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Test 2 Inflammation Flashcards

1
Q

What help in the storage of fats? What helps in the release of fat as FFA’s?

A

Storage: Chylomicrons, VLDL (lipoprotein lipase)

Release:
ATGL, HSL (hormone sensitive lipase)

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2
Q

What neurotransmitters are signals in weight management?

A

NE
Dopamine
Serotonin
Orexin

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3
Q

What are the 8 category causes of obesity

A
  • Genetics
  • Sedentary lifestyle
  • Inflammation (overeating and adipose produce inflammatory signals)
  • Sleep patterns/stress (increased cortisol which increases appetite)
  • taste, satiety and portions
  • obesogens
  • viruses
  • gut micro flora
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4
Q

What are examples of obesogens that are one cause of obesity?

A

Endocrine disrupters

BPA, phthalates

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5
Q

What country spends the least amount of money on food? Most?

A

US

Most: azerbaijan

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6
Q

<16 BMI

A

Severe thinness

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7
Q

16-16.9

17-18.5

A

Moderate thinness

Mild thinness

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8
Q

Normal BMI

A

18.5-24.9

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9
Q

Pre-obese BMI

A

25-29.9

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10
Q

Obese class 1, 2, 3 BMI

A

1: 30-34.9
2: 35-39.9
3: 40+

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11
Q

Health waist circumference in males? Females?

A

Men: < 40
Female: < 35

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12
Q

Healthy waist to hip ratio men? Women?

A

Men: <0.95
Female: <0.8

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13
Q

Waist to height ratio male and female:

Underweight
Slim

A

Underweight Male and female: <0.35

Slim-male: 0.35-0.43
Female: 0.35-0.42

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14
Q

Waist to heigh ratio male/female-healthy?

A

Male: 0.43-0.53
Female: 0.42-0.49

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15
Q

Waist to height ratio male/female—obese?

A

Male: 0.58-0.63
Female: 0.54-0.58

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16
Q

Rate of weight loss for BMI 27-35?

A

0.5-1lb/wk for 6mo

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17
Q

Rate of weight loss for BMI >35?

A

1-2lbs/wk for 6 months

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18
Q

Lifestyle modifications for weight loss?

A 
-Goal setting
   (Increase walking/1fruit at lunch)
-Self-monitoring (diary/weigh ins)
Stimulus control (ABC)
Cognitive restructuring (challenge/correct negative thoughts)
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19
Q

Dietary modifications for weight loss

A
  • restricted energy diets
  • formula diets/meal replacements
  • commercial programs
  • very low calorie diets
  • fasting
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20
Q

Restricted-energy diet

A

Calorie deficit of 500-1000
Focus on whole plants
Limit alcohol and high sugar

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21
Q

Formula diets/meal replacements

A

Lean cuisine, slim fast/cliff bars

Used to promote structure/portion sizes

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22
Q

Very low calorie diets

A

<800 cal/d

Only used on those with >30 BMI

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23
Q

Fasting

A

<200cal/d

50% of rapid weight loss is fluid
Increases likelihood of gout/gallstones

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24
Q

What diet is best for preservation of lean mass: alternate day fast or very low calorie?

A

Alternate day fasting

And on fasting days may eat up to 500 cal for female and males 600 cal

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25
Recommended amount of physical activity for weight loss?
60-90 min/day Weight maintenance: 150–250min/wk
26
What are some weight loss medications often prescribed?
Orlistat Lorcaserin Phentermine-topiramate
27
Orlistat
Pancreatic lipase inhibitor GI upset, leaky stools Ex: Xenical Alli
28
Lorcaserin
Serotonin receptor agonist that acts as an appetite suppressant HA, cough, fatigue, constipation (do not take with antidepressants) Ex: Belviq
29
Phentermine-topiramate
Appetite suppressant Tingling of hands and feet, dizziness, trouble sleeping and birth defects Ex: Qsymia
30
Supplement for weight loss
CLA—required in 3.4g/day Used to reduce body fat and build muscle
31
What supplements may act as fat burners?
Bitter orange Green Tea Extract (heart arrythmias) Raspberry ketones
32
What nutritional deficiencies are prominent in patients who have undergone bariatric surgery?
Iron Ca Vit D, B12
33
General causes of unintentional weight loss
``` Wasting-chronic infection Poor food intake Malabsorption Hormonal imbalances (thyroid) Increase in activity without increase in energy intake Poor living situation CA (cancer) ```
34
What are some major risk factors for CVD?
``` HTN Age Diabetes Microalbuminuria Family history ```
35
What are some modifiable risk factors for CVD?
``` Lipoproteins High LDL High TG High TMAO Low HDL Inflammatory markers (CRP, fibrinogen) ```
36
What are lifestyle risk factors for CVD
``` Smoking Poor physical activity Poor diet Stress Lack of sleep Alcohol ```
37
What are co-morbidities for CVD
HTN Obesity Metabolic syndrome
38
Desirable level for: | Total cholesterol
<200
39
Desirable level for: | HDL
>60
40
Desirable level for: | LDL
<100
41
Desirable level for: | Triglycerides
<150
42
What is metabolic syndrome?
Having 3+ of the following: ``` Waist circumference > 40(M), >35 F TG: >150 HDL: <40 BP: >130/85 Fasting glucose: >110 ```
43
What are some recommended swaps for decreasing risk of CVD?
1. Swap trans fat for MUFA/PUFA 2. Swap saturated fat for PUFA 3. Do not swap UFA for carbs
44
Diets proved to decrease risk of CVD?
- Mediterranean - DASH - Vegan
45
What are the basics of the Mediterranean diet?
``` 0-1 serving: eggs/dairy 0-2: vegetable oils 1-2: nuts/seeds 3-4: fruits 6-9: veggies 5-12: whole grains 1-3: legumes/soy ``` ***mostly whole grains, veggies, and fruits
46
What are the basics of the DASH diet?
Low fat, low sodium diet - plant based - lean meats - nuts - seeds - low-fat diary - high potassium, mg, Ca, fiber 25-30% fat (MUFA) 25% protien Limit foods that have more sodium than calories!!
47
Nutritional therapy for elevated LDL?
1. Consume high veggies, fruits, whole grains. Some: low-fat dairy, poultry, fish, legumes/nuts 2. Limit sweets, sugar sweetened beverages and red meat 3. Aim for 7-10% of energy from saturated fat 4. Avoid trans fat 5. Exercise 3-4x/wk of mod/Vig.
48
Nutritional therapy for elevated TG
1. Eat high veggie, fruit, whole grain. Some: low fat diary, poultry, fish, legumes, and nuts 2. Limit sweets, sugar sweetened beverages and red meats 3. 2-4g of EPA & DHA daily (omega 3)—FISH!! 4. 3-4x/wk exercise
49
Normal BP
> 120 | >80
50
Elevated BP
120-129 and >80
51
High BP stage 1
130-139 or 80-89
52
High BP stage 2
140+ or 90+
53
Hypertensive crisis
180+ and/or 120+
54
What 3 food/nutrients have the largest affect on BP?
Sodium (less than 2300mg) Plant-based diet Weight loss (3-5% body weight)
55
What is the nutritional therapy for hypertension?
1. High veggies, fruits, whole grains. Some: low-fat dairy, poultry, fish, legumes, nuts 2. Lower Na, increase K intake 3. 3-4x/wk exercise
56
What are the 3 most preventable risk factors for chronic disease?
Unhealthy diet Smoking Physical inactivity
57
Deficiency
Low level of nutrient found in blood that CAUSES a specific disease
58
Insufficiency
Subclinical or deficiency nutrient pools due to chronic poor intake
59
Deficiency vs insufficiency-which MC to see in practice
Insufficiency
60
What are some chemical mediators in inflammation?
Cytokines Lipid-derived compounds (prostaglandins, leukotrienes, thromboxanes) ROS
61
Estimated that 30% of patients baseline level of inflammation is due to _______ produced by________q
Cytokines produced by adipocytes More adipocytes= more inflammation
62
Gut inflammation precedes weight gain and adipocytes inflammation and can cause M2 macrophages to switch to M1 that have what effects?
M1: pro-inflammatory Microbicidal TH1 Rxn Tissue damage M1 means “kill”
63
Pathway of inflammation
1. Diet/stress lead to changes in the gut microbiome. (More LPS-lipopolysaccharides produced with high fat diet.). 2. Gut changes: —> increased LPS activates NF-kB—> stimulate production of inflammatory cytokines—> produce ROS (also increase NF-kB) 3. Immune cell activation—aka systemic inflammation
64
What are some biomarkers of chronic inflammation
CRP TNF-a ESR ``` Liver: ALT/AST (liver inflammation), GGT (liver disease) Eosinophils (allergies, parasites, autoimmune, CA) Lipid peroxides (oxidative stress) ```
65
What are some nutrient modulators of inflammation
``` Omega 3/6 Mg Zn B complex vitamins Flavonoids ```
66
What are the co-enzymes and cofactors for AA and EPA?
Mg, Zn, Vitamin A, C, B6, Niacin Coenzyme: desaturase and elongase
67
What mineral acts as a calcium-channel blocker and low dietary intake is a major risk factor for chronic disease?
Magnesium
68
What are Mg’s balanace parterns?
Mg: Ca and Zn
69
What mineral is associated with obesity-induced inflammation?
Magnesium
70
RDA for Magneium (roughly)
310-320mg
71
What foods is Mg rich in?>
Nuts/seeds
72
What mineral deficiency causes decrease production of T-lymphocytes?
Zinc
73
Low Mg and Zn alter what?
Gut permeability =leaky gut
74
What is the biomarker for zinc deficiency?
Alkaline phosphate
75
What is zincs balance partner
Copper
76
What mineral is required for signaling during inflammatory reactions?
Zinc
77
Zinc rich foods?
Oysters**** | Beef, crab
78
S/s of zinc toxicity? Deficiency?
Tox: metallic taste Def: lack of taste
79
What vitamin is most important for methylation? And stimulated epigenetic-induced gene expression
B complex
80
What vitamin alters redox status within organelles
B complex
81
Functions of B complex
- methylation - stimulated epigenetic-induced gene expresssion - alters redox status
82
Zinc functions
- signaling during inflammatory reactions - maintain gut permeability (+ Mg) - maintains production of T-lymphocytes
83
Magnesium functions
- ca+ channel blocker | - decreases risk for chronic disease
84
Flavinoids and example foods they are found in
Phytonutrients that often provide color to plants ``` Ex: alpha lipoic acid Curcumin (turmeric) Quercetin (everything) Lycopene (tomatoes) Catechins (tea/coffee/wine/chocolate) Epigallocatechin-3-gallate (green tea) ```
85
What are on the anti-inflammatory index?
``` Turmeric Fiber Flavones Tea Beta-carotene Isoflavones Mg Omega 3 ```
86
Increased inflammation leads to increase in what other health issue
Mental health
87
What constitutes the mind diet
``` Green leafy: 6x/wk Nuts: 7/wk Berries: 2/wk Beans: 3/wk Whole grains: 3+/d Fish: 1/wk Poultry: 2/wk Olive oil Wine: 1glass/d ``` Avoid: ``` Red meat: <4/wk Butter: <1TBsp/d Cheese: <1/wk Sweets: <5/wk Fast food: <1/wk ```
88
What are some side effects of chronic inflammation
- energy dysregulation due to mitrochondrial dysfunction - changes in gut microbiome - alter body fat distribution Plus many diseases: CA, CVD, Alzheimer’s, DM, Arthritis,Autoimmune, neurologic, pulmonary etc.
89
What decreases bone mineral density?
Imbalance in protein and low calcium intake High animal protein and low calcium triples risk of fracture
90
What does protein do to the acid load?
Increases
91
What increases PRAL (potential renal acid load)
``` Proteins Bread Jello Pudding Bacon Walnuts Sunflower seeds Peanuts ```
92
What are alkaline/decrease PRAL?
``` Fruits Veggies Herbs/spices Brown sugar Molasses Cocoa Coffee ```
93
Neutral foods in regards to PRAL
``` Corn Butter Oils Cows milk Honey White sugar Water Tea ```
94
What things affect calcium absorption?
- protein increases - foods with mineral binders (phytate/oxalate) lower absorption - doses less than 500mg at a time
95
What minerals have an affect on bone density
Calcium Potassium/Magnesium (eat more) Sodium (eat less)
96
Vitamins that have an effect on bone density
Vitamin A, D, K
97
Ca:P ratio ideal for bone
>1
98
What is the nutritional therapy for GERD? General
5R protocol ``` Remove Replace Reinoculate Repair Rebalance ```
99
What should you remove for GERD?
``` Arginine Alcohol Caffeine Chocolate High fat Spicy food Acidic food Smoking Stress ```
100
What should you replace with GERD?
Betaine HCL
101
What should you re-inoculate in GERD?
Lactobacillus acidohilus
102
What should you repair with GERD
DGL Antioxidant rich foods Fish oil
103
What should you rebalance with GERD
Breathing Exercise Meditation
104
What are micronutrients of concern in patients with stomach conditions
B12 Iron Ca
105
What are some natural eradicators of H. Pylori
``` Green tea Broccoli Black currant oil Kimchi Probiotics (lactobacillus/bifidobacterium) ```
106
Etiology of constipation
Lack of fiber or fluid intake *** Low energy intake Iron + Ca supplements (binders) Lack exercise
107
Nutritional therapy for constipation
1. Increase whole grain intake to 6-11/d 2. Increase veggies to 5-8/d 3. High fiber cereals to get at least 25g-F, 38g-M 4. Increase fluid intake to 2L/d
108
Treatment for diarrhea
Replenish fluids Limit: lactose, sugar alcohols, fructose and lots of sucrose Try probiotics
109
Test for fat malabsorption
72 hour fecal fat test >6g/24hrs
110
S/s of fat malabsorption
Pale, greasy, smelly stools Diarrhea WITHOUT distention or gas Frothy
111
Test for protien malabsorption
Fecal nitrogen | Serum albumin
112
S/s of protein malabsorption
Edema | Muscle atrophy
113
Test for carb malabsorption
Hydrogen breath test
114
S/s of carb malabsorption
Watery diarrhea Flatus Abdominal distention
115
Test for fluid/e-lyte malabsorption
Serum electrolyte panel Creatinine Urea nitrogen
116
S/s of fluid/e-lyte malabsorption
Tachycardia | Dry mouth
117
Test for bile salt malabsorption
Serum 7-a-hydroxy-4cholesten-3-one
118
S/s of bile salt malabsorption
Watery diarrhea
119
Generally, how do you test for micronutrient malabsorption
Serum tests
120
What is leaky gut
Increased intestinal permeability
121
What might cause leaky gut
Infections, medications, dysbiosis
122
What patients might you find leaky gut in?
Celiac, crohns, MS, IBS, SIBO
123
What test is done to diagnose leaky gut?
Lactulose-mannitol test Lactulose—non-absorbable disaccharide Mannitol—sugar alcohol
124
Celiac disease 4 step pathyphysiology
Genetic susceptibility Exposure to gluten Environmental trigger Autoimmune response Requires all 4 to cause celiac
125
What is the physiology behind celiac disease
Autoimmune reaction to protein that over time causes damage to small intestinal lining—villi that leads to medical complications and malabsorption
126
Nutritional celiac disease symptoms
``` Anemia (low iron/folate) Increased fx risk Clotting issues (Vit K Def) Delayed growth Lactase deficiency ```
127
Extraintestinal s/s of celiac disease
- malaise - arthritis - dermatitis herpetiformis - infertility - hepatitis - ataxia - psychiatric syndromes ***cluster diseases: hepatitis, type 1 diabetes, hashimotos, and celiac
128
Cluster/associated disorders with celiac disease
``` Autoimmune cluster: type 1 diabetes Thyroiditis Hepatitis GI malignancy IgA deficiency ```
129
Dermatitis herpetiformis seen with which disease?
Celiac disease
130
Celiac disease vs. gluten sensitivity/intolerance
Disease: autoimmune disease where the body attacks itself Tests to diagnose Intolerance: NO immune rxn Could be due to IBS and is diagnosed using elimination diet
131
Diagnosing celiac disease for high probability cases (anemic, dermatitis herpetiformis, psychiatric issues, C. HA, GI issues)
Duodenal biopsy and TTGA IGA. Yes if both positive. If only one + —> HLA DQ2, IgA level, DGP IgG
132
Diagnosing celiac disease in low probability group
*** test TTGA & IgA. + TTGA= duodenal biopsy - TTGA but low IgA—> TTGA IgG...if positive= duodenal biopsy -TTGA and normal IgA= unlikely MUST BE EATING GLUTEN DURING TESTING
133
Diagnosing kiddos under 2 years with celiac
Screen for TTGA and DGP (IgA and IgG)
134
Nutritional therapy for celiac disease
Gluten free for life Avoid: wheat, rye, barley and malt Up to 50g/d of oats potentially tolerated
135
Initial nutritional therapy for gluten patients
1-2months: limit sugars, diary, lactose and sucrose Then follow diet recommendations of avoiding, wheat, rye, barley and malt
136
What are some safe gluten-free options?
Grains and flour: amaranth, bean flours, corn, rice, soybean, potato, quinoa, flax Alcohol: wine, distilled liquor, gluten free beer Cheese, eggs, meats, fish, beans, legumes, nuts, seeds, fruits, veggies normal
137
What are some hidden sources of gluten?
1. Medications 2. Communion wafers 3. Toothpaste, mouthwash, lipstick 4. Cross contamination
138
Nutritional deficiencies in celiac patients
``` Niacin riboflavin B12 folate Iron ``` +(Ca, Mg, Vit D —at time of diagnosis)
139
Refractory celiac disease
Patients who do not respond to a gluten free diet Present with severe malabsorption diarrhea and weight loss
140
Gluten free diets high in what?
Saturated fats Starch Sucrose (Recall low in niacin, riboflavin, folate, B12 and iron and fiber)
141
What is a nutritionally complete gluten free diet?
- focus on foods naturally gluten free - 5 fruits/veggies per day - add amaranth, quinoa and buckwheat - meat, fish and dairy
142
What is the 5R protocol for gluten related disorders
``` Remove: gluten grains Replace: digestive enzymes, DPP-IV Reinoculate: VSL #3 Repair: L-glutamine, zinc, vitamin A Rebalance: mindful eating and relaxation ```
143
Replace what in those with celiac?
Digestive enzymes | DPP-IV (dipeptidylpeptidase)
144
Reinoculate what in those with celiac?
VSL #3
145
Repair what in those with celiac
L-glutamine Zinc Vitamin A
146
What are the most common burst boarder enzyme deficiencies?
Lactose intolerance and fructose malabsorption
147
What is the most common form of cab malabsorption
Lactose intolerance
148
How is lactose intolerance diagnosed?
Hydrogen breath test
149
How is fructose malabsorption diagnosed
Hydrogen breath test
150
What is the protein requirement for those with IBD
1.3-1.5g/kg/d
151
Supplements required for those with IBD
``` Folate B6,12 Iron Zinc Mg K Fe Omega 3 PERT (pancreatic enzyme replacement therapy) Boswelia ```
152
IBD 5R protocol
Remove: food triggers. Mc: cereal, milk, egg, veggies/citrus fruits Replace: digestive enzymes Reinoculate: VSL #3 Repair: boswelia serrata, zina, vitamin A, mastic gum Rebalance: meditate, yoga, deep breathing, acupuncture (moxibustion)
153
What are the IBS subtypes?
IBS-C (constipation) IBS-D (diarrhea) IBS-M (mixed) Unsubtyped IBS-insufficient evidence to meet the others
154
FODMAP diet. What is it and for what?
Fermentable oligo, di, and monosaccharides and polyols restriction Limit fermentable foods (sugars, oligosaccharides and sugar alcohols) Start very restrictive and then slowly add things back in
155
What are the foods to eliminate on the FODMAP diet?
Dairy: all except lactose free and hard cheese Non-dairy: NO: coconut milk, beans, hummus, lentils (yes to almond and rice milk and nuts/seeds) Grains: only wheat free grains Fruits: avocado, apples, canned fruit, cherries, guava, mango, pear, papaya, peach, plum, prunes, watermelon Veggies: artichokes, asparagus, beets etc
156
What is diverticular disease associated MC with?
``` Obesity Low fiber Vitamin D deficiency Sedentary lifestyle NSAID use ```
157
Nutritional therapy for diverticular disease
1. High fiber 2. Probiotic You CAN have nuts, seeds, corn, popcorn and berries
158
SIBO
Small intestinal bacterial overgrowth Overproliferation of bacteria in the SI that is normally only found in the LI potentially due to low stomach acidity, liver/gallbladder disease or pancreatitis
159
What probiotics are avoided with SIBO
Lactobacillus acidophilus and lactobacillus fermenti | Produce D-lactate that could cause life threatening lactic acidosis
160
Causes of SIBO
Low stomach acidity Liver or gallbladder disease Pancreatitis
161
What diet is useful for treating SIBO?
FODMAP
162
5R protocol for SIBO
Remove: microbes using antibiotics, artificial sweeteners Replace: betaine HCl Reinoculate: introduce prebiotic-free probiotic Repair: omega 3 from cold water fish, L-glutamine, zinc, vitamin A Rebalance: eat every 3-5hr, acupuncture, deep breathing yoga
163
What are the two forms of IBD? And which is MC?
Chron’s and ulcerative colitis Chrons
164
What test can you order to test for liver function
AST/ALT tests | GGT
165
Nutritional requirements for liver disease
B vitamins Vit ADEK (if steatorrhea) Mg and Zn (Avoid Iron)
166
Herbal supplements for liver disease
Milk thistle | Contains antioxidants that may reduce free radicals
167
Diets at risk for gallstones
Low fiber High fat diet High animal protein diet (Vitamin C may be protective to gallstones)
168
Nutritional recommendations for those with cholecystitis/gallstones
Low fat diet: 30-45g/d Supplement Vitamin C Increase citrus foods Ox bile (bile salt supplement)
169
What lab tests can assess pancreatic function?
1. Secretin stimulation test (pancreatic secretions) 2. Glucose tolerance test (endocrine function) 3. 72 hour fecal fat test (exocrine function) 4. Fecal elastase <15mcg/g = insufficiency
170
What are the nutritional recommendations for patient with pancreatitis?
- Easy digestible carbs (sugar/starches) - low fat (not producing enzyme—> cannot digest) - PERT - ADEK, B12 supplements
171
How can kidney stones be prevented?
1. FLUID!!!!! 2. Juicies (cranberry for struvite and black currant for uric acid) 3. Reduce Animal protein—> limit food with + PRAL 4. Reduce Oxalate + increase Ca (binds oxalates and doesnt allow them to be absorbed) 5. Na: K <1 6. Decrease: citrate, fructose, Vit C supplements and high doses of VitD 7. Increase B6 and EPA (omega 3)
172
Calcium stones
Associated with increased intake of calcium. To prevent, make sure ca is taken with meals to balance urinary oxalate
173
Oxalate stones. Etiology and recommendation
Fatty malabsorption Low Vit B6 Excess Vit C Lack of oxalobacterformigens =Limit oxalate containing foods
174
What are oxalate containing foods
``` Rhubarb Spinach Strawberries Chocolate Wheat bran/whole grain wheat Nuts Peanuts Beets Tea High dose turmeric ```
175
Pathway of fat malabsorption oxalate stones
Increased lipids in the SI cause ca++ to bind to them instead of oxalate and oxalate is then free to be absorbed by the body
176
Uric acid stones. Etiology and recommendation
MC due to low urine pH (Too many acidic foods, too few alkaline foods) = limit meat, fish, poultry Avoid Oran meat, anchovies, sardines, broth and gravy
177
Treatment for inflammation
Increase omega 3 Decrease omega 6 Increase: B Vitamines Mg, Zn
178
Lifestyle recommendations for inflammation
Weight loss Decrease smoking and alcohol MIND DIET!!! Poultry 2x, beans 3x, berries 2x, nuts 5x, fish 1x, whole grain 3xd, veggies 1xd Avoid: added sugars, processed grains, refined oils, trans fat
179
Recommendation for weight loss
BMI 27-35: .5-1lb/wk, 35+ = 1-2lb/wk Increase protein 20-25%
180
Strong bone dietary recommendations
Protein Limit excess fiber Vit D, K Ca, K, Mg LIMIT Vit A (excess) and Na Limit caffine, alcohol, smoking Decrease high acid foods Ca: P >1
181
Recommendations for CVD
- Decrease trans fat, sugars, starches, Na - increase omega3, K - Mediterranean diet: moderate fat, olive oil, plants, legumes - DASH diet: low fat, plants, moderate protein
182
General Mediterranean diet vs DASH
Mediterranean

Clinical Nutrition (5 decks)

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