inflammation / immune nervous system

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33
Q

Molecular mimicry is a process that occurs within the GI tract . It can result in

A

Autoimmunity : molecular mimmicry occurs when an antigenic fragment looks very similar to a self antigen and the corresponding immune response can produce self reactive lymphocytes

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34
Q

What is non alcoholic fatty liver disease most directly linked to

A

Met syn ass with insulin dysfunction and met syn

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35
Q

Patient complains of bil neuropathic pain in his feet and has a hx of herpetiformis you suspect

A

Celiac : bil neuropathy is one of the most frequent neurological manifestations of celiac

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36
Q

What does PTSD stand for

A

Production, transport , sensitivity, detox
These are the 4 key elements of the hormone cycle that should be considered when examining a patient suspected of having a hormonal dysfunction

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37
Q

Patient on statin has muscle pain and fatigue what would you give

A

CoQ10 stating deplete and then produce muscle pain, myopathy and rhabdo

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38
Q

What is the relationship between EPA and DHA and systemic inflammation

A

Both can inhibit a number of aspects of inflammation including production of eiosanoid like prostaglandins and leukotrienes from the omega 6 fatty acid arachidonic acid production of inflammatory cytokines and T cell reactivity

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39
Q

Patient has elevated thyroid antibodies x three years and high and high doses of thyroxine now she is getting fatigue pms and forgetful you should

A

Get a reverse T3: since increasing doses of T4 are not increasing her metabolic rate you. Should consider investigating whether elevated reverse T 3 ( and RT3:TT3 ratio) are putting the brakes on her metabolism

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40
Q

DMSA can result in system reduction in

A

Cadmium, calcium, Mercury

It has an affinity for cations both nutritional and toxic

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41
Q

Why are insulins proinflammatory

A

Estrogens stimulate cox 2 which increases production of inflammatory Eicosanoids

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42
Q

Prolonged cortisol elevations can promote

A

Immune suppression and adiposity : cortisol is an immune suppressant and it promotes redistribution of adipose tissue which can lead to increased adiposity

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43
Q

BIA

A

Is used for serial tracking of changes in body composition

BIA is best used longitudinally within an individual patient to track changes over time

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44
Q

What foods should be avoided before a provoked toxic metals test

A

Fish seafood

Fish shellfish kelp and some other seafoods often contain significant organic arsenic

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45
Q

Which of the receptors has been linked to risk of increased excitotoxicity

A

NMDA receptors for glutamate are linked to excitotoxicity because large stimuli displace magnesium in the channel lumen and allow large amounts of calcium into neurons

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46
Q

What blocks the action of aromatase

A

Green tea inhibits the aromatase conversion of testosterone to estrogen and also the 5 alpha reductase conversion of testosterone to DHT

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47
Q

A normal TSH and a normal T4 but sym of low thyroid can develop because

A

Neither accurately reflect T3 in circulation - free T3 levels have a greater effect on thyroid mediated effects on metabolism than TSH or FT4

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48
Q

What does stress do to the gut

A

Increases intestinal permeability

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49
Q

Branch chained fatty acids

A

When BCAA levels are low fatigue can develop via increased CNS uptake of tryptophan

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50
Q

Cofactor of ATP production

A

Acetyl CoA is the two carbon end product of both carb and FA metabolism . It feeds into the TCA cycle which produces NADH and FADH that feed the electron tranport chain

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51
Q

Estrogen dominant environment increases chances of

A

PCOS

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52
Q

You worry about rapid weight loss because

A

Lipolysis mobilizes lipophilic toxins including xenobiotics

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53
Q

What does metformin decrease

A

Serum B12 and folate

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54
Q

What would you us to treat congestive cardiomyopathy

A

Ribose, coq10, l carnitine

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55
Q

How would you treat actominophen overdose

A

The phase two conjugation pathway and primary co factor for detox of acetaminophen are glutathione conjugation, and n acetyl cysteine

N acetylcysteine is the nutrient of choice for the treatment of an acetaminophen overdose . It serves as a source of cysteine for glutathione synthesis

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56
Q

Transdermal progesterone might cause?

A

Pedal edema because it can be converted to aldosterone
Progesterone is an upstream precursor for the mineral corticoid aldosterone which causes the kidneys to conserve sodium which can precipitate fluid retention

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57
Q

What is the upstream precursor for the mineral corticoid aldosterone

A

Progesterone is an upstream precursor for the mineral corticoid aldosterone

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58
Q

The conversion of T4 to RT3 is stimulated by what

A

Low calorie diet : T4 is increasingly converted to metabolism slowing molecule RT3 also by stress cortisol trauma, inflammation (cytokines) toxins , infections, liver kidney dysfunction, and certain meds

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59
Q

62 yo female on PPI osteoporosis is thin and bmi 20 , decreased muscle mass, low protein what would you do

A

More protein, and exercise BIA strength program and protein

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60
Q

What does DMSA have an affinity for

A

Cations nutritional and toxic

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61
Q

List what can increase T4 to metabolism slowing RT3

A 
Low calorie diets
Stress cortisol
Trauma
Inflammation cytokines 
Toxins
Infection
Liver kidney dysfunction
Certain medications
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62
Q

What are a few actions of green tea

A

Inhibits the aromatase conversion of testosterone to estrogens and also the 5 alpha reductase conversion of testosterone to DHT dihydrotestosterone

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63
Q

What is molecular mimicry

A

Occurs when an antigenic fragment looks very similar to a self antigen and the corresponding immune response can produce self reactive lymphocytes

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64
Q

Zinc deficiency has a negative affect on what enzyme

A

The bone related enzyme alkaline phosphatase

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65
Q

What would you order to rule out celiac
A HLA B27
B HLA DQ2 and DQ8
C salivary antigliadin antibody

A

B HLA DQ 2 and DQ8

HLA DQ 2 and or DQ 8 are present in nearly 99% of celiac cases, thus their absence vertiably rules out celiac disease

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66
Q 
ALS appears to be caused in part by
Chronic infection 
Aging
Accelerated oxidative stress
Deficiencies of dopamine
A

Accelerated oxidative stress

This is evidenced by familial cases of ALS caused by mutations in the superoxide dismutase (SOD1) Gene

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67
Q 
Which of the following is a NF kappa B inhibitor 
Dioxin
Lead
Alpha Lipoic acid
Vitamin B12
A

Alpha Lipoic acid

It inhibits the release and translocation of proinflammatory NF-B from cytoplasm to the nucleus

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68
Q

The effect of mindfulness meditation on stress eating :
Inhibits neuro genesis in the brain which may stop the neuronal reinforcement of this pattern of behavior
Stimulates the sympathetic nervous system and may enhance the burning of calories
Increases the parasympathetic tone which may increase her awareness of how much she is eating
Normalizes the HPA axis and may allow for new choices and insights to emerge in the moment

A

Normalizes the HPA axis and may allow the new choices and insights to emerge in the moment
Mindfulness meditation can reduce stress and allow the patient to make thoughtful food choices instead of stress induced ones

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69
Q 
Which of the following is an effective way to limit the action of beta glucuronidase 
MTHFR
Methycobalamine
Calcium d glucarate 
Vitamin D
A

Calcium D glucarate which provides a substrate for bacterial beta glucuronidase , thereby avoiding enterohepatic - re circulation and preserving phase II glucuronidated substrates for excretion in the stool

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70
Q 
Which of the following increases serotonin in the CNS
Melatonin
Decreasing heart rate variability 
Lenghten telomeres 
Meditation
A

Meditation can increase levels of serotonin in the CNS potentially modulating mood disorders

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71
Q 
Which fatty acids inhibit Delta 5 desaturase
Arachidonic acid
Gamma linolenic acid 
Dihomo gamma linolenic acid 
Eicosapentaenoic acid EPA
A

EPA in an inhibitor of the enzyme delta 5 desaturase D5D that produces -AA

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72
Q

Select the correct statement regarding modifiers of Alzheimer’s disease
Vitamin K supplements are associated with a reduced incidence of AD
Vitamins A supplements
Vitamin E supplements
Vitamin C and E supplements in combination are associated with reduced incidence of AD

A

Observational studies suggest that higher dietary intake of vitamin C and E might protect against dementia and altzheimers

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73
Q

Why is lipoprotein associated phospholipase A2 (Lp-PLA2) a useful test to assess vulnerable plaque

A

Lp -PLA2 generates two proinflammatory mediators , lysophosphatidylcholine and oxidized non esterified fatty acids, which play a role in the development of atherosclerotic lesions and formation of a necrotic core, leading to more vulnerable plagues

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74
Q

What is the most common autoimmune disease in the United States

A

The most common autoimmune disease in the U.S. is Hashimoto’s thyroiditis . It affects between 0.1 % and 5 % of all adults in the western countries

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75
Q 
Adequate melatonin decreases the risk of estrogen related diseases primarily by
Increasing vitamin d
Normalizing the 2/16 ratio 
Acting as a antioxidant 
Triggering apoptosis
A

Melatonin appears to have antioxidant effects which may contribute to its health benefits

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76
Q

Select the best statement regarding branch chain amino acids BCAA
When BCAA levels are depleted fatigue can develop via increased CNS uptake of tryptophan
Nuts are a good source of BCAA because they are high in alanine
The brain is able to consume large amounts of BCAA due to the effects of the small polar amino acid transporter
Skeletal muscles use BCAA as their preferential fuel

A

When BCAA are depleted eg via exercise there can be an increased uptake of tryptophan in the CNS leading to increased fatigue

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77
Q

Or has gas, bloating, and eczema the most appropriate diet plan is

A 
The fodmap diet
The cardiometabolic food plan
The elimination diet 
The core food plan 
Gas and bloating may be associated with food intolerances , eczema may be associated with food sensitivities or allergies .  All of these are best addressed by an elimination food plan
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78
Q 
Primary phase 1 bio transformation pathways include
Sufation glucuronidation methylation 
Amino acid conjugation, phosphorylation 
Acetylation glutathione conjugation 
Oxidation reduction hydrolysis
A

Phase 1 reactions use oxidation reduction, or hydrolysis or exposure polar groups to make substances more water soluble

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79
Q 
Insulin has which of the following effects 
Increases small dense LDL particles 
Lowers triglycerides 
Deceases hs CRP 
Increases HDL
A

There is a strong association between LDL -P and insulin resistance which is driven by elevated insulin levels

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80
Q

Patient who had chemo for prostate cancer , which is now in remission and takes NSAID for knee pain, and lots of stress , he is now having food reactions what is the most likely underlying reason for his nw complaint

A

Increased intestinal permeability

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81
Q

Insulin resistance :
Is independently predictive of low HDL -c and elevated triglycerides
Enhances beta oxidation of fatty acids
Blocks androgen production by ovarian theca cells
Is associated with increased risk of lung cancer

A

Insulin resistence initiates a characteristic triad of high triglycerides low HDL cholesterol and high small dense LDL level

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82
Q

How do you describe the web like inter connection of functional medicine

A

Physiological processes are related such that nothing happens in a vacuum , any change has repercussions throughout the body

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83
Q

48 yo with hx of iron def anemia has fatigue and is menopausal with infrequent night sweats, has bloating after meals you prescribe a highly absorb form of iron and

A 
Low dose estradiol and estriol
HCL #
A pancreatic enzyme 
Methycobalamin
Her issues with iron may reflect poor absorption , which could be from low stomach acid and the bloating after meals is consistent with Hypochlorhydria
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84
Q 
A demonstrated physiological effect of meditation is to
Increase norepinephrine 
Increase serotonin 
Increase cortisol
Decrease dopamine
A

Increase serotonin - meditation can increase serotonin which may cause increased feelings of contentment and satiety

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85
Q

42 yo female with five years of fatigue , sleep 12-14 hours a night and is exhausted by modest exercise , ex with chronic fatigue you border a salivary panel and expect to find
Elevated levels of cortisol and DHEA
Reduced levels of cortisol and elevated DHEA
Elevated levels of cortisol and reduced DHEA
Reduced levels of cortisol and DHEA

A

Adrenal insufficiency correlates with stage 3 of selves general adaptation syndrome and is marked by profound fatigue and low levels of both DHEA and cortisol

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86
Q

Dx of microscopic colitis which supplements would you use
Resveratrol, white willow bark, ginko biloba
Calcium zinc milk thistle
Mixed carotenoids vitamin e pycnogenol
Omega 3 fatty acids, curcumin quercetin

A

Both N - 3 fats and curcumin have anti inflammatory effects and quercetin enhances epithelial barrier function

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87
Q 
Which of the following is a cofactor in ATP production 
Acetyl CoA
Carbon dioxide 
Glucose 
Fructose
A

Acetyl CoA is the two Carbon common end product of both carbohydrate and fatty acid metabolism . It feeds into TCA cycle which produces NADH and FADH that feed the electron transport chain.
NAD nicotinamide adenine dinucleotide is a coenzyme found in all living cells NADH is the reduced form NAD is oxidized form

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88
Q

Primary phase 2 enzymes include :
Beta glucuronosyltransferase and sulfotransferase
Pyruvate kinase and hexokinase
Mixed function oxidase and superoxide dismutase

A

UPD glucuronosyltransferase and sulfotransferase
Phase 2 reactions involve conjugating various substrates with glutathione glucuronide sulfate acetate methyl or amino acid glycine taurine etc groups

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89
Q

Which of the following accurately describes the control of adrenaline and or cortisol release during the stress response
Adrenocorticotrophic hormone ACTH stimulated adrenal medulla to release adrenaline
Corticotropin releasing hormone CRH stimulates the adrenal medulla to release cortisol
Corticotropin releasing hormone CRH stimulates the adrenal cortex to release adrenalin
Adrenocorticotropic hormone ACTH stimulates the adrenal cortex to release cortisol

A

ACTH from the anterior pituitary is the signal for the adrenal cortex to release glucocorticoids including cortisol

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90
Q

Norma TSH and normal T4 still with symptoms because

A

Neither accurately reflects the amount of free T3 in circulation
Free T3 levels have a greater effect on thyroid mediated effects on metabolism than TSH or free T4

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91
Q 
Deficiency of which of the following leads to mitochondrial decay oxidative damage decreased cytochrome p450 activity and anemia 
Copper
Zinc 
Magnesium
Iron
A

Iron is part of the cytochrome proteins including p450 complex and is needed to run the electron transport chain. It is also key component in hemoglobin . Oxidative stress is associated with both iron deficiency and iron excess

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92
Q

Insulin resistence
Blocks androgen production by ovarian theca cells
Enhances beta cell oxidation of fatty acids
Is independently predictive of low HDL -c and elevated triglycerides
Is associated with increased risk for lung cancer

A

Insulin resistance initiates a characteristic triad of high triglycerides low HDL cholesterol and high small dense LDL level

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93
Q

Teen three months in a new house has dull ha in the am since move it is better with ASA you should review with him
Fluorescent lighting in his room and at school
Food allergies
Cell phone use
Stress and chemical fumes in the home

A

Stress and chemical fumes

Change of environment can trigger dysfunction

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94
Q

What are estrogens three major phase 2 detox pathways
Glucuronidation , sulfation, glycine conjugation
Taurine conjugation sulfation, and glucuronidation
Glucuronidation , sulfation, and methylation
Sulfation , glutathione conjugation, and methylation

A

Glucuronidation , sulfation, and methylation

Estrogen bio transformation is primarily done through glucuronidation, sulfation, methylation

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95
Q

Which of the following explains why estrogens are pro inflammatory
Estrogens stimulates cox 2 which promotes inflammation
Estrogens activate the aromatase enzyme to increase testosterone and inflammation
Estrogens decrease cortisol which promotes inflammation
Estrogens increase insulin sensitivity which promotes inflammation

A

Estrogens stimulate cox 2 which increases production of inflammatory eiosanoids

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96
Q 
A 15 year old male presents to your clinic with a hx of asthma. And an identified environmental trigger of grass pollen.  Which foods could also exacerbate his asthma because of pollen food antigen cross over 
Celery carrots bananas
Potato tomato peaches
Melons , bananas cucumbers
Apples , apricotes, hazelnuts
A

Cross reactions have been noted between grass pollen and potatoe, tomatoes peaches

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97
Q 
Food sensitivity is commonly mediated by IgG type antibody interactions .  The mechanism by which IgG causes symptoms is which of the following
Macrophage induction
Histidine decarboxylase
Circulating immune complexes 
Mast cell degranulation
A

With IgG antibodies antigen antibody complexes are likely the primary cause of symptomatic reactions associated with food sensitivities

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98
Q

Select the correct statement regarding transdermal estrogen therapy
Estrone should be given transdermally in the smallest dose to achieve the best clinical effect
Transdermal preparations of estradiol are safer than oral
Estradiol is not recommended as a transdermal agent because it’s levels are difficult to test for in serum
Testing estradiol levels prior to starting transdermal therapy is not recommended because the levels are always fluctuating

A

Transdermal estrogens bypass the hepatic first pass metabolism effect which can convert estrogen into more harmful metabolites
Transdermal preparations of estradiol are the safest

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99
Q 
In a patient with cystic fibrosis which treatment is best for delivering glutathione 
Oral 
Neb
IV
A acetyl cysteine, glycine , glutamine
A

Neb inhaled is the only known method that increases GSH levels in the epithelial lining fluid (ELE) of the lower resp tract

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100
Q 
Which two act as anti inflammatories 
Devils claw and rhodiola 
Boswellia , and turmeric 
Ginger and oregano
Licorice and white willow bark
A

Curcumin downregulates cox 2 and iNOS enzymes, likely by suppressing NF-kB activation. In DBPC trails Boswellia extract has been found to reduce pain and improve physical functioning

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101
Q

Primary phase 2 enzymes include
Pyruvate kinase and hexokinase
Beta glucuronidase and catalase
UPD glucuronosyltransferase and sulfotransferase

A

UPD glucuronosyltransferase and sulfotransferase
Phase 2 reactions involve conjugating various substrates with glutathione , glucuronide, sulfate, acetate methyl or amino acid ( glycine taurine etc) groups

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102
Q

Select the correct statement about MTHFR
It is believed that the gene variants have survived because they convey protection against colon cancer
This enzyme is required to convert methionine into homocysteine
MTHFR has genetic variants which can cause reduced enzyme activity
The enzyme crosses the blood brain barrier

A

MTHFR has genetic variants which can cause reduced enzyme activity
MTHFR catalyzes the conversion of folate to 5 methyltetrahydrofolate Which acts as a methyl donor for the methylation of homocysteine back into methionine. Several common genetic variants are known to slow MTHFR activity

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103
Q 
Which of the following best describes the effect of insulin on this process of beta oxidation
Insulin speeds up beta oxidation
Insulin slows down beta oxidation
Insulin speeds up the citric acid cycle 
Insulin slows lipogenesis
A

Insulin promotes glucose uptake and fatty acid synthesis . It does this in part by slowing the process of fatty acid metabolism beta oxidation

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104
Q 
The effectiveness of mind body techniques in improving hormone balance is modulated via the 
Hippocampus 
Hypothalamus
Amygdala
Frontal cortex
A

The hypothalamic pituitary adrenal axis HPA And the hypothalamic pituitary gonadal HPG can be modulated by meditations effect on the hypothalamus

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105
Q 
Transport of fatty acids into the mitochondria is facilitated by which nutrient 
Taurine 
Carnitine 
Coenzyme Q 10
Pantethine B5
A

Carnitine

The carnitine shuttle helps move fatty acids into the mitochondria for beta oxidation

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106
Q 
57 yo female has chronic insomnia she wakes early and cannot get back to sleep you suggest a salivary cortisol and DHEA which of the following lab finding would you expect
Elevated morning cortisol 
Elevated noon cortisol
Depressed evening cortisol
Elevated DHEA
A

Elevated morning cortisol

Waking early is associated with elevated morning cortisol

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107
Q

What does an elevated reverse T3 do? (And RT3:TT4 ratio)

A

It puts the breaks on the metabolism

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108
Q 
42 year old with depression strong FMH of same the single most useful nucleotide polymorphism to consider would be
CYP1B1
APOE 
TNF alpha
MTHFR
A

MTHFR polymorphisms are common and can have a major impact on mood disorders . Once identified appropriate supplementation may be effective

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109
Q

With Normal TSH and normal free T4 symptoms of low thyroid function can develop because
Serum levels of T3 do not reflect tissue levels
Neither accurately reflects the amount of free T 3 in circulation
There is scientific disagreement as to the normal reference range for both measurements
Neither accurately reflects the conversion of free T3 to free T4

A

Neither accurately reflects the amount of free T3 in circulation
Free T 3 levels have a greater effect on thyroid mediated effects on metabolism than TSH or free T4

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110
Q

What is the role of insulin

A

Insulin promotes glucose uptake and fatty acid synthesis . It does this by slowing the process of fatty acid metabolism ( beta oxidation )

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111
Q

What does calcium D glucarate do

A

Calcium D glucarate provides a substitute substrate for bacterial beta glucuronidase thereby avoiding enterohepatic recirculation and preserving phase 2 glucuronidated substrates for excretion in the stool

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112
Q

How does meditation improve hormone balance

A

The hypothalamic pituitary adrenal axis HPA and the hypothalamic pituitary gonadal HPG can be modulated by meditations effects on the hypothalamus

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113
Q

What is acetyl CoA

A

A 2 carbon common end product of both carbohydrate and fatty acid metabolism . It feeds into the TCA cycle which promotes NADH and FADH that feed the electron transport chain

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114
Q

Which of the following is the most likely mechanism in which exogenously administered estrogens leads to elevations of TSH ?
Estrogens increase the output of all anterior pituitary hormone
Estrogens have a direct effect on stimulating hypothalamic thyroxine
Estrogens increase the conversion of T4 to T3
Estrogens stimulate the production of thyroid binding globulin and therefore decrease the amount of free thyroid hormone

A

Estrogens stimulate the production of thyroid binding globulin and therefore decrease the amount of free thyroid hormone
Low free thyroid hormone levels feed back to increase TSH release from the anterior pituitary

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115
Q

What is the signal for the adrenal cortex to release glucocorticoids including cortisol

A

ACTH from the anterior pituitary is the signal for the adrenal cortex to release glucocorticoids including cortisol

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116
Q 
Which of the following has proven to affect health the most 
Perception of socioeconomic status 
Community norms and values
Average yearly income 
Rural or metropolitan environment
A

Perception of socioeconomic status

Socioeconomic status is a major health indicator but really the perception of that status that matters the most

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117
Q

Select the correct statement about MTHFR
The enzyme crosses the blood brain barrier
The enzyme is required to convert methionine into homocysteine
MTHFR has genetic variants which can cause reduced enzyme activity
It is believed that the gene variants have survived because they convey protection Against colon cancer

A

MTHFR has genetic variants which can cause reduced enzyme activity
MTHFR catalyzes the conversion of folate to 5 methyltetrahydrofolate which acts as a methyl donor for the methylation of homocysteine back into methionine . Several common genetic variants are known to slow MTHFR activity

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118
Q

Key nutrients photochemicals known for improving permeability include:
Glycine , vitamin E , grapefruit seed extract
Glutamine , N-Acetyl glucosamine , zinc
Vitamin C , garlic , N acetyl- Cysteine
Glutathione , iodine , berberine

A

Certain nutrients have been shown to help maintain healthy structure and function of mucosal cells and promote normal intestinal permeability . These include L glutamine, N acetyl -D-glucosamine, zinc, and gamma linolenic acid

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119
Q

Describe phase 2 reactions

A

Phase 2 reactions involve conjugating various substrates with glutathione, glucuronide, sulfate, acetate, methyl or amino acid ( glycine , taurine, etc.,) groups

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120
Q

Elevated cortisol is associated with

A

Some types of depression and decreases calcium absorption at the intestines and inhibits bone formation

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121
Q

What is the phase 2 conjugation pathway and the primary cofactor for the detoxification of acetaminophen

A

Glutathione conjugation and N acetylcysteine
N acetylcysteine is the nutrient of choice for the treatment of an acetaminophen overdose . It serves as a source of cysteine for glutathione synthesis

122
Q

T is increasingly converted to the metabolism slowing molecule RT3 by

A 
Low calorie diets
Stress cortisol
Trauma 
Inflammation cytokines 
Toxins
Infections 
Liver kidney dysfunction
Certain medications
123
Q

Why are there ethnicity specific reference ranges for waist circumference

A

Different ethnic groups tend to have varied distributions of subcutaneous versus visceral fat

124
Q

High levels of what can cause peripheral neuropathy

A

Vitamin B6

125
Q

What affect Dow stress have on the gut

A

Acute psychological stress increases intestinal permeability and chronic psychological stress is also associated with increased intestinal epithelial permeability

126
Q

What is the signal for the adrenal cortex to release glucocorticoids including cortisol

A

ACTH from the anterior pituitary is the signal for the adrenal cortex to release glucocorticoids including cortisol

127
Q

6 month old mom has trouble beast feeding using soy formula bad eczema and a couple ear infections with antibiotics you would
Vitamin A and D
Soy elimination zinc and probiotics
Elimination diet for mom and kid
High quality prenatal for mom and elimination diet

A

The eczema could be from zinc deficiency and probiotics are indicated following the antibiotic therapy a sensitivity to soy could be preceding the ear infections

128
Q

Why does exogenously administered estrogen lead to elevated TSH

A

Estrogens stimulate the production of thyroid binding globulin and therefore decrease the amount of free thyroid hormone
Low free thyroid hormone levels feed back to increase TSH release from the anterior pituitary

129
Q

Mind body techniques improve hormone balance via the

A

Hypothalamus
The hypothalamic pituitary axis HPA and the hypothalamic pituitary gonadal HPG can be modulated by meditations effects on the hypothalamus

130
Q

Dark line in the gingival sulcus could mean

A

Lead sulfate deposition (buttons lines) or maybe cadmium, bismuth, Mercury, cis platinum, arsenic

131
Q

Atopy of skin might indicate

A

Permeability immune balance protein loss , EFA / GLA , an, vit D/A , C

132
Q

Causes of acne

A

Deficiency of zinc, vit A, EFA dietary allergens , high GL diet, diary (IGF-1)

133
Q

What could seborrheic keratosis indicate

A

Arsenic exposure without adequate diet leads in sk. A diet higher in nutrients which will help the bio transformation and excretion of the arsenic is associated with resolving sk

134
Q

Clubbing

A

Inflammatory bowel , sprue

135
Q

Beau’s lines

A

Hypocalcemia , zinc def

136
Q

Koilonychia (spooning )

A

Low: iron, protein, zinc , cu

137
Q

Onychorrhexis ridges lines in the nail

A

Iron, folic acid, protein

138
Q

Median nail dystrophy

A

Malnutrition

139
Q

Leukonychia punctata white specs

A

Zinc def

140
Q

Leukonychia white vertical lines

A

Selenium deficiency

141
Q

Mees lines wider white vertical lines on nails

A

Arsenic tox, hodgkins, CHF , leprosy, malaria, chemo, carbon monoxide poisoning , other systemic insults

142
Q

Functional lab tests to evaluate the toxic patient to look for issues of nutrition and assimilation

A

Dysbiosis SIBO : overgrowth of pathogenic microorganism
Increased levels of beta glucuronidase
Markers of GI inflammation
Intestinal permeability
Malabsorption deficiency of amylase, pancreatic enzymes , hcl
Leaky gut

143
Q

Tests to look for toxic damage - oxidative stress

A

To look for oxidative stress: 8-hydroxy deoxyguanosine 8-OH- dG, lipid peroxides ( thiobarbituric acid reactive substances - TBARS), oxygen radical absorbance capacity (ORAC) , isoprotanes

144
Q

Functional labs tests to evaluate the toxic patient

A

Glutathione GSH whole blood
Reflects GSH in the tissues
Deficiency ass with many chronic illnesses
Linear correlation with NK function
Glutathione per oxidase
Se dependent enzyme
Found in cytosol and mitochondria
Superoxide dismutase
Converts (dismutation ) superoxide into oxygen & H2O2 (catalase subsequently converts H2O2 into oxygen and water )
A metalloprotein found in cytosol (Cu Zn dependent) and mitochondria Mn dependent

145
Q

What is a random unprovoked heavy metals in urine good for?

A

Excellent for showing current exposures to metals that are excreted by endogenous processes
Reflects the level of heavy metals in the bloodstream during the hours immediately before bladder voiding

146
Q

Provoked urine for heavy metals tells you

A

Metals mobilized by provoking agents from aqueous extracellular space
Reflection of total body burden

147
Q

What is the toxic burden equation

A

Disease risk = susceptibility x life time exposure x potency

148
Q

What are the functional medicine principles of detox

A 
Minimize exogenous toxic exposures 
Ensure adequate hydration 
Optimize bowel health and elimination 
Balance and assist phase 1 and 2 bio transformation function
Enhance antioxidant reserve 
Optimize mitochondria function
149
Q

What do you use to optimize bowel health and excretion during detox

A

Fiber :
soluble : psyllium , flax, pectin, oat bran, inulin, FOS, fenugreek
Insoluble: rice bran, wheat bran, beet fiber
Cholagogues and choleretics
Artichoke,
Oregon grape root ( mahonia aquifolium) : berberine
Dandelion taracacum officinale
Glucaric acid

150
Q

What is glucuronidation

A

A major detoxification process catalyzed by UPD glucuronosyltransferase that convert a vast variety of endogenous compounds , including bilirubin, steroid and thyroid hormones and retinoids or vile acids, into more hydrophilic and therefore excretable metabolites

151
Q

What regulates glucuronidation

A

Dual regulatory control
Genetic expression level of isoenzymes , determines the amount of a different isoform available
Activity of individual isoforms to their functional state by specific substances including certain nutrients

152
Q

What are UPD glucuronosyltransferase enzymes

A

Members of a super family of enzymes with considerable genetic polymorphisms making some people more susceptible to Gilbert’s
And reduced glucuronidase activity of specific substances in these individuals makes them more susceptible to the effects and endo and exotoxins

153
Q

List the nutritional support for optimal phase 1 and 2 bio transformation

A

Phase 1:
Macronutrients and broad spectrum micronutrient support
Antioxidants to quench free radical produced by phase 1 reactions
Phase 2 :
Cofactors for conjugation
Phytonutrients inducers of phase 2 enzymatic reactions

154
Q

What are the phytonutrient inducers of phase 2 enzymes supplements for

A 
Milk thistle 
Curcuminoids
Carnosol rosmarinus officinalis
Indole 3 carbinol 
Diidolylmethane 
Sulforaphane
155
Q

What supplements can be used to optimize glutathione level

A 
Reduced glutathione 
N acetyl cysteine 
Lipoic acid 
Whey protein 
Magnesium
Vitamins C
Vitamin E 
Pantothenic acid
SAMe
156
Q

Supplements to optimize phase 1 & 2 conjugation antioxidant capacity and gene expression

A 
Catechins EGCG
Curcuminoids
Garlic
Indole 3 carbinol 
Diindolylmethane
Sufloraphane
Quercitin 
Milk thistle 
Lignans
Resveratrol 
Proanthocyanidins 
Ellagic acid 
Artichoke extract
Rosemary
Andrographis
Aloe Vera extract
157
Q

FODMAPS list the three independent mechanisms

A

Low absorptive capacity of the small intestinal epithelium
Rapid transit through the small bowel
Bacterial overgrowth of the distal small bowel

158
Q

What is 8-OHdG

A

A Biomarkers it has been a pivotal marker for measuring the effect of endogenous oxidative damage to DNA and as a cofactor of initiation and promotion of carcinogenesis

159
Q

What does carnitine do

A

It transfers long fatty acids across the mitochondria membrane

160
Q

The secondary causes of mitochondria dysfunction

A 
High oxidative stress
High nitric oxide (NO)
High SCFA esp propionate 
High TNF alpha and inflammation 
Low folate and b vitamins 
Low mineral co factors 
Low CoQ 10 
Low glutathione 
Low carnitine
161
Q

How does the body protect its self from ROS

A 
Enzyme 
     Catalase (Fe)
     Superoxide dismutase - SOD ( Zn, Cu, Mn)
     Glutathione per oxidase (Se) and glutathione reductase
Dietary anti oxidants 
     Vit C for aqueous compartments
     Vit E for lipid compartments 
     Carotenoids, flavonoids , etc
Endogenous anti oxidant molecules 
     Glutathione
     Cysteine 
     CoQ 10
     Lipoic acid 
     Uric acid
     Cholesterol
162
Q

What molecules are central to assembly of the electron transfer complexes and catalase

A

Heme and they are therefore at the core of energy formation

163
Q

enzyme in the heme synthesis pathway required multiple co factors including

A

Antioxidants (Lipoic acid )
B vitamins ( 2,5,6,7)
Minerals (Mg,Zn, Cu, Fe)

164
Q

What are the hallmarks of mitochondrial disease

A

An typical common disease
More than one organ system is involved
Recurrent setbacks or flare up in a chronic disease occur with infection or stress
Unpredictable in time, severity, constellation and presentation

165
Q

What findings would suggest mitochondria dysfunction

A 
Elevated lactic acid
Amino acids elevated 
     Alanine
     Glycine 
     Proline
     Sarcosine
     Tyrosine 
Ox stress markers
Organic acids urine
     TCA cycle intermediates
     Ethylmalonate
     3- methyl gluaconate
     Dicarboxylic acids
Acylcaritines
     Low free carnitine 
     Elevated actyl free carnitine ratio
166
Q

What transports fatty acids into the mitochondria matrix for oxidation

A

L carnitine

167
Q

Co enzyme Q10 does what

A

Serves as a coenzyme (cofactor upon which enzyme depend for their function ) for several key enzymatic processes

168
Q

List three activities in which CoQ10 is involved

A

Production of cellular ATP via ETC
Potent antioxidant removes super oxides and inhibits free radicals from destruction of cell membranes
Inhibits LDL oxidation

169
Q

Alpha Lipoic acid is a

A

Co factor in multi enzyme complexes that catalyze oxidative decarboxylation of a keto acids as pyruvate dehydrogenase complex

170
Q

List the actions of alpha Lipoic acid

A

Reduces inflammation by blocking activation of stress activated signaling pathways
Increases glucose metabolism - activates AMPK in periphery inhibits in the brain
Increases insulin sensitivity decreases triglycerides synthesis
Decreases diabetic complications
Increases intracellular and mito glutathione
Translation metal chelator

171
Q

List some of the conditions you were us alpha Lipoic acid for

A 
Liver disease
Amanita poisoning 
Radiation exposure
Neurodgenerative dz
DM
Neuropathy
Insulin resistence
Met syn
Hyper triglycerides 
PCOS
172
Q

What are the principles of the IFM mito food plan

A 
Phyto density 
Low glycemic 
Anti inflammatory anti oxidant
Fats and oil
Cooling impact
Fasting caloric restriction carb retriction
Organic clean food
173
Q

Exercise and fatigue

A

Exercise frees FFA from adipose
FFA completes for TRP binding on plasma proteins increasing plasma TRP
Skeletal muscle consumes BCAA
Less BCAA competition for transport into CNS increase TRP transport into CNS
Graded exercise creates biogenesis and tolerance to tryptophan load

174
Q 
46 yo w/ BMI 33 worried about br ca risk mother had at 60 has a normal CRP and low 2/16 estrogen ratio which is the appropriate therapy 
Increased cruciferous veg
Genetic counseling 
Calcium vitamin K vitamin D
Increased resistance training
A

Increasing cruciferous veg can help increase the 2:16 ratio and decrease the risk of breast cancer

175
Q 
Select the most common manifestation of iron overload from the options below 
Peripheral neuropathy
GERD 
Chronic depression 
SOB
A

Iron overload can lead to cytotoxicity and it is a risk for peripheral neuropathy

176
Q

IFM mnemonic DIGIN stands for

A

Digestion, intestinal permeability , gut microbiota, inflammation /immune, nervous system
DIGIN mnemonic helps provide framework for assessment of gut dysfunction

177
Q

What do elevated levels of N terminal teleopeptide (NTx) indicate

A

Increased bone reabsorption

N terminal teleopeptide molecules see mobilized from bone by osteoclasts and subsequently excreted in the urine

178
Q 
52 yo homeless man with darkened skin , flakey skin, sun exposed skin on his face and hands, decreased taste, tongue fissuring , and somewhat disoriented .  What supplement would you consider
B 1 thiamine 
B 2 riboflavin 
B6 pyridoxine 
B 3 niacin
A

B 2 riboflavin
B2 deficiency can lead to various problems with dry , flakey, cracked skin, particularly at the corners of the mouth, a sore, red, or burning tongue, and impaired nervous system function
Without ribo dry skin, corners of mouth, red sore tongue that burns, and impaired nervous system

179
Q

What three foods have a cross over pollen food antigen crossover reaction with grass pollen?

A

Potato tomato peaches

180
Q

List three nutrients that support the energy production in cardiac myocytes

A

Ribose, coQ10, and L carnitine

181
Q

Transport of fatty acids into the mitochondria is facilitated by

A

The carnitine shuttle helps move fatty acids into the mitochondria for beta oxidation

182
Q

What is elevated cortisol associated with

A

Some types of depression

Decreases calcium absorption at the intestines and inhibits bone formation

183
Q

Fish, shellfish, kelp, and other seafood contain

A

Significant organic arsenic

184
Q

Arginine is

A

The ultimate source of nitric oxide produced by nitric oxide synthase

185
Q

What is Tetrahydrobioterin (BH4)

A

An essential cofactor for all NOS isoforms

186
Q

What do phase one reactions use to introduce or expose polar groups to make substances more water soluble

A

Phase one reactions use oxidation, reduction, or hydrolysis to introduce or expose polar groups to make substances more water soluble

187
Q

What is the phase two conjugation pathway and primary cofactor for the detoxification of acetaminophen

A

Glutathione conjugation and N acetylcysteine
N acetylcysteine is the nutrient of choice for the treatment of an acetaminophen overdose. It serves as a source of cysteine for glutathione synthesis

188
Q

What does Lipoic acid do

A

Inhibit the release and translocation of proinflammitory NF-B from the cytoplasm to the nucleus

189
Q

What does curcumin do

A

Downregulates cox 2 and iNOS enzymes likely by suppressing NF-kB activation

190
Q

In trials what have they found with boswellia

A

It reduces pain and improves physical functioning

191
Q

The heart generates what percent of its ATP through beta oxidation

A

60-90% the heart generates the vast majority of its energy through the breakdown of fatty acids in beta oxidation

192
Q

What is the effect of insulin on beta oxidation

A

Insulin promotes glucose uptake and fatty acid synthesis . It does so in part by slowing the process of fatty acid metabolism (beta oxidation)

193
Q

Estrogen biotransformation is primarily done through

A

Glucuronidation, sulfatation, or methylation

194
Q

Why does exogenously administered estrogen lead to elevated TSH

A

Estrogens stimulate the production of thyroid binding globulin and therefore decrease the amount of free thyroid hormone
Low free thyroid hormone levels feed back to increased TSH release from the pituitary gland

195
Q

57 year old woman with chronic insomnia wakes early and cannot get back to sleep . What do you suspect you will find on salivary panel

A

Elevated morning cortisol

196
Q

How do EPA and DHA decrease inflammation

A

They are omega three fatty acids which can inhibit a number of aspects of inflammation including production of Eicosanoids like prostaglandins and leukotrienes from omega six fatty acid arachidonic acid production of inflammatory cytokines and T cell reactivity

197
Q 
Deficiency of which of the following leads to mitochondrial decay, oxidative damage, decreased cytochrome P 450 activity and anemia
Zinc
Mag
Copper 
Iron
A

Iron
Iron is part of the cytochrome proteins including p450 complex and is needed to run the electron transport chain. It is also a key component in hemoglobin . Oxidative stress is associated with both iron deficiency and excess

198
Q 
Ethnicity affects the standards for which of the following markers of met syn
Triglycerides 
Waist circumference 
HDL
BMI
A

Waist
Different ethnic groups tend to have varied distributions of subcutaneous versus visceral fat, so some ethnicity specific references ranges for waist circumference have been developed

199
Q

Which fatty acid inhibits delta 5 desaturase

A

Eicosapentaenoic acid EPA

EPA is an inhibitor of the enzyme delta 5 desaturase (D5D) that promotes AAa

200
Q 
Select the most common manifestation of iron overload 
GERD
Peripheral neuropathy 
Sob
Chronic depression
A

Iron overload can lead to cytotoxicity , and is a risk factor for peripheral neuropathy

201
Q 
Eating two fatty fish meals weekly has been shown to 
Increase osteoporosis 
Increase risk of infection 
Decrease risk of cad
Decrease risk of RA
A

Fish intake has been linked to decreased risk of cad and reduced severity of RA

202
Q 
Saccharomyces boulardi has been shown to be effective in which of the following conditions 
GERD
C. Diff
IBS 
Pancreatic insuffciency
A

A significant decrease in reocurrance of c diff was observed in patients treated with antibiotics and s boulardi

203
Q

Why are estrogens pro inflammatory

A

Estrogens stimulate cox 2 which promotes inflammation

Estrogens stimulate cox 2 which increases production of inflammatory Eicosanoids

204
Q

Factors that contribute to proper production of thyroid hormones

A 
Iron
Iodine
Tyrosine 
Zinc
Selenium
Vitamins E, B2, B3, B6, C, D
205
Q

Phase one reactions

A

Oxidation
Reduction
Hydrolysis
Dehalogenation
Introduce or expose a functional group on the parent compound
Render parent more polar
May activate inert compounds eg pro drugs and pro carcinogens

206
Q

Nutrients used on phase one

A 
Riboflavin B2
Niacin B 3
Pyridoxine B6
Folic acid
Glutathione 
Branch chained amino acids 
Flavonoids 
Phospholipids
Nuts for phase one: ribo (riboflavin) and nancy (niacin) were pyromaniac s (pyridoxine) and frolicked (folic acid) around with gluts (glutathione ) waving about branches (BCAA ) with flav (flavonoids) and phos (phospholipid )
207
Q

Reactions of phase two

A 
Sulfation 
Glucuronidation
Glutathione conjugation 
Acetylation
Amino acid conjugation 
Methylation 
Covalent linkage between parent compound and a polar water soluble moiety
Phase  two products are generally metabolically inactive and prepared for elimination by bile or urine
208
Q

Nutrients used in phase two

A 
Glycine
Taurine
Glutamine 
N acetylcysteine 
Cysteine
Methionine 
Nuts for phase two: 2 gluts (glycine glutamine) had torrid (taurine) affair in a cistern (n acetylcysteine) and then too meth (methionine)
209
Q

What are endotoxins

A

End products of metabolism

Bacterial endotoxins

210
Q

What are exotoxins

A 
Drugs 
Agri chemicals 
Food additives 
Household 
Pollutants contaminants
Microbial
211
Q

What is the toxic equation

A

Total toxic load = total toxic exposure - ability to detox + excrete toxins

212
Q

List the causes of mitochondria dysfunction

A 
High oxidative stress 
Exposure to medication 
Exposure to heavy metals 
Exposure to chemicals 
Exposure to PCBs 
Exposure to pesticides 
MIT became dysfunctional from: heavy metal, too many chemicals , PCB's , and pests, and then taking meds
213
Q

What enzymes protect the body from ROS

A

Catalase Fe
Superoxide dismutase - SOD (Zn, Cu, Mn)
Glutathione peroxidase (Se) and glutathione reductase

214
Q

What dietary anti oxidants protect the body from ROS

A

Vitamin C for aqueous compartments
Vitamin E for lipid compartments
Carotenoids, flavonoids, etc

215
Q

What endogenous anti oxidant molecules does the body use to protect from ROS

A

Glutathione, cysteine , CoQ10, Lipoic acid , uric acid, cholesterol
Gluts fell into cistern with ten Qs and dropped some acid Uric pulled them out with chol they all fought off ROS

216
Q

What leads to brain derived neurotrophic factor (BDNF)

A

Caloric restriction
Exercise
DHA
Mental exercise

217
Q

What do you do to support the mitochondria

A 
Good nutrition 
Stay cool and hydrate
Prevent infection 
Supplements 
     CoQ10 
     Omega 3 FA
Exercise 
Avoid toxins
218
Q

Android obesity

A

Apple shape
Above the waist
Over fat over vat
Think met syn

219
Q

Gynoid obesity

A

Pear shape
Below the waist
Over fat over sat
Think gut / detox/ HPATG dysfunctions hypothalamic pituitary adrenal axis

220
Q

What leads to insulin resistance and hyper insulinemia

A

Inability to suppress hepatic glucose production so elevated serum glucose so glucose toxicity leading to further impaired insulin secretion
Over production of FFA by adipose cells so stimulates gluconeogenesis increases muscle insulin resistence impairs insulin secretion so elevated serum glucose and glucose toxicity leading to further impaired insulin secretion
Increased muscle cell resistance to insulin action so elevated serum glucose so glucose toxic ip leading to further impaired insulin secretion

221
Q

What genetic variant is associated with MI and atherosclerosis

A

9P21 33 gene enhancers are located in the 9P21 region are implicated in inflammatory pathways .

222
Q

What is the pathophysiology of CHD/CAD

A 
Endothelial  dysfunction early
Abnormal vascular compliance /vsmh / cardiac
Hypertrophy late
Inflammation 
Oxidative stress 
Immune vascular dysfunction
223
Q

Heart energy

A

Mostly fatty acids then glucose

224
Q

Microalbuminuria

A

One of the earliest abnormalities in vascular system and kidney tha reflects endothelial dysfunction and increased vascular permeability
High correlation with progression to proteinuria, renal disease, LVH, and future CVD, CHD, MI, CHF, and CVA
Linear relationship of albumin creatinine ratio ACR starting below 5 mg/gm
Triggers tubular renin angiotensive aldosterone system (RAAS) activation via megalin / cubilin receptors and inflammatory oxidative stress reaction with NFkB/AP-1
Reduced best with BP control with RAAS drugs and also with omega 3 fatty acids and Lipoic acid

225
Q

The following symptoms of swelling and bleeding gums loosening of teeth and weakening of connective tissue and bruising are related to

A

Vitamin c deficiency
Vitamin C plays a crucial role in the formation of collagen, a major component of connective tissue. Connective tissue has structural and supportive functions which are indispensable to blood vessels and all tissues within the body.

226
Q

What is one of the actions of carnitine

A

Carnitine facilitates the transport of fatty acids into the mitochondria

The carnitine shuttle helps move fatty acids into the mitochondria for beta oxidation

The car shuttle fatty acids into MIT to join beta oxidation

227
Q

Elevated formiminoglutamate (FIGLU) is associated with what nutrient insufficiency

A

Folic acid
FIGLU is an intermediate compound formed in the metabolism of histidine to glutamate. Tertrahydrofolate (THF) is required to convert FIGLU into glutamate, therefore FIGLU is used as an indicator of folic acid THF deficiency

228
Q

Patient with concerns of weight gain of thirty pounds , he has made no changes get but is sampling low fat foods, and has purchased a pair of walking shoes. What phase is he in

A

Preparation for change

Intentional acts designed to facilitate the change process illustrates that the patient is preparing for change

229
Q

What is glutathione conjugation

A

Phase two reaction in the liver glutathione combines with toxins and converts them into water soluble mercaptates effectively detoxifies acetaminophen and nicotine

230
Q

What is glucuronidation

A

Glucuronidation is the addition of glucuronic acid to a substrate. It is often involved in zenobiotic metabolism of substances such as drugs, pollutants , bilirubin, androgens, estrogens, mineralocorticoids, fatty acid derivatives, retinoids, and bile acids.

231
Q

Which fatty acid inhibits delta 5 desaturase

A

EPA

Emily kills delta force five

232
Q

Hyper keratosis Pilari can be caused by

A 
EFA
Vitamin A
Vitamin C
Zinc
Certain B vitamins 
SNPs for elongases and desaturases 
SIBO 
Malabsorption 
Emily, Adrienne , zackery, B,Malory , Bo , all scratching back of arms and sniping paper
233
Q

What could cause acne in an eight year old

A

Not enough zinc vitamin-A or EFA

234
Q

PFC MVP

A 
Protein
Fats and oils
Carbs and fiber
 Minerals
Vitamins water and fat soluble 
Phytonutrients
235
Q

How to decrease IgG reactions

A 
Avoid
Quercitin 
Vitmain C
EFA 
Vitamin C
Bromelain
Nettle
236
Q

What are estrogen’s three major phase two pathways
Taurine conjugation sulfation and glucuronidation
Glucuronidation sulfation and glycine conjugation
Sulfation glutathione conjugation and methylation
Glucuronidation sulfation methylation

A

Glucuronidation sulfation methylation

237
Q

Calcium D glucarate can limit the action of

A

Beta glucuronidase

238
Q

What is glucuronidation

A

The addition of glucuronic acid to a substrate
Often used in xenobiotic metabolism of substrates such as drugs, pollutants, bilirubin, androgens Estrogens, mineralocorticoids

239
Q

Glutathione conjugation

A

A phase two detoxification reaction in the liver ; glutathione combines with toxins and converts them into water soluble mercaptates

240
Q

Imagery can help with anxiety because

A

It activates brain function in ways that are different from the actually experience and will therefore help protect from the negative impacts of a bad experience
The right brain appears to have special links to emotion . Right brain processes are rapid, complex, whole pattern, spatial, and are specialized for visual imagery

241
Q

Research shows that elimination diet to be effective in what condition

A

Eosinophilic esophagitis

242
Q

Recent research suggests that which two interventions may be useful in diverticulitis

A

Vitamin d and probiotic

243
Q 
What conditions are considered non IgE allergies
Atopic 
Asthma
Eosinophilic gastroenteritis 
Migraines
A

Eosinophilic gastroenteritis

244
Q

Two primary mechanisms that relate diet to systemic disease
Free radical production and nutritional insufficiencies
Amount of trans medium chain fatty acids
Balance of fatty acids and carbs derived from grains
Oxidative stress and glycemic load

A

Oxidative stress and glycemic load

245
Q

Elemental diet have been shown to be particularly useful in

A

Inflammatory bowel disease and RA

246
Q

The activity of delta 6 desaturase an enzyme required for conversion of DGLA to GLA may be impaired by

A

Alcohol

Factors known to inhibit D6D activity include alcohol , aging, diabetes, and radiation

247
Q

Alpha Lipoic acid

A

Inhibits the release and translocation of proinflammatory NF kappa B from the cytoplasm to the nucleus

248
Q

High glycemic foods

A

Tend to increase inflammation via NF kappa B and can increase serum hs CRP

249
Q

Triggers of autoimmunity

A

A combination of genetic susceptibility with an environmental trigger. These triggers commonly include trauma infection toxins foods

250
Q

Enterohepatic re circulation is

A

The cycling of drugs , xenobiotics, and metabolites after excretion in the biliary system which are then reabsorbed in the intestine
Enterohepatic recycling occurs by biliary excretion and intestinal reabsorption of a solute sometimes with hepatic conjugation and intestinal de conjunction

251
Q

Fasting as what effect on biotransformation

A

Fasting generally inhibits the action of phase two enzyme systems

Phase two biotransformation systems are all highly nutrient and energy dependent and fasting decreases the availability of both

252
Q

What is smoking effect on the family of c P450 enzymes

A

Cigs induce CYP - 1A2
Polycyclic aromatic hydrocarbons (PAH) in tobacco smoke are believed to be responsible for the induction and cytochrome P450 CYP1A2 and possibility CYP 2 E 1

253
Q

Glutathione

A

Is s tripeptide made of glutamate, cysteine , glycine , and the rate limiting substrate of its synthesis is sulfa containing acid cysteine

254
Q

Phase 1 and 2 detox pathways

A

Phase 2 biotransformation conjugated reactive intermediates from phase 1 and makes them less lipophilic and more easily excreteable in bile and urine

255
Q

Select the correct statement about Gilbert’s syndrome
Associated with insufficient conjugation of bili with glucuronic acid
UPD glucuronosyltransferase production is suppressed by EGCG flavonoids
Affects the glucuronidation of phase one
In the UGT - 1A1 28 variation there is an increase in UGT enzyme production

A

Is associated with insufficient conjugation of bilirubin with glucuronic acid
Gilbert’s syndrome is characterized by episodes of mild intermittent jaundice in the absence of liver disease . It is found in approximately 6-12% of the population. Mutations in the UGT 1A1 Gene especially homozygosity for the UGT 1A1 28 variant are responsible

256
Q

Metallothionein

A

The production of Metallothionein proteins is especially dependent on the availability of cysteine
Cysteine is a critically important sulfur bearing amino acid in glutathione synthesis as well as in Metallothionein synthesis

257
Q

Toxin induced models of Parkinson’s disease related to heavy metals include

A

Mn, Cu, Pb, Hg

258
Q

DMSA is an effective chelator for

A

Mercury and lead
DMSA and other dithiol agents have a binding affinity for, lead, mercury, cadmium, arsenic, bismuth, tin, nickel, thallium

259
Q

Lipolysis and detox

A

Lipolysis can be expected to increase the burden on phase two biotransformation systems
Lipolysis mobilizes lipophilic toxins which need to be conjugated by the phase 2 detox system in the liver to facilitate excretion

260
Q

During the adaptive phase of stress response

A

Cortisol levels raise but DHEA levels stay flat or decline causing a rise in the cortisol DHEA ratio

261
Q

What is the normal action of 17/20 lyase

A

17/20 lyase is a key enzyme in the steriodogenic pathway whose activity is down regulated in situations of acute stress an effect that is part of the cortisol steal

262
Q

Describe cortisol steal

A

In the cortisol steal enzyme action is altered such that pregnenolone goes to cortisol production leaving less to be converted to DHEA and the sex hormones

263
Q

What would an elevated cortisol do to thyroid hormones

A

Decline in T3 and increase in RT3

264
Q

What nutrient would help lower thyroid antibodies in hashimotos

A

Selenium

265
Q

Why is it important to test thyroid auto antibodies

A

Symptoms of thyroid dysfunction may occur in the presence of normal thyroid hormone levels

266
Q

Inhibition of the enzyme 17/20 lyase results in

A

Decreased testosterone production

Fewer 17-20 year old men less testosterone
17/20 lyase converts 17 OH progesterone and 17 OH pregnenolone into androgens DHEA and androstenedione

267
Q

Conjugated equine estrogens

A

Increase inflammatory markers regardless if given with or without synthetic progestin

CEE generally increase plasma CRP and interlukin 6 (IL-6)

268
Q

What would you expect in a woman with low levels of SHBG and symptoms of estrogen dominance

A

Higher levels of insulin

There is a significant inverse association between levels of SBHG and fasting seum insulin in both genders

269
Q

What effects does progesterone have on estrogen

A

It decreases the effect of estrogen

270
Q

List two aromatase inhibitors that will limit conversion of testosterone into estrogen

A

Chrysin and green tea extract are known aromatase inhibitors that will limit conversion of testosterone into estrogen

271
Q

Low free testosterone is associated with

A

Insulin resistance

Studies in healthy men have shown an inverse correlation between testosterone and insulin levels

272
Q

What inhibits the aromatase conversion of testosterone to estrogen and also the 5 alpha reductase conversion of testosterone to DHT

A

Green tea

273
Q

Recent trials have reported what potential adverse events in testosterone replacement ?

A

Myocardial infractions

274
Q

What two conditions have been implicated in the pathogenesis of NAFLD and PCOS

A

Visceral fat accumulation and adipose tissue dysfunction

Not subcutaneous adiposity and inflammation

275
Q

List the five finite vascular responses to the infinite number of vascular insults

A 
Inflammation 
Oxidative stress 
Autoimmune reactions 
Altered gene expression 
Endothelial , vascular smooth muscle , and cardiac dysfunction
276
Q

Insulin resistence at the receptors leads to hyperglycemia , hyperinsulinemia which leads to a host of other physiologic responses including

A

Increased free estradiol insulin can stimulate ovarian estrogen androgen and progesterone secretion in vitro

277
Q

List two interventions that can help prevent neurodegenerative disease and improve cognitive function

A

DHA and nuclear regulatory factor (erythroid derived 2 ) like NRF2 activators
DHA is highly concentrated in the brain and supports optimal function of the brain , eyes, immune system. Activation of Nrf2 stimulates production of important antioxidants which also protect brain function

278
Q

What modifiable behaviors can upregulated BDNF transcription

A

Exercise, DHA , caloric restriction

279
Q

Older adults with too little what in the blood may have twice the risk of Alzheimer’s disease as seniors with sufficient levels

A

Vitamin D

280
Q

What is 8 Hydroxy-deoxyguanosine

A

8 OHdg is one of the major products of DNA oxidation . It’s concentration is a measurement of oxidative stress specific to DNA

281
Q

What two nutrient are critical for ATP synthesis via the electron transport pathway

A

Riboflavin and niacin
NAD nicotinamide adenine dinucleotide and FAD flavin adenosine dinucleotide serve as electron shuttles in the Mitochondria . Niacin Aka nicotinic acid , is a building block of NAD and riboflavin is a central component of FAD

282
Q

What organ system consumes the least amount of cellular ATP

A

Kidney

283
Q

Patient with increased BMI waist circumference was it to hip ratio and BIA is

A

Android obese

284
Q

A potent source of oxidative stress is

A

Peroxynitrite (*ONO2)

285
Q

Imagery is helpful because

A

It is the language of the right brain and can facilitate insight into issues

The right brain appears to have special links to emotion. Right brain thought processes are rapid , complex, whole pattern spatial and are specialized for visual imagery

286
Q

Insufficient copper, zinc, iodine, iron, and or zinc can cause

A

Smell and taste disorders

Zinc deficiency is associated with decreased smell, there are also associations between smell and copper iodine and iron

287
Q

Deficiency of what vitamin is associated with seb derm and pain knots in the distal finger joints

A

B6

288
Q

Exercise prescription should have

A

Frequency, duration, intensity

289
Q

For optimal wound healing , as far as omega fatty acids are concerned , you need

A

Relatively equal consumption of omega 3 and 6 fatty acids

Om3 and om6 are both required for the body to function but generally have opposite effects when it comes to the inflammatory response . However inflammation is a important component in wound healing so om6 deficiency would be a problem

290
Q

Riboflavin B2 deficiency is associated with what medical problems

A

Gum disease, angular blepharitis glossitis and seborrhea

291
Q

What to ABCD of functional medicine assessment stand for

A

Anthropometrics , biomarkers , and functional labs, clinical indicators from nutritional assessment and lifestyle assessment

292
Q

Most likely etiology of SIBO is

A

Hypochlorhydria

Low stomach acid allows more bacteria to survive which can colonize the gut

293
Q

What dose hydrochloric acid do

A

Helps sterilize the bolts, denatures proteins, activates proteolytic pepsinogen to pepsin, prepares minerals for optimal absorption, and triggers the release of downstream digestive fluids from the pancreas and gallbladder

294
Q

What is a symptom of low hydrochloric acid

A

Bloating or belching immediately after a meal
Low acid in the stomach can lead to dyspeptic symptoms following meals due to insufficient digestion in the stomach and down stream in the GI tract becasue chyme acidity triggers the exocrine pancreass and gallbladder to expel their critical digestive secretion into the duodenum

295
Q

What is intestinal dysbiosis

A

Microbial imbalance within the intestinal tract
Unlike frank infection intestinal dysbiosis occurs when there is imbalance among beneficial and commensal microbial species in the gut

296
Q

In published studies probiotics have been found to be useful for

A

Asthma, inflammatory bowel disease, ibs
Positive associations have been found between negative changes in the intestinal microbiome and chronic diseases including IBD , IBS, other allergic disorders, cancer, CVD, metabolic syndrome, obesity

297
Q

4 triggers of autoimmune disease

A

Trauma infection toxins foods
Auto immunity is usually a combination of genetic susceptibility with an environmental trigger . These triggers commonly include trauma, infection, toxins, and foods

298
Q

Molecular mimicry occurs when

A

There are sequence similarities between foreign and self peptides sufficient to result in the cross activation of auto reactive T and B cells by pathogen , toxins , or food derived peptides

299
Q

The activity of delta 6 desaturase an enzyme required for conversion of DGLA to GLA may be impaired by

A

Alcohol aging, diabetes , radiation

300
Q

What does lipolysis do in detoxing

A

Lipolysis mobilizes lipophilic toxins , which need to be conjugated by the phase 2 detox system in the liver to facilitate excretion

It can be expected to increase the burden on phase 2 biotransformation systems

301
Q

Inhibition of the enzyme 17/20 lyase would result in

A

Decreased testosterone production

17/20 lyase converts 17/OH progesterone and 17 OH Pregnelone into the androgens DHEA and androstenedione

302
Q

Most potent source of oxidative stress is

A

Peroxynitrite ONO2

Fun Med Review Quiz (1 decks)

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