Test 1 Flashcards
Where does SJW grow naturally?
USA and Europe
What is the scientific name of St. John’s Wort?
Hypericum perforatum
What part or SJW plant is used?
Aerial portion - harvested during the flowering season
What are the two important active constituents of SJW?
Hypericin
Hyperporfin
Describe the bioavailability and metabolism of SJW
Both are poorly understood
What are 5 physiological effects of SJW?
- Inhibits monoamine oxidase
- Inhibition of neurotransmitter reuptake
- Modify receptors and modulate the hypothalamic-pituitary-adrenal axis
- Induces cytochrome P-450 activity
- Effects metabolism of several drugs
What has clinical research shown SJW to be effective for?
Mild to moderate depression by reducing sadness, hopelessness, worthlessness, exhaustion and poor sleep
(Ancient Greece - neuralgia, anxiety, neurosis, depression)
The Detoxification/Restorative Program assumes that exposure to xenobiotics may occur from
which parts of the external environment?
Fat stored drugs and chemical residue coming from medical and pharmaceutical drugs as well as industrial, commercial and agricultural chemicals.
How are exercise and heat used in detoxification strategies?
The program is designed to increase mobilization of toxic substances, sauna to make them sweat and prevent their re-absorption and recirculation.
Name the five organs of detoxification.
Intestine, liver, kidney, skin, lungs.
What are the sources of endotoxin production in the human body?
Free radicals and their metabolites from ionizing radiation, low polyunsaturated fat, and inadequate antioxidant nutrients and cofactors.
What is the relationship between intestinal dysbiosis and systemic diseases?
Bad type of bacteria in the gut will create a bad environment including toxins. Our cells need perfect nutrition for optimal health. Abnormal flora de-activates some digestive enzymes. The GI tract is the largest immune organs in the body
What is the relationship between food allergy and intestinal hyperpermeability?
Allergies can be an irritant that leads to hyperpermeability.
What happens in Phase 1 of Liver detoxification?
Cytochrome P-450 mixed function oxidase enzyme pathway. Enzymes in cells of liver membrane and are synthesized when exposed to certain chemicals and converts toxins into less harmful chemicals and produce free radicals. The free radicals can be converted into potentially carcinogenic items.
What happens in Phase 2 of liver detoxification?
Conjugation pathway. The liver adds another substance to a toxic chemical. This makes the toxin water soluble, and can then be excreted in bile or urine. This conjugation is done with sulphur-containing amino acids
Name the four methods for restoring detoxification function of the intestine.
Improve digestion, improve elimination, treat hyperpermeability, improve intestinal microecology (dysbiosis).
Describe the detoxification methods used in the Hubbard program
Daily doses of Niacin to stimulate lipid mobilization, moderate aerobic exercise, intermittent sauna to force sweating, ingestion of cold-pressed oils to help prevent re-absorption, Vitamin and mineral supplements.
. As reported in the scientific literature, what types of health problems and toxic exposures has
the Hubbard program been successfully used to treat?
Reducing levels of foreign compounds stored in fat, and significantly improve neurological function.
How could a patient have an allergy that is provoking symptoms without knowing they have an allergy?
Symptoms of food allergy or intolerance may not be triggered immediately after reintroduction of the foods; therefore, a person can get an erroneous impression their allergy or intolerance is cured. With repeated ingestion of the food, however, symptoms may gradually return
What are the pros and cons of laboratory testing for food allergies?
Costly and often unreliable, because there are several possible mechanisms for allergic responses, and lab tests must usually be specific for one mechanism, such as either IgE or IgG. Furthermore, some known mechanisms are not testable at this time, such as T-cell mediated sensitivities.
What foods are almost always eliminated in a food allergy elimination diet?
Wheat, corn, citrus, soy, other legumes, nuts, milk, eggs, beef, pork, shellfish, coffee, tea, chocolate, yeast
Describe how you would explain the method of the allergy elimination and challenge program to a patient
Food allergies and intolerance are best treated by avoidance of the offending food for a prescribed period of time, followed by a “rotation” diet, in which problem foods are only eaten every three to four days, instead of daily
What health problems or risks may be helped by the prostaglandin-modification program?
Chronic inflammation, conditions relating to platelet function, smooth muscle irritability, cardiovascular disease, reducing Triglycerides.
What food sources of arachidonic acid should be limited in the prostaglandin-modification program?
Animal flesh, dairy fats, egg yolk.
What foods can be eaten frequently to improve the balance between “friendly” and “unfriendly” prostaglandins?
Cofactors for optimal prostaglandin metabolism like vitamin B6, magnesium, zinc. Provide precursors or friendly prostaglandins.
What are the sources for gamma-linolenic acid supplementation?
2-6 capsules of borage oil, 6-18 capsules of primrose oil
What are the sources like For omega-3 fatty acid supplementation?
2-4 oz, fish has 1000mg, need 5-10 high-potency fish oul capsules per day.
What precautions should be taken when using Omega 3’s?
Omega-3 can lead to increased bleeding time and should be avoided by people that bleed easy. During pregnancy strictly avoid fish oil that has high levels of retinol (vitamin A). Avoid supplements that contain mercury.
What are three mechanisms behind the concept of an anti-inflammatory diet?
Eicosanoid modification, allergy elimination, natural substances (often found in plants) can lower indicators of systemic inflammation
What foods would typically appear in the anti-inflammatory diet (AI)?
- fruits, vegetables, good sources of Omega-3 FA, whole grains, brown rice, lean protein like chicken, ginger, curry, and other spices.
What foods should be limited or removed in the AI diet?
saturated or trans fats, refined carbs, white rice, red meat, dairy, refined or processed foods.
What are the 5 steps in the dyslipidemia care pathway? (very long answer, sorry)
1- Determine serum lipids, preferably full lipoprotein analysis after 12 hour fast.
2- Evaluate history of the primary risk factors. Men over 45 women over 55 (or postmenopausal), Family history of premature CHD (MI or sudden death) before 55 years in first degree relative male or 65 in first degree female, cigarette smoking, hypertension 140/90 and above or taking antihypertensive meds, HDL below 40, High HDL above 60 will take one risk factor away.
3- Determine the 10-year risk assessment for patients with 2 or more primary risk factors.
4- Determine required interventions for LDL cholesterol from the table.
5- Determine whether additional interventions are required for the metabolic (insulin-resistance) syndrome when any three of the following are present: abdominal obesity, TG levels 150 or above, Blood pressure is 130/85, fasting glucose 100 or above.
What clinical measurements are needed to assess whether the metabolic syndrome is present?
abdominal obesity, TG levels 150 or above, Blood pressure is 130/85, fasting glucose 100 or above.
. Which three dietary fats are limited in the Therapeutic Lifestyle Changes?
Saturated, trans, cholesterol
What additional dietary interventions beyond the Therapeutic Lifestyle Changes can also
specifically affect LDL levels?
Increase fiber from fruit, vegetables, whole grains, oat bran, flaxseed, glucomannan.
How may alcohol intake either improve or worsen certain serum lipid levels?
1-2 drinks a day for men or 1 for women can increase HDL levels.
Which supplements can have the most dramatic effects on LDL levels?
Red yeast rice, niacin, phytosterols, pantethine.
Which supplements can have the most dramatic effects on HDL levels?
Niacin, policosanol, chromium, gugulipid, pantetine, phytosterols.
Which supplements can have the most dramatic effects on triglyceride levels?
Fish oil, niacin, pantethine, inostitol hexaniacinate.
When might it be advisable to refer the patient to a dietitian or a personal trainer?
those marked for elevated LDL if elevations are severe or unresponsive to conservative interventions within 3-6 months. Choose those marked for elevated triglycerides if unresponsive to conservative interventions within 3-6 months
Explain why some supplements are reserved for aggressive intervention only
Can cause problems with liver and are basically the same as statins (red yeast rice).
How does excessive alcohol affect hypertension and the various types of dyslipidemia?
It can add 2-3 systolic points if more than 1-2 drinks a day.
What nutrients do the DASH diet supply that might contribute to its blood-pressure lowering
effect?
Vegetables, fruits and low fat dairy products. Also has very low Levels of sodium.
Which dietary supplements show the most promise for effectively lowering blood pressure?
Coenzyme Q and Garlic
What common foods are high in salt?
• Fast foods, pizza • Ethnic foods (Asian, Mexican, etc) • Salty snack foods (chips, crackers, pretzels, nuts, etc) • Smoked, cured, preserved, pickled foods (sausage, ham, lunchmeats, hot dogs, olives, pickles, etc.) • Tomato products • Cheese products • Canned soups • Canned vegetables
What precautions must be followed when recommending increased potassium intake?
Need to make sure the kidneys can eliminate the potassium. Can be contraindicated with kidney disease, some elderly patients, diabetic patients, and patients taking potassium-sparing diuretics.
Which supplements should be used for those with insulin resistance?
chromium, coenzymeQ, and magnesium.
What levels should you lower in order to reduce risk of stroke? and how would you do this?
Homocysteine reduction can lower the risk of strokes. Lower homocysteine levels by B12, B6, Whole grains, legumes, fruits, vegetables.
how can you reduce oxidized LDL levels?
stop smoking, increase monosaturated fats, vitamin E and C, Plant polyphenols.
. Which diets or supplements have been shown to prevent, slow, or reverse atherosclerosis in
humans?
Omega-3 polyunsaturated fatty acids, vitamin E, alcohol.
What foods have been combined into the cardiovascular risk reduction diets known as the Dietary Portfolio and the Polymeal?
Diets low in saturated fats, and use soy protein, nuts.
. Name the two or three best interventions for modifying insulin resistance
weight loss, low glycemic diet, chromium, magnesium, Co Q10
. Name the two or three best interventions for modifying coagulation dysfunction
asprin, Vitamin E, Alcohol, garlic
. Name the two or three best interventions for modifying vascular inflammation
Quit smoking, antioxidants, plant based diet, prostaglandin-modification.
. Name the two or three best interventions for modifying elevated homocysteine
folic acid, B12, B6, Plant based diet.
. Name the two or three best interventions for modifying oxidized LDL
quit smoking, meditranean diet, Vit E C, polyphenols.
. Name the two or three best interventions for modifying endothelial dysfunction/vascular compliance
Quit smoking, antioxidants, healthy diet, aerobics, polyphenols, fix everything else listed above.
List the supplements that are most useful for cardiovascular risk reduction because of their ability to modify more than one risk factor.
Fish olis, garlic, Multivitamin, chromium, co Q 10 (hypertension), Vitmain C, Vit E.
Which supplements help stabilize cardiac rhythm?
Fish oil 1-3 grams/day.
Garlic:
Scientific name
allium sativum
Garlic:
Parts used
bulb, containing individual cloves
Garlic:
Active constituents:
Allicin and related sulfur compounds.
Garlic:
Bioavailability:
Aged garlic might not have the same clinical benefits.
Garlic:
Metabolism:
alliin must be activated by mixing with other garlic enzyme (allinase) to release allicin. Allicin decomposes to other sulfur compounds.
Garlic:
Physiological effects
antimicrobial, hypocholesterolemic, antithrobotic/fibrinolytic, antioxidant, Tumor inhibiting, anti-carcinogenic.
Garlic
Uses
Historically used as a spice, used in Chinese medicine, and in Greek and Rome medicine.
Garlic
Hyperlipidemia-
standardized fresh garlic powder. Reduces total serum cholesterol by 9-12%. Average LDL reduction of 16%. TG reduction of 8.5%. Aged garlic extract not as good.
Garlic:
Hypertension
reduced BP by 8-16 mmHg systolic and 7-9mmHg diastolic.
garlic
Atherosclerotic disease
- 900 mg/day of standard garlic powder reduced artery plaque formation by 5-14% in adults 50-80.
Garlic
Common cold prevention
one capsule a day of allicin-containing garlic supplements reduced new colds by 63% and total illness days by 70%. However, garlic has not demonstrated any usefulness for treating infections in human studies.
garlic
dosage
need 1.3% alliin content yielding 0.6% allicin potential. Use 600-900mg per day (3.6-5.4 mg allicin potential. Enteric coating may improve results and compliance. Garlic oil not as effective as powder. 1 clove of fresh garlic has therapeutic effects if not cooked. Aged garlic extract not as effective. Only half of the products tested by comsumerlab met allicin yield claims.
Garlic
Contraindications
pre-surgical status, known allergy to garlic.
Garlic
Side effects
no significant adverse effects, can have hemorrhagic episodes, breath or body odor (eliminated with enteric coating), heartburn or flatulence.
Garlic
Interaction with other botanicals and drugs
anticoagulants- can increase bleeding time. Altered drug metabolism- decreased levels of HIV drugs.
Garlic
During pregnancy or lactation
no adverse effects in pregnancy (but levels found in amniotic fluid), not recommended during lactation may cause colic.
Acute Inflammation with proteolytic enzymes
General uses
They can control pain, inflammation and improve healing time.
Acute Inflammation with proteolytic enzymes
Types?
There are 2 types: extract from bovine pancreas(trypsin and chymotrypsin) and pineapple stem (bromelain).
Acute Inflammation with proteolytic enzymes:
How often to take?
3-4 tablets 3 times per day on an empty stomach, and should try a therapeutic trial of 5-14 days.
Acute Inflammation with proteolytic enzymes
2 mechanisms of function
- Reduce inflammation by causing a breakdown of inflammatory proteins that cause vascular permeability and pain. 2. Improve circulation and reduce edema by breaking down cell debris and fibrin, facilitating their uptake by the lymphatic system.
Acute Inflammation with proteolytic enzymes
Efficacy
- less than 40% uptake that is why so much is needed. Research looks good for proteolytic enzymes and acute inflammation.
Acute Inflammation with proteolytic enzymes
Contraindications
clotting disorders or anticoagulation therapy, pre-surgical status, systemic infection.
Traumatic inflammation with Flavonoids
Where do they come from?
- Flavonoids come from: citrus, curcumin, bilberry or oligomeric proanthocyanidins, grape seed extract.
Traumatic inflammation with Flavonoids
Dose
900-1800mg/day. Bilberry-115mg/day to get the amount of anthocyanosides needed.
Traumatic inflammation with Flavonoids
rationale
- significantly restrict vascular permeability to limit swelling and may also inhibit inflammatory prostaglandins. THEY ARE ONLY USEFULL BEFORE THE PEAK OF THE INFLAMMATORY PHASE.
Traumatic inflammation with Flavonoids
efficacy
Football players that took 1800mg/day for 1 week and then 600mg/day for season had reduced healing times of injury by 2/3 of the placebo group and the group where Vit C and flavonoids where used showed no additional benefit. Benefits included recovery time by ½, reduced incidence of muscle cramps, and minimal swelling. Also showed reduced complications with surgeries.
Traumatic inflammation with Flavonoids
contraindications
none.
Combining enzymes and flavonoids
Dose
10 or more tablets per day divided between meals.
Combining enzymes and flavonoids
Efficacy
Wobenzym, Phogenzym have shown to be effective combinations and should have enteric coating.
When does a spasm occur?
protective or secondary to direct trauma.
describe a cramp
acute stretching of chronically short muscles, water/electrolyte disturbances in athletes, vascular disturbances in elderly.
What supplements should be taken with spasms?
calcium, magnesium, valerian, kava.
Which supplements should be taken for cramps/
If low calcium or magnesium is present then offer supplements. If peripheral vascular disease is suspected recommend Vitamin E and ginkgo biloba extract. Nocturnal leg cramps respond well to magnesium. Mineral imbalances or deficiencies are considered unlikely contributors to muscle cramps however, potassium, magnesium and calcium may prevent impaired local circulation and increased irritability of muscle tissue in some cases.
When do DOMS occur?
response to unaccustomed exercise.
What supplement/dose should be taken for DOMS?
Vitamin C 400-3,000 mg/day.
What is the rationale for taking Vitamin C for DOMS?
- oxidative stress mechanisms have been considered as a contributing factor in DOMS and Vitamin C taken in Gram amounts taken before exercise has the best evidence for reducing symptoms
What other supplements have been shown to help with DOMS?
Other evidence shows that Vitamin E, L-carnitine or consumption of tart cherry juice may also be effective
What is the efficacy of Vitamin C for DOMS?
Need to take 400-3,000 mg/d Vitamin C taken several days (around 30) before strenuous activity has been shown to reduce DOMS and related strength loss.
Rehabilitation phase (long term healing) supplements: In general, which supplements should be taken?
- take a broad-spectrum vitamin-mineral supplement and consuming a diet with adequate to generous portions of protein. Also could use oral cartilage extracts (CS, GS).
What is the recommended dose of Rehab phase supplements?
Recommended guidelines for dietary allowance for vitamins and minerals should be enough besides higher doses of Vitamin C (up to 1000mg/d), and zinc (up to 50mg/day), typical western diet is sufficient in proteins, CS (1200 mg/d), GS (1500mg/d).
What is the rationale for supplements taken during Rehab phase?
Regenerating disrupted tissues requires the availability of appropriate protein and non-protein precursors. Animal studies have shown accelerated healing with supplements of Vitamin A, Vitamin E, Vitamin C, Vitamin B, zinc and GAGs (which comprise the matrix of most CT).
What is the efficacy for supplements taken during rehab phase?
For disc disorders: manganese, calcium, potassium, magnesium, iron, zinc, mussel concentrate. MULTIVITAMIN.
What must be controlled in the early phase of fracture healing?
Need to control inflammation and then can benefit from nutrients specific for both CT and Bone tissue proliferation.
What supplements/dose should be taken with fracture healing?
- a broad-spectrum vitamin mineral supplement with increased protein. Additional calcium, vitamin D, phosphorus, and magnesium. 6 grams of microcrystalline hydroxyapatite for delayed union.
What is the rationale for supplements during fracture healing?
Animal studies showed that fracture healing time was accelerated by vitamin D and zinc supplemetns
Valerian
Scientific name
Valeriana officinalis
Valerian
part used
Root
Valerian
active parts
Volatile oils, VALERENIC ACID, flavonoids
Valerian
physiological effects
Sedative-hypnotic, anti-depressant, anti-convulsant and antispasmodic. Binds to GABA-A receptors and changes EEG wave patterns, and counteracts the effects of caffeine.
Valerian
uses
Used historically for over 2,000 years. Sleep
Valerian
Dose
at least 500 mg/day and need at least 0.8% valerenic acid. Consumer lab found that only 3 out of 10 products have valerenci acid content high enough
Valerian
contraindications
should not be combined with sedative or barbiturate therapy, or general surgical anesthesia without medical consent and supervision
Valerian
Side effects
- mood and psychomotor effects: none. High oral doses in pregnant rats did not affect the rats or their babies
Kava
Scientific name
Piper methysticum
Kava
part used
Rhizome= a continuously growing horizontal underground stem that puts out lateral shoots and adventitious roots at intervals.
Kava
Active constituents
kava-lactones.
Kava
Bioavailability and metabolism
Unknown
Kava
Physiological effects
Analgesic, muscle relaxing, anti-convulsant, anti-depressant, Smooth muscle relaxation. Binds to GABA receptors.
Kava
Uses
Ritual beverage for ceremonial purposes in south pacific. Kava was superior to placebo for anxiety in a meta-analysis. Kava also reduced the mental stress
Kava
Dosage
- 50-100 mg (35-70 mg kava lactones) TID for anxiety, 120-200mg/day for stress related insomnia. Consumer lab found that most Kava supplements had the claimed amount.
Kava
Contraindications
- Current use of sedative, antidepressant or anti-psychotic therapy. Elective surgery with general anesthesia.
Kava
Side effects
- Intoxication symptoms similar to alcohol with excessive consumption. 68 out of thousands experienced hepatotoxicity, but this might have been coincidence or they may have used other parts of the plant besides the Rhizome. GI distress, may cause yellow pigmentation of skin.
Kava
Interactions
alcohol will enhance the cognitive impairment (which KAVA doesn’t have alone). May cause excessive sedation if taken with Benzodiazepines. Not recommended during pregnancy
Which low macronutrients are included in the longevity program?
total fat, saturated fat, Minimal to no hydrogenated fat, low cholesterol, Omega- 6, High glycemic load carbohydrates (try to eat low glycemic load carbs), salt, alcohol.
Which high dietary nutrients are included in the longevity program?
dietary fiber, omega-3, micronutrient and phytonutrient density, monounsaturated fats.
What supplements are included in longevity program?
broad-spectrum multi-vitamin, antioxidants, Vitamin D, Fish oil.
What are some non-dietary parts of longevity program?
mental health management, environmental health management.
Allergy Elimination program
Lab tests: benefits vs drawbacks?
costly and often unreliable.
Types of allergy elimination diet?
Water fast, hypoallergenic formula, hypoallergenic diet (lamb, rice), Remove suspect foods only.
Allergy elimination
Describe Challenge after elimination 1-3 weeks after elimination:
Reintroduce foods one at a time every 24-48 hours, monitor for reappearance of symptoms, non-provoking foods may be incorporated into diet.
Allergy elimination
Long term management
rechallenge provoking foods after 3-6 months to see if tolerated. Rotation diet should be used allowing use of a food only once every 2-7 days. Protein maldigestion, increased intestinal permeability may increase chance for food allergies. Don’t forget to consider non dietary items as causes.
Prostaglandin-modification program
Plan and goals
enhance friendly prostaglandins and inhibit unfriendly prostaglandins to help with chronic inflammatory conditions and conditions relating to platelet function, smooth muscle irritability.
Prostaglandin-modification program
What should be removed from diet?
unfriendly arachidonic acid found in animal flesh, dairy fats, egg yolks. Also remove dietary inhibitors of normal prostaglandin metabolism like trans fats, alcohol.
Prostaglandin-modification program
What should be added to diet?
Cofactors for optimal prostaglandin metabolism like vitamin B6, magnesium, zinc. Provide precursors or friendly prostaglandins like
Vascular disease
Risks: dyslipidemia
high LDL, High TG, Low HDL
Vascular disease
What are the mechanisms of vascular disease?
- Inflammatory disease of vessel walls. Numerous factors initiate endothelial damage, and this increases expression of LDL receptors and increased adherence of monocytes and macrophages and T cells. This leads to progression of atherosclerosis that can lead to the development of plaque that can rupture and cause acute coronary syndrome.
how to treat dyslipidemias
Start with emphasizing LDL reduction for 12 weeks then focus on non LDL goals
What is step 1 of conservative interventions for dyslipidemia?
Further clinical evaluations to rule out familial dyslipidemia, DM, Hypothyroidism, nephrotic syndrome, chronic renal failure, obstructive liver disease, drug side effects.
What is step 2 of conservative interventions for dyslipidemia?
Therapeutic lifestyle changes: Reduce Saturated fats to less than 7% of dietary calories, reduce dietary cholesterol to less than 200 mg/day, reduce trans fats, use whole grain, fruits, and vegetables as much as possible, increase aerobic physical activity to 3 or more times a week, reduce weigth.
What is step 3 for conservative intervention for dyslipidemia
- Treatment monitoring: Re-measure lipids at 4-6 weeks and at 3 months.
When should you use aggressive interventions for dyslipidemia?
if patient has severe elevations of LDL or unresponsive to conservative interventions for 3-6 months
What is included in aggressive interventions of dyslipidemia? Step 1
increase compliance and dietary restrictions: refer to a qualified professional such as a registered dietitian or personal trainer
What is included in aggressive interventions of dyslipidemia? Step 2
Continue to monitor as in the conservative interventions
What are some optional ideas for aggressive interventions of dyslipidemia?
Niacin (nicotinic acid therapy), red yeast rice (1200-2400 mg or 10-30 mg/day total monacolins for high LDLs, Statins
Name a few basic things that can be done to help treat hypertension
- weight loss Low alcohol intake, low salt intake, high plant food intake, high potassium intake,
take: coenzyme Q, garlic, calcium, magnesium, fish oils.
