Revision paper questions Collated

Question 1

Describe the pathway or chain of events that could link periodontal disease to increased risk of CVD?

Answer 1

Increases systemic inflammation and raised inflammatory cytokines such as TNF, IL-1, IL-6, CRP which impair vasodilation.

Promotes endothelial dysfunction, arterial stiffness and ↑ fibrinogen (plaque formation).

Question 2

Why would you give Arginine to a female fertility client? What dose is suitable? (2 marks)

Answer 2

As a precursor to nitric oxide, it is required for angiogenesis, fertility and hormone secretion

Supports cell division and embryo development

1000–2000 mg x day

Question 3

Describe THREE natural dietary interventions you would include in a protocol to support psoriasis. Justify your reason for each

Answer 3

Fibre (and adequate water) to facilitate bowel elimination; to support gut commensals and SCFA production.
 Antioxidant-rich fruit and vegetables to reduce inflammation and support liver detoxification.
 EPA / DHA — inhibit inflammatory mechanisms, e.g., leukocyte chemotaxis, prostaglandin and leukotriene production from arachidonic acid and the production of inflammatory cytokines.
 Detox protocol (detox lecture). Consider a juice cleanse, fasting etc.
 Consider applying specific AI protocols (e.g., AIP).
 Digestive support — e.g., bitters, digestive enzymes.
 Probiotics and prebiotics to support commensals.
 Weight loss as needed — ↓ inflammatory mediators.
 Stress management (see stress lecture).
 Topical applications (also see eczema): Coconut oil — anti-fungal and replenishing.
 Neem — anti-inflammatory (COX and LOX inhibition) and inhibitory effect on microbial growth.
 Aloe vera — inhibits COX and hence PG2 production. Vulnerary (activates fibroblast collagen synthesis).

Question 4

Why would vitamin A be prescribed to support immunity in a client? What dose would be suitable?

Answer 4

Supports lymphatic tissues and immune cells, maintains lung barrier function

Dose: 2500–5000 iu / day

Question 5

Why would you tell your client to reduce salt intake to support urinary health?

Answer 5

high salt is linked with immune cell activation and renal tissue remodelling ↑ risk of kidney disease

Question 6

Your client has a BMI of 29, and several risk factors for metabolic disease. What are TWO mechanistic reasons why obesity would make you more susceptible to Alzheimer’s disease?

Answer 6

Obese individuals have increased peripheral inflammation and neuroinflammation.

Obesity over-activates the sympathetic nervous system, suppressing parasympathetic acetylcholine activity.

Obesity, therefore, stresses and inflames the entire body and brain.

Question 7

Why would you prescribe Vitamin D to a male with low testosterone?

Answer 7

Increases Leydig cell testosterone production (1 mark) and supports a healthy testosterone/oestradiol ratio

Question 8

Why might dietary fibre be a preventative intervention to support and mitigate cancer progression? Detail three specific reasons

Answer 8

↑ transit time and ↑ exposure to carcinogens

Reduce insulin levels

reduction in serum oestrogen concentration

Dilute bile acids believed to promote colon carcinogenesis

Question 9

List TWO foods to include and TWO foods to avoid when following an autoimmune protocol.

Answer 9

Include: * Vegetables (8 portions a day) esp. green leafy veg, a rainbow of colours, cruciferous, onions and garlic, sea vegetables. * Grass-fed organic meat. * Fish and shellfish. * Herbs and spices. * Healthy fats (e.g., oily fish, EVOO, avocado). * Probiotic / fermented foods e.g., sauerkraut. * Glycine-rich foods (e.g., bone broth).
- Exclude: * Alcohol, dairy, grains, legumes, refined sugar / oils. * Eggs (esp. the whites). * Nuts (incl. butters, flours, oils). * Seeds (incl. seed oils). * Nightshades. * Sweeteners (even stevia). * Emulsifiers, thickeners and food additives. * Potentially gluten-cross reactive foods.

Question 10

Why would Zinc be a suitable intervention for a client with Bronchitis? Give TWO mechanistic reasons.

Answer 10

Modulates antiviral and antibacterial immunity and regulates the inflammatory response.

Helps maintain mucous membrane integrity.

Maintains phagocytic and NK cell function.

Supports aspects of cellular and humoral immunity

Question 11

On reviewing your client’s food diary, you notice they are not meeting the required protein needs for the amount of physical activity and sport they are doing. What are TWO implications of inappropriate protein consumption for this client?

Answer 11

Reduce performance
Hinder training and recovery
Lower immunity
Catabolise muscle

Question 12

Why would Frankincense (Boswellia) be a suitable intervention for supporting someone with pain control? What dose would be appropriate?

Answer 12

Blocks the synthesis of 5-lipoxygenase, including leukotriene B4.

300 mg 3 times daily.

Question 13

Discuss the role of poor methylation in male and female fertility. What are the key methylating nutrients that you would be looking to use to support methylation?

In your answer refer to food sources, testing and any other specific recommendations related to the methylation nutrients

Answer 13

Poor methylation: = max 5 marks
 MTHFR ― an important folate-metabolising enzyme that is crucial for reproductive function.
 A common MTHFR polymorphism (C677T) results in reduced MTHFR activity leading to impaired folate metabolism and elevated homocysteine
 This = poor egg maturity and egg quality, ↑ oestrogen.
 Polymorphisms increase the risk of adverse pregnancy outcomes including neural tube defects, pre-eclampsia (high blood pressure and fluid retention) and gestational hypertension.
 C677T polymorphism is associated with ↓ fertility in men, possibly through DNA hypomethylation and changes in sperm maturation

Key methylating nutrients: Folate/B12/B6/B2/Methionine

Question 14

Describe some of the causes and risk factors of Interstitial Cystitis. What would be a suitable protocol for a client presenting with interstitial cystitis?

In your answer ensure you cover a range of naturopathic interventions and supplements, including dosages and a clear rationale for your recommendations.

Answer 14

Injury to the protective glycosaminoglycan layer of the bladder wall. Increases permeability, allowing potassium and chemical irritants in urine to damage underlying tissues.

Allergic — elevated IgE levels are observed in some cases of IC. Activation of mast cells ↑ histamine and cytokine release = pain.

*Neurogenic pain — excitation of sensory nerves triggers inflammation through release of neuropeptides. Triggers include mast cell activation, stress, autoimmune events (e.g., SLE, IBD).

Alterations to the urinary microbiome — ↓ Lactobacillus species, ↓ microbial diversity and ↑ pro-inflammatory cytokines observed.

*Follow guidelines for UTIs aiming to remove urinary irritants, reduce inflammation and promote microbial balance and diversity.
*Assess for food allergy / intolerance.

*Elimination diet or IgG / IgE antibody testing. Environmental allergy (mould, pollen, mites etc.) — IgE antibody testing.
*Follow the CNM Naturopathic Diet emphasising antioxidant-rich vegetables alongside anti-inflammatory foods and herbs e.g., oily fish (EPA); turmeric, fresh ginger.
*Include aloe vera juice (inner leaf gel) — inhibits COX and hence PG2; appears to increase production of glycosaminoglycans.

Quercetin (500x2): anti-allergic/anti-inflam ↓ NFkb

N-Aceytl glucosamine (1500-2000x3)/Chondroitin (200-400x3): ↑ glucosaminoglycan synthesis in bladder, ↑ mucous membrane integrity. ↓ Inflamm cytokines

Probiotics (lactobaccilus)
Corn silk (demulcent)
Gotu Kola (connective tissue integrity, heals bladder ulcerations)
Caster oil packs - pain relief.

Question 15

Discuss key components of the Swank and Wahls Diets, and their role in Multiple Sclerosis (MS) support. What other specific nutrients would you include in your protocol to support a client with MS (include the intervention dosage)?

Answer 15

The Swank diet
 The Swank diet was devised by Dr Roy Swank in 1949:
 Dr Roy Swank observed 70 years ago that his MS patients thrived on a low saturated fat diet —— under 15 g / day.
 We now know that many MS patients have difficulty metabolising saturated fat in mitochondria — and the poorly metabolised fat disrupts the myelin sheath.
 Fruit and vegetables.
 No red meat permissible in the first year; pork also excluded.
 White meat poultry and white fish — under 50 g / day.
 Dr Swank’s work has now been expanded by Professor George Jelinek, who also suffers from MS

Dr Terry Wahls
 Dr Terry Wahls is in MS remission after following a paleo diet: Green leafy vegetables.
 Sulphur-rich vegetables, such as cabbage, onions and asparagus.
 Colourful fruits and vegetables due to their phytonutrient content, such as beetroot, oranges, berries and carrots.
 Omega-3 fatty acids. Sources: Salmon, herring, and sardines.
 Grass-fed meats and organ meats.
 Seaweed.
 Dr Wahls’ diet is less strict on saturated fat intake. However grass-fed meats are lower in saturated fat than intensively farmed animals – MUST mention

Supplements which support MS patients (per day):
 Vitamin D (2000 iu).
 Vitamin K (90 mcg).
 Hesperidin (500 mg).
 Quercetin (500 mg).
 Sulforaphane (250 mg).
 Alpha lipoic acid (300 mg).
 Citicoline (250 mg).
 Omega-3 fatty acids (750 mg).
 Vitamin B12 (1000 mcg) and methyl folate (500 mcg).

Question 16

Why might a rheumatoid arthritis client have low levels of DHEA?

Answer 16

DHEA inhibits pro-inflammatory cytokine production due to inhibition of nuclear factor-kappa B (NF-kappa) activation

Question 17

Why would you give Coq10 to a female fertility client? What dose is suitable?

Answer 17

Important for oocyte development

Improves ovarian response to IVF / ICSI treatment

Question 18

Your client has been recently diagnosed with Atopic Dermatitis. What are THREE dietary interventions (not supplements) you would recommend as part of their protocol. Provide reasons for your interventions

Answer 18

Follow the CNM Naturopathic Diet, with a focus on the inclusion of anti-inflammatory foods.
Often associated energetically with excess heat in the blood — focus on cooling foods / beverages.
↑ daily sources of omega-3 fatty acids (e.g., ‘SMASH’ fish, flaxseeds, chia seeds, spirulina, etc.).

↑ quercetin-rich foods (see mechanism later), e.g., apples, kale, blueberries, spinach, red onions.

Although AD is not considered autoimmune, it does ↑ the risk of other AI diseases. An AIP may be beneficial (see immune lecture).

Pre and probiotics — support a healthy gut microbiome / correct dysbiosis, enhance SCFA production → anti-inflammatory (reduce inflammatory cytokine formation). Help maintain tight junctions. Researched strains include L. salivarius, L. rhamnosus, L. acidophilus and B. lactis.

5R protocol / intestinal barrier support as needed (see GI health lecture).

Immunomodulatory / anti-inflammatory — help correct Th1 / Th2 imbalance (see immune lecture). E.g., echinacea (dampens

Th2 — 4 g), turmeric (500–2000 mg), boswellia (250‒500 mg)

Question 19

Why might poor sleep and heavy metal toxicity be a potential cause of low immunity?

Answer 19

Poor sleep — ↓ immune memory, ↓ anti-viral cytokines (IL-12 / IFN-γ), ↑ inflammatory cytokines (e.g., IL-6), ↓ lymphocyte blastogenesis.

 Heavy metal toxicity can inhibit lymphocyte proliferation

Question 20

Detail TWO reasons why excess body fat might influence cancer progression?

Answer 20

promotes oxidative DNA damage.
facilitates alteration in carcinogens.
changes insulin metabolism.
negatively affects the immune system

Question 21

How might an essential fatty acid deficiency influence childhood anxiety?

Answer 21

EFAs — deficiency is linked to neuroinflammation, lower dopamine and reduced neuroplasticity.

It can also impact myelination sheath functioning.

Pre-teens and teenagers are especially vulnerable to EFA deficiencies due to hormonal changes and developmental growth requirements.

Question 22

Why would we optimise fasting glucose/insulin and Vitamin D status as part of the MEND protocol for a client with neurodegeneration/ Alzheimer’s Disease?

Answer 22

optimise fasting glucose/insulin - AD links to type 3 diabetes

Vitamin D – Reduce inflammation often low in AD and ageing

Question 23

Hepatitis B Virus and Helicobacter Pylori are implicated in which TWO cancers?

Answer 23

Hepatocellular carcinomas
Gastric cancer

Question 24

Why would Zinc be prescribed to support immunity in a client?

Answer 24

Inhibits viral replication, permeability of barriers, and ↑ specific anti-viral immune defences.

It boosts immunity in children and can reduce respiratory infection risk in the elderly.

Chelated form e.g., zinc citrate, gluconate 10–15 mg / day (or any suitable dose)

Question 25

When creating a protocol for a sports athlete which TWO individual factors that would influence your recommendations around how much/and what specific protein sources to recommend for them?

Answer 25

Individual requirements
Intensity of exercise
Duration of exercise
Phases of the training

Question 26

Why would White Willow be a suitable intervention for supporting someone with pain?

Answer 26

Salicin is converted in the liver to acetyl salicylic acid (ASA).

Question 27

How is elevated homocysteine associated with CVD? What is ONE potential cause of increased homocysteine in a client

Answer 27

Elevated homocysteine: associated with LDL oxidation
monocyte adhesion
ED dysfunction

Potential cause: Low folate and B12, Genetic polymorphisms

Question 28

Detail FOUR ways Sirtuins support healthy Ageing

Answer 28

insulin sensitivity
mitochondrial activity
cardiovascular health
fat metabolism,
DNA integrity
lower inflammation
Promote autophagy to aid cellular rejuvenation.

Question 29

Discuss the aetiology of Atherosclerosis in relation to endothelial dysfunction, inflammation and dyslipidaemia. In your answer refer to the key mechanisms and pathophysiology involved in each.

Answer 29

Aetiology – endothelial dysfunction (precedes atherosclerosis):
1. Disturbance to the protective glycocalyx layer and damage to ED cells. Factors include: inflammation, ↑ oxidative stress, oxidised LDLs, hyperglycaemia, endotoxemia, abnormal shear stress.
2. Leads to altered regulation of inflammatory cytokines, eicosanoids and compounds that promote clotting risk.
3. Upregulation of chemoattractant molecules promotes migration of phagocytic and inflammatory immune cells into blood vessels.
40. Disturbance of NO metabolism ↑ hypertension risk. ↑ shear stress worsening ED. Plaque development.

Inflammation:
1. plays a critical role in the genesis, progression, and manifestation of atherosclerotic disease.
2. ED dysfunction, subintimal cholesterol accumulation and monocyte/T cell recruitment drives the inflammatory response.
3. Monocytes become resident macrophages in the sub endothelial space and form ‘inflammasomes’ releasing inflammatory cytokines which activate IL-6 and stimulate CRP production enhancing the inflammatory cascade in the vessel walls.
4. Inflammation thins the fibrous plaque cap. Instability/rupture.
5. Pro-inflammatory cytokines differentiate VSMC into osteoblast-like cells increasing plaque calcification.

dyslipidaemia:
1. Lipids are a fundamental component of atherosclerotic plaques. Thus, dyslipidaemia is a significant risk factor and is marked by: - ↑ total cholesterol – ↑ LDL, VLDL, IDL, Lp(a), ↓ HDL; ↑ TGs.
2. TGs are hydrophobic and must combine with lipoproteins to travel in plasma. In a similar manner to oxidised LDLs, TG-rich lipoproteins (e.g. VLDLs and VLDL remnants) are prone to endothelial accumulation and uptake by foam cells and are strongly linked with endothelial dysfunction.
3. High TGs are also linked with low HDLs

Question 30

Discuss the different immunological challenges that might face a client struggling with suboptimal fertility. What environmental factors would you also be looking to address as part of a detailed case history. In your answer give specific examples of these

Answer 30

Immunological
1. Tissue type compatibility — if mother’s immune system responds negatively to paternal HLA proteins, this can affect implantation / pregnancy outcome.
2. Blood clotting defects — ↑ risk of early / late term loss, risk of maternal embolism / stroke, placental blood flow restriction.
3. High uterine NK cells — can trigger ↑ TNF-alpha, cytokines (early pregnancy loss). High BPA exposure linked to NK cell activity.
4. Autoimmunity — immune system rejects the embryo
5. Anti-sperm antibodies (ASAs) — sometimes, a woman’s immune system will produce ASAs which destroy sperm, leading to fertilisation difficulties or miscarriage. ASAs can also be found in the ejaculate.
6. Antiphospholipid syndrome — autoimmune disorder which causes increased risk of blood clotting and ↑ miscarriage and stillbirth risk.
7. Thyroid antibodies — Leading to autoimmune thyroiditis and ↑ miscarriage and pre-term labour risk.
8. Ovarian antibodies (antibodies to various cellular components of the ovary) — affects egg and embryo development, ↓ fertilisation and pregnancy rates, implantation failure

Environmental factors
1. Excessive radiation (mobile phones, x-rays and radiotherapy, frequent flying) — damages oocytes.
2. Environmental toxin exposure (e.g., mercury, lead, phthalates, solvents) — associated with infertility and miscarriage.
3. Chronic alcohol consumption — leads to diminished ovarian reserve and ovulatory dysfunction.
4. Caffeine — ↑ cortisol production, slows COMT (oestrogen dominance)
5. Xenoestrogens, pesticides and endocrine disruptors (e.g., plastics, cans, detergents, candles, flame retardants, cosmetics).

Question 31

Your client has been recently diagnosed with psoriasis and wants to take a holistic approach to support the underlying drivers of this condition. Describe what natural dietary inclusions you would include in your protocol to support this condition, describing the rationale behind them. What are some specific nutrients you would recommend? Ensure your answer has details of the nutrient, dose and reason as part of your answer.

Answer 31

1. Fibre (and adequate water) to facilitate bowel elimination; to support gut commensals and SCFA production.
2. Antioxidant-rich fruit and vegetables to reduce inflammation and support liver detoxification.
3. EPA / DHA — inhibit inflammatory mechanisms, e.g., leukocyte chemotaxis, prostaglandin and leukotriene production from arachidonic acid and the production of inflammatory cytokines.
4. Detox protocol (detox lecture). Consider a juice cleanse, fasting etc.
5. Consider applying specific AI protocols (e.g., AIP).
6. Digestive support — e.g., bitters, digestive enzymes.
7. Probiotics and prebiotics to support commensals.
8. Weight loss as needed — ↓ inflammatory mediators.
9. Stress management (see stress lecture).
10. Topical applications (also see eczema): Coconut oil — anti-fungal and replenishing.
     Neem — anti-inflammatory (COX and LOX inhibition) and inhibitory effect on microbial growth.
     Aloe vera — inhibits COX and hence PG2 production. Vulnerary (activates fibroblast collagen synthesis).

Nutrients:
Vit A (retinol) (5000): For epithelial cell differentiation, collagen synthesis and
intercellular adhesion.

Vitamin D: ↓ TNFa, IL 1/6/8, anti-inflam, immunomodulatory effects. ↓ keratinocyte
prolif + cell differentiation.

Vitamin E (400-800): ↓ proinfl cytokines

Se (100-200): often low in psoriasis patients (malnutrition/alcohol/excessive skin loss?)

Omega-3 (6g): AA high. Leukotriene B4 - principal mediator of inflamm in psoriasis. When COX/LOX metabolise EPA which has replaced AA in cell membranes, it can attenuate inflammation.

Zinc (15-30): A coenzyme for DNA and RNA polymerases. plays a key
role in excessive keratinocyte proliferation in psoriasis.

Question 32

Explain how impaired barrier defences can lead to low immunity

Answer 32

Poor skin quality (e.g., topical steroids
Irritants, nutrient deficiencies such as zinc and EFAs)
damaged lungs (e.g., smoking, pollutants) / gut permeability / tonsillectomy / adenoidectomy / appendectomy.

Question 33

Explain why diabetes mellitus can impact male fertility.

Answer 33

Neuropathy, neurogenic impotence and retrograde ejaculation

Question 34

Describe THREE natural dietary interventions you would include in a protocol to support psoriasis. Justify your reason for each

Answer 34

Fibre (and adequate water) to facilitate bowel elimination; to support gut commensals and SCFA production.
Antioxidant-rich fruit and vegetables to reduce inflammation and support liver detoxification.
EPA / DHA — inhibit inflammatory mechanisms, e.g., leukocyte chemotaxis, prostaglandin and leukotriene production from arachidonic acid and the production of inflammatory cytokines.
Detox protocol (detox lecture). Consider a juice cleanse, fasting etc.
Consider applying specific AI protocols (e.g., AIP).
Digestive support — e.g., bitters, digestive enzymes.
Probiotics and prebiotics to support commensals.
Weight loss as needed — ↓ inflammatory mediators.

Question 35

List and explain FOUR key functions of the endothelium

Answer 35

Semi-permeable barrier: role in fluid balance, host defence and selective movement of substances e.g. glucose and oxygen.
- Regulates vascular tone: secretes vasodilators (e.g., NO) and vasoconstrictors (e.g., endothelin).
- Enzymes: contains angiotensin converting enzyme (ACE) – plays a key role in regulating blood pressure.
- Angiogenesis: ED cells are the origin of all new blood vessels.
- Haemostasis: The luminal surface of ED prevents platelet adherence and coagulation (non-thrombotic, anticoagulant).
- Immune defence: Healthy ED cells deflect leukocyte adhesion and oppose local inflammation

Question 36

Explain the proposed mechanism as to how D-mannose supports urinary tract infections (UTI’s). What is the recommended adult dose?

Answer 36

It binds type 1 fimbriae of uropathogenic E.coli, forming a physical “coating” that prevents their binding to the urothelium

500mg every 2 hours for 3 - 5 days.

Question 37

Explain the role of osteoclasts and osteoblasts in the role of bone remodelling.

Answer 37

Osteoclasts stimulate the production of enzymes that dissolve minerals and protein in bone

Osteoblasts create a protein matrix primarily of collagen, resulting in remineralisation of the bone.

Question 38

List TWO allopathic treatments for angina

Answer 38

Nitrates (e.g. GTN), calcium channel blockers (e.g. amlodipine), beta-blockers (e.g. atenolol), revascularisation (angioplasty, stents and coronary artery bypass graft surgery).

Question 39

List FOUR symptoms of Parkinson’s disease

Answer 39

Characteristic tremor — often called ‘pill rolling’, which looks as if a patient is rolling a pill between their index finger and thumb. * Muscle rigidity or dystonia — stiff or weak muscles and difficulty maintaining posture. * Shuffling gait (dragging feet). * Constipation and loss of sense of smell — may occur many years before Parkinson’s disease diagnosis. * Bradykinesia or slowness of movement. Affects handwriting (micrographia), facial expression and speech.

Question 40

Name FOUR cellular characteristics associated with cancer

Answer 40

Mitochondrial failure/damage. * Increased DNA damage. * Increased activity of chemokines. * Increased activity of cytokines. * Increased hormonally driven activity. * Alteration in cell cycle activity. * Activation of otherwise ‘silent’ oncogenes. * Genomic instability.

Question 41

List FOUR anti-ageing nutrients

Answer 41

B vitamins. * Omega-3 fatty acids. * Magnesium. * Vitamin D. * Vitamin K. * CoQ10. * Shiitake and reishi mushrooms. * Extra virgin olive oil. * Beetroot. * Wheatgrass and barley grass. Resveratrol. * Alpha-lipoic acid. * Green tea. * Berries. * Pomegranate. * Cruciferous vegetables. * Garlic and onions. * Turmeric and ginger. * Nuts and seeds.

Question 42

How much carbohydrate would you recommend post exercise

Answer 42

1g CHO per kg bodyweight (1 mark) up to 2 hours post exercise then every 2 hours

Question 43

What FIVE causes and risk factors are for the formation of urinary calculi and suggest a natural approach to support?

Answer 43

Causes and risk factors:
Dehydration — urine becomes too concentrated allowing minerals and other compounds to precipitate out of solution, forming crystals.

Altered urinary pH — too acidic = calcium oxalate and uric acid stones; too alkaline = struvite and calcium phosphate stones.

Dietary acid load (animal protein, dairy, soft drinks i.e., phosphoric acid) is the greatest predictor of calcium oxalate and uric acid stones: ‒ ↑ secretion of calcium (oversaturates urine) ‒ ↓ secretion of citrate (needed to solubilise calcium oxalate in urine) ‒ ↑ excretion of uric acid (oversaturates urine).

High table salt intake — increases urinary calcium.

Calcium stones are linked to:
↓ fibre,
↑ refined carbohydrates and alcohol.
↑ Calcium supplementation and possibly a low vitamin K2 status (not storing calcium in bones)
Possible dysbiosis.
High oxalate-rich foods
Low citrate increases urinary calcium.
Excess sodium, low potassium, excessive exercise and acid-forming foods.

High protein intake, especially animal protein, increases uric acid (a by-product of protein metabolism).

Purine-rich foods e.g., organ meats, sardines, chicken (↑ uric acid).

Natural approach:
↑ fluid intake (distilled, filtered water) at least 8 glasses daily.
Alkalise with a plant-based diet high in chlorophyll. Regular green juices / smoothies.
↓ animal proteins and high purine foods.
↓ salt (i.e., table salt)
Avoid alcohol (↑ uric acid).
↑ potassium-rich foods (fruit and vegetables) to reduce urinary calcium. Fruit is also often rich in citrate.
Avoid oxalate-rich foods such as spinach, rhubarb, strawberries, beetroot, almonds and cashews.
Magnesium (600 mg / day) as citrate — ↑ the solubility of calcium oxalate and ↓ risk of calcium phosphate and calcium oxalate precipitating out of solution.
Pyridoxine (25 mg / day) — reduces endogenous production and urinary excretion of oxalates.
Folate (5 mg / day) — for uric acid stones. ↑ purine scavenging and xanthine oxidase inhibition, resulting in ↓ uric acid production.
Blackcurrant juice is alkalising and can be used for uric acid stones.
Struvite (10–15%) and pure calcium phosphate stones (~5%): use cranberries and betaine-rich foods e.g., beetroot to lower urinary pH.
Stinging nettle leaf (Urtica dioica) has diuretic properties and is alkalising. Use as a tea: 1 tsp per cup, 3 cups per day. *

Combine with demulcent herbs to lubricate the urinary tract (e.g., marshmallow root) * Lemon juice 1 teaspoon every ½ hour for two days can help to soften stones. The citric acid component binds to calcium to promote excretion.

Castor oil packs can be applied to front, sides and back to reduce inflammation and decrease spasm.

Question 44

Explain how a myocardial infarction (MI) is characterised, including the signs and symptoms.

Explain how L-carnitine, hawthorn and magnesium can support someone with ischaemic heart disease syndrome such as MI. Include an appropriate dose with your answer.

Answer 44

MI = * an acute blockage of a coronary artery usually due to a thrombus, resulting in the death of myocardial tissue.

Prolonged ischaemia leads to myocardial necrosis.

Ischaemic myocardial cells release adenosine and lactate onto nerve endings causing pain.
Infarcted areas produce scar tissue. The remaining tissue hypertrophies and can result in cardiac dysfunction and heart failure.

Divided into: – ST-Segment Elevation MI (STEMI) = full occlusion (severe). – Non-ST-Elevation MI (NSTEMI) = partial occlusion.

Signs and symptoms:
Severe prolonged crushing retrosternal chest pain. Pain radiates to the left shoulder, jaw / neck or arms. Sweating, cool / clammy skin. Feeling of ‘impending doom’. Dyspnoea and syncope. Nausea, vomiting, weakness.

L-carnitine * 1000 mg x 2 daily * Improves FA utilisation and myocardial ATP production, which may also prevent the production of toxic FA metabolites. * These would normally impact cardiac cell membranes = impaired myocardial contractility.

Magnesium * 200 to 400 mg x 3 daily * Magnesium deficiency has been shown to produce coronary artery spasms. * Magnesium controls the movement of calcium into smooth muscle cells, leading to smooth muscle contraction. * Deficiency also ↑ ROS.

Hawthorn (Crataegus spp.) * 1,000–1,500 mg * Its flavonoids have been shown to inhibit the enzyme 3’,5’-cyclic-AMP, * which is thought to be responsible for dilating the coronary arteries.

Question 45

What is the pathophysiology of Multiple Sclerosis including the proposed risk factors. Discuss in detail TWO nutrients that have shown to be deficient in those who have MS.

Answer 45

MS is an autoimmune disease:
The myelin sheath is a fat and protein compound which wraps around a nerve to support nerve impulses. * The myelin sheath is produced by cells called oligodendrocytes. * In MS, autoreactive and inflammatory immune cells infiltrate the blood-brain barrier and attack the myelin sheath. * If sustained, this attack can lead to the loss of oligodendrocytes and neurodegeneration.

MS considered to be a T-cell mediated disease: * Shift in T-cell subpopulations away from anti-inflammatory Tregulatory cells (T-regs), towards autoreactive Th17 T cells.

Proposed risk factors for MS include: – Vitamin D deficiency, raised BMI. – Infections such as Epstein-Barr virus. – Childhood trauma / stress. – Homocysteine, mitochondrial dysfunction. – Cigarette smoke exposure. – Certain autoimmune diseases. – Environmental toxins, e.g. dioxins, air pollution.

Vitamin D deficiency associated with MS: * MS is more prevalent in countries further away from the equator. * Vitamin D helps shift adaptive immune system expression away from autoreactive T-cells and toward anti-inflammatory T-regs. * Doubling vitamin D level decreases MS relapse risk by 27%. * MS patients with low vitamin D were found to have more brain lesions and increased numbers of relapses. * Sufficient vitamin D during pregnancy and at birth protects child from MS in later years. * Serum vitamin D levels of 75–100 nmol / L have been proposed to protect against MS development and / or MS relapse.

Vitamin K deficiency found in MS patients: * Key aim of MS therapy is to promote the regeneration of oligodendrocytes and remyelination in the central nervous system. * Gas 6 (growth arrest specific 6) is a vitamin K-dependent anti-inflammatory protein which protects oligodendrocytes and promotes remyelination. * MS patients are frequently vitamin K deficient, with blood levels around one-third of those expected. * Deficiency thought to be due to poor microbial synthesis in the gut, low absorption or low dietary intake.

Vitamin B12 also found to be deficient in MS patients: * Studies show B12 supplementation improves neuron growth and survival and regenerates the myelin sheath. * B12 deficiency leads to many health symptoms that are shared with MS thereby making it difficult to differentiate between them. * The phospholipids contained within the myelin sheath are methylated, and so require B12 to support methylation. * Many MS patients present with high homocysteine and low B12.