Test 2 Flashcards
What are some nutritional or botanical supplements for fibromyalgia that help with improving sleep?
hydroxytryptophan, melatonin (no dramatic), herbal sedative (kava or valerian), tryptophan
What are some nutritional or botanical supplements for fibromyalgia that help with improving mental function?
Acetyl-L-Carnitine,
Cognitive = Ginkgo Biloba (standardized)
Depression = St. John’s Wart, and S-adenosylmethionine
Anxiety = kava
Which Therapies that have been clinically tested in fibromyalgia patients?
stress reduction, cognitive-behavioral therapy, acupuncture
- What kind of benefits has exercise been shown to have on fibromyalgia patients?
improved pain and tenderness and improved fitness
Some pts must start very gradually to avoid worsening symptoms
- What multidisciplinary programs have helped fibromyalgia patients?
Low impact exercise
Water aerobics, fitness centers, and personal trainers
Supplements: S-adenosylmethionine (helps liver with detox, improves NT production), 5-hydroxytryptophan (don’t combine with antidepressants), and Acetyl-L-Carnitine
What types of diets that have been shown to help patients with fibromyalgia.
various types of plant based diets
raw foods
low salt, uncooked vegan diet rich in lactobacteria
What food elimination mights some FM patients benefit from>
gluten
dietary excitotoxins, aspartame
typical food allergy elimination diet
What are some nutritional or botanical supplements for FM that could help with fatigue?
Coenzyme Q10 (300 mg/day)
What type of exercise is most effective and has the most evidence for treating FM?
Aerobic exercise is the most effective. Resistance training has produced some benefits. water-based activity yoga tai chi
What issues should educational and counseling address with FM?
psychological distress (depression)
fear and pain and activity
coping and pacing skills and other self-mgmt practices
What type of counseling have good evidence for improving FM outcomes?
Cognitive Behavioral Therapy
Mindfulness-based stress reduction reduces ____ and improves _______ in short term studies.
Pain
quality of life
Gingko Biloba
Common and Scientific name?
Scientific name: Gingko Biloba
Common name: Maidenhair tree
Part of GB plant used?
leaf
Physiological effects of GB?
Constituents: Flavone glycoside and Terpene lactones
Affects NT function
Affects blood flow characteristics
Inhibits neuronal damage from certain pathological mechanisms
Clinical evidence of effectiveness for indicated uses of GB
Measuring cognitive function
Memory test and other cognitive testing
Alzheimer’s disease
Extraction and standardization criteria for effective preparations
Standardized leaf extract (6% terpene lactones and 24% flavone glycosides)
180-240mg per day in divided doses
Expect results in 6 weeks or more in cases of cognitive impairment
Contraindications for GB
Children under 12
Side effects of GB
Transient HA
Occasional upset GI
Occasional allergic skin reactions
Interactions of GB?
May increase bleeding tendency in susceptible individuals taking anti-coagulants or anti-platelet drug
Changes to the effectiveness or side effects of certain drugs
Describe the dietary management of migraine headache. What would you try first in an adult migraine patient? For children with migraine?
Trial period of CMT and other PT modalities
Consider dietary triggers (allergies more likely in children)
Consider supplements
What are the sources of some of the specific food chemicals or additives associated with migraine?
asoactive amines - cheese, wine (other products of fermentation, spinach, dark chocolate, tempeh, banana, milk chocolate, pineapple
Tyramine, phenylethylamine, other natural amines
Alcohol, sodium
Nitrites - bacon, ham, pork, cold cuts, and other cured meats
Tartrazine - yellow food dye #5 (Food additive)
Monosodium glutamate - Asian cuisine, canned veggies, and processed meats (Food additive)
Aspartame - NutraSweet (food additive)
What would make you suspect your migraine patient had episodes caused by hypoglycemia?
HA may be triggered by brain glucose deprivation or excessive adrenal reaction
Look for other hypoglycemic sx
Lab dx not consistently helpful
2) Which supplements may be useful for migraine prevention?
Magnesium - vascular tone regulator, may affect platelets and serotonin; fewer less severe HA; 9mg/kg/day effective for children
Butterbur (petasides hybridus) - rhizome part used; spasmolytic, analgesic, and anti-inflammatory properties
Feverfew (tanacetum parthenium) - dried powered leaf; fewer headaches, less nausea, and vomiting; no side effects
Riboflavin - fewer headaches, less severity; low dose worked as well as high dose; no side effects
Combo migraine formulas
Co-Enzyme Q
Which supplements for migraine have the following properties?
Product must be processed to remove toxic component
Butterbur
Which supplements for migraine have the following properties?
GI side effects are common at large doses:
Magnesium (spread doses throughout day)
Butterbur (mild)
Which supplements for migraine have the following properties?
Function includes mitochondrial coenzyme role
Riboflavin
Co-enzyme Q
Which supplements for migraine have the following properties?
Function includes vascular tone regulation
Magnesium
Butterbur
Which supplements for migraine have the following properties?
Whole leaf more effective than extracts
Feverfew
Which supplements for migraine have the following properties?
Active ingredient is parthenolide
Feverfew
Which supplements for migraine have the following properties?
Active ingredient is petasin
Butterbur (15%)
What natural treatments may be effective for tension headache?
Tiger Balm - camphor, menthol, Cajeput, and clove oil
Application to forehead and temples relieved acute HA better than placebo and = to Tylenol
Peppermint Oil - 10% solution in alcohol
What natural treatments may be effective for cluster headache?
Melatonin - low levels in cluster patients
Intranasal Capsaicin - once daily, helped prevent and even abort HA
How do glucosamine and chondroitin compare as options for treating osteoarthritis?
GS has more possible side effects/precautions
The bioavailability of CS is only 12%, where GS is 26%
There are disparate opinions as to which is superior in the long run.
How does MSM compare to glucosamine and chondroitin?
3 small trials of variable quality showed some benefits for MSM, but the evidence is weak compared to GS and CS.
What is the rationale for the nightshade-free diet? What foods must be eliminated?
Some plants in the nightshade family contain natural toxins, including solanine that may cause joint problems in sensitive people
tomatoes, white potatoes, eggplant, hot and sweet peppers, tobacco (up to 6 months of avoidance may relieve symptoms)
Common and scientific names
Capsaicin
Common: Cayenne
Scientific name: Capsicum annuum, C. frutescens
Part(s) of plant used
Capsaicin
fruit
Physiological Effects
Capsaicin
- stimulation of C-nociceptor neurons through vanillas receptor
- Desensitization of C-nociceptor neurons over time by depleting substance P
- may have indirect effects on inflammation
Clinical evidence of effectiveness for indicated uses Capsaicin
- clinical studies showed capsaicin was more effective than placebo in treating pain associated with chronic arthritis, LBP, neck pain, post-herpetic neuralgia, diabetic neuropathy
- Reduced tender points in FM
- aborts cluster HA
What medicinal forms does capsaicin typically come in?
typically comes in cream form or adhesive plasters
Contraindications:
Capsaicin
Open skin lesions
Interactions
Capsaicin
no info available
Metabolism
Capsaicin
absorbed capsaicin is metabolized in the liver and excreted in the urine
Bioavailability
Capsaicin
therapeutic topical ointment should contain capsaicin
products containing cayenne, cayenne tinctures, or capsicum oleoresin have not been testes for therapeutic efficacy except capsicum plasters
Common and scientific names
Willow
Common: White willow, willow bark
Scientific: Salix alba, other species
Part(s) of plant used
Willow
Bark
Physiological Effects
Willow
Analgesia, typically slower onset than aspirin, but lasts longer
- anti-inflammatory via COX1, COX2,
- Antipyretic
indicated uses
Willow
arthritis, LBP, fever, HA, pain and NMS complaints
Contraindications
Willow
hypersensitivity to salicylates
-no evidence for reyes in children, though some authorities express concern
-
Side effects
Willow
occasional stomach upset
Metabolism
Willow
2.5 hour half life
240mg of salicin equivalent to 87mg aspirin
Active constituents
Willow
Salicylates,
flavonoids
Interactions
Willow
anticoagulant or antiplatelet agents (potential increases in bleeding time)
Standardization
Willow
Bark extract standardized for salicin
40-80mg salicin TID
Assalix brand used in clinical trials available from pro distributer
Common and Scientific names:
Devils claw
Common: devils claw
scientific: harpagophytum procumbens
Part used
Devils claw
Tubers
Active constituents
devils claw
iridoid glycosides, harpagosides, harpagide, procumbide
Bioavailability
Devils claw
in vitro and in vivo research suggests that there is a loss of activity of Harpagophytum extract is exposed to low pH in stomach
Physiological effects
Devils Claw
anti-inflammatory
analgesic
reduced activity of matrix-degrading enzymes in chondrocytes
Uses:
Devils Claw
digestive bitter, analgesic, antipyretic
Contraindications
Devils claw
anticoagulant (one case was reported of purpura while taking warfarin) peptic ulcer (stimulating effect on gastric secretions)
Side effects
Devils claw
infrequent mild GI symptoms
Name some other supplements that may be helpful with degenerative arthritis
Niacinamide Vitamin C Vitamin D Vitamin E SAMe capsaicin curcumin devils claw ginger willow bark
What is the mechanism for the effects of DL-phenylalanine on chronic pain?
blocks the actions of a pain-inducing protein called enkephalinase.
What botanicals appear most effective for treating osteoarthritis according to published evidence?
SAMe DMSO MSM Devils Claw Willow ginger capsaicin
5) How many times per day should capsaicin ointment be applied to duplicate successful protocols used in clinical trials?
apply topically to skin over painful area four times daily.
Which supplement needs to be taking in megadoses for treating OA?
SAMe
4) Of all the supplements studied for treating osteoarthritis, which is the only one with evidence for reducing the need for total joint replacement?
Glucosamine sulfate
What are the symptoms of neuroglycopenia?
Headache, confusion, dizziness, depression, drowsiness, fatigue, lethargy, mental or neurological impairment, visual disturbances
What are the symptoms of hyperadrenalism>
Nervousness, anxiety, irritability, tremors, sweating, tachycardia, palpitations, insomnia, hunger, weakness
What is the cause of neuroglycopenia?
inadequate glucose delivery to brain
What is the cause of hyperadrnalism?
excessive catecholamine secretion in response to low or falling blood glucose
What are the symptoms of fasting hypoglycemia?
May be neuroglycopenic or hyperadrenergic Occur when meals are skipped or during overnight sleep
What are the causes of fasting HG?
Excessive fasting insulin levels or inadequate glucose release from liver
What is the treatment for fasting HG?
Treat liver, pancreas, or hormonal disorders, if present
Maintain blood sugar with frequent low- glycemic meals and snacks
What are the symptoms of reactive HG?
May be neuroglycopenic or hyperadrenergic Occur after high glycemic meals, or possibly other triggers (allergies,1 caffeine2)
What is the cause of reactive HG?
Excessive or poorly regulated insulin secretion relative to blood sugar levels, insulin sensitivity abnormalities, or glucagon disturbances
What is the treatment for reactive HG?
Treat insulin resistance, gastrointestinal or pancreas disorders, if present
Eliminate high glycemic foods and alcohol Consider chromium, 200 mcg/day3
What does diagnosis of HG typically require?
occurrence of symptoms together with lab evidence of low plasma glucose, with relief produced by ingestion of carbs.
Explain why hypoglycemia symptoms may develop without blood glucose falling below normal. What precise name has been given to this syndrome? (Long answer, sorry)
the rise in plasma epinephrine and cortisol during some episodes of hypoglycemia13 and “idiopathic postprandial syndromes”14 suggests a possible mechanism whereby the falling glucose levels cause an adrenergic response that could trigger symptoms before blood glucose has dropped below normal. In this case blood glucose values might never become clinically abnormal, and carbohydrate replacement may have no effect on acute symptoms.
Describe the most effective natural treatments for fasting and reactive hypoglycemia.
Glucomannan Vitamin E Magnesium Chromium Zinc CoEQ10
What are some examples of low glycemic index foods in the following categories: BREAD
Pumpernickel, chewy breads (with intact kernels) oat bran bread
What are some examples of low glycemic index foods in the following categories: BREAKFAST CEREALS
unsweetended whole grain, oatmeal, 100% bran, psyllium fortified
What are some examples of low glycemic index foods in the following categories: OTHER STARCHES
Yams, barley, buckwheat, bulgur wheat, rye kernels, wheat kernels, quinoa, carrots, most pasta and pizza
What are some examples of low glycemic index foods in the following categories: LEGUMES
Most
What are the symptoms of fasting hypoglycemia?
May be neuroglycopenic or hyperadrenergic Occur when meals are skipped or during overnight sleep
What are the causes of fasting HG?
Excessive fasting insulin levels or inadequate glucose release from liver
What is the treatment for fasting HG?
Treat liver, pancreas, or hormonal disorders, if present
Maintain blood sugar with frequent low- glycemic meals and snacks
What are the symptoms of reactive HG?
May be neuroglycopenic or hyperadrenergic Occur after high glycemic meals, or possibly other triggers (allergies,1 caffeine2)
What is the cause of reactive HG?
Excessive or poorly regulated insulin secretion relative to blood sugar levels, insulin sensitivity abnormalities, or glucagon disturbances
What is the treatment for reactive HG?
Treat insulin resistance, gastrointestinal or pancreas disorders, if present
Eliminate high glycemic foods and alcohol Consider chromium, 200 mcg/day3
What does diagnosis of HG typically require?
occurrence of symptoms together with lab evidence of low plasma glucose, with relief produced by ingestion of carbs.
Explain why hypoglycemia symptoms may develop without blood glucose falling below normal. What precise name has been given to this syndrome? (Long answer, sorry)
the rise in plasma epinephrine and cortisol during some episodes of hypoglycemia13 and “idiopathic postprandial syndromes”14 suggests a possible mechanism whereby the falling glucose levels cause an adrenergic response that could trigger symptoms before blood glucose has dropped below normal. In this case blood glucose values might never become clinically abnormal, and carbohydrate replacement may have no effect on acute symptoms.
Describe the most effective natural treatments for fasting and reactive hypoglycemia.
Glucomannan Vitamin E Magnesium Chromium Zinc CoEQ10
What are some examples of low glycemic index foods in the following categories: BREAD
Pumpernickel, chewy breads (with intact kernels) oat bran bread
What are some examples of low glycemic index foods in the following categories: BREAKFAST CEREALS
unsweetended whole grain, oatmeal, 100% bran, psyllium fortified
What are some examples of low glycemic index foods in the following categories: OTHER STARCHES
Yams, barley, buckwheat, bulgur wheat, rye kernels, wheat kernels, quinoa, carrots, most pasta and pizza
What are some examples of low glycemic index foods in the following categories: LEGUMES
Most
What clues would lead you to suspect your patient was at high risk of having or developing an insulin resistance disorder?
1) impaired glucose tolerance
2) dyslipidemia
3) hypertension
4) Clinical obesity
(also associated disorders like fatty liver, acanthosis, PCOS)
(general risk factors)
Which micronutrients are associated with improved insulin function or reduced risk of insulin resistance disorders?
Glucomannan Vitamin E Magnesium Chromium Zinc CoEQ10
What other disorders should always be screened for and treated along with treating insulin resistance disorders?
diabetes
Lowering homocysteine may improve what other vascular or diabetic risk factors?
CHF, atherosclerosis
how does a fasting diet benefit RA?
Fasting may remove allergens, reduce gut permeability or modify immune response.
How does a food allergy diet benefit RA?
ncreased gut permeability has been detected in patients with RA,3 and this may allow antigens or microbiological by-products to enter systemic circulation. removing allergens removes inflammatory toxins from systemic circulations.
How does the prostaglandin modification diet benefit RA?
Altering cell membrane fatty acids may result in modified eicosanoid metabolism, altered membrane
signaling pathways, and decreased production of inflammatory cytokines
Why does the arachidonic acid restriction diet benefit RA?
it is an anti-inflammatory diet
Why does a vegan/vegetarian diet benefit RA patients?
Sensitivities to foods of animal origin
Changes to prostaglandin/eicosanoid production
Changes to immune response35
Changes to gastrointestinal function/bacterial flora
Why does Vitamin E help RA patients?
RA patients have impaired antioxidant function, and low vitamin E in their joints. Taking supplements helps restore this balance
Which supplement should not be given to RA patients and why?
Iron may increase inflammatory damage and should not be given unless deficiency is proven by low serum ferritin
Which botanicals might help with RA?
Capsaicin Boswellia curcumin devils claw ginger
