Unit 3 Assessment Flashcards
1
Q
The process of digestion begins in?
A
The brain.
2
Q
Following the sight, sound, and smell of food the brain sends signals to…
A
The salivary glands to produce saliva and the gastric glands to produce gastric juices in preparation for food/digestion.
3
Q
The brain is responsible for nearly ___ % of gastric secretions?
A
20%
4
Q
In order for the first phase of digestion to function optimally, we need to be in a _________________ state.
A
Parasympathetic State.
5
Q
Two enzymes are then released to help break down carbohydrates and fats. What are these two enzymes, what do they breakdown, and where are they produced?
A
Salivary amylase (which is made in the stomach and pancreas) help to breakdown complex carbohydrates and lingual lipase (made in the pancreas) works to breakdown fats.
6
Q
Why is chewing beneficial to digestion?
A
Chewing helps mechanically breakdown food, allowing for greater surface area for digestive secretions to do their work.
7
Q
Once the food is swallowed it passes from the mouth, through the ________, into the _______.
A
It passes from the mouth, through the esophagus, into the stomach.
8
Q
What valve is located between the esophagus and the stomach and what is its main role?
A
The lower esophageal sphincter (LES) that is responsible for separating the esophagus and the stomach, preventing food and gastric secretions in the stomach from refluxing back into the esophagus.
9
Q
When the brain alerts the stomach that a meal is coming, it produces the hormone _______.
A
Gastrin.
10
Q
What signals does gastrin give?
A
It tells other parts of the stomach increase the production of protective mucus, increase gastric motility, and stimulates the release of hydrochloric acid.
11
Q
What does the stomach do to churn the food?
A
Contract.
12
Q
The LES needs to _________ in order to allow food to move into the stomach.
A
Relax.
13
Q
In the stomach, HCL works together with the enzyme ______ to breakdown proteins.
A
Pepsin.
14
Q
Pepsin however is first released into the stomach (produced in the stomach by gastric chief cells) in its inactive form __________ and then converted into pepsin by HCL.
A
Pepsinogen
15
Q
What are two of the benefits of acidic HCL?
A
The highly acidic environment that HCL creates reduces the viability of potential pathogens and helps prevent the overgrowth of opportunistic microbes in the stomach.
16
Q
The pH of HCL is….
A
Low, as it is highly acidic.
17
Q
HCL tells the LES to __________ to prevent _________________.
A
Tighten, to prevent acid reflux.
18
Q
Food that has been digested and is ready to leave the stomach is referred to as ______________.
A
Chyme.
19
Q
The ______________ opens to allow the chyme to pass from the stomach into the small intestine, a process called ______________
A
Pyloric valve, a process known as gastric emptying.
20
Q
Define gastric motility?
A
The coordinated movements of the stomach muscles and its secretions to move through the stomach.
21
Q
Gastric emptying begins about _________ after eating and can take up to ___________ hours to complete.
A
30 minutes after eating, up to 4-5 hours to complete.
22
Q
In the ___________________ is where most nutrient absorption takes place.
A
In the small intestine.
23
Q
The small intestine is approximately _________ feet long and comprised of ____ sections.
A
Approximately 22 feet long, comprised of 3 sections.
24
Q
What are the three sections of the small intestine in order?
A
The duodenum, jejunum, and the ileum.
25
In the duodenum, the __________ connects to the small intestine.
Common Bile Duct
26
What does the common bile duct do?
It allows bile and digestive juices from the accessary organs (liver, gallbladder, and pancreas) to mix into the chyme.
27
Cells in the duodenum also make __________ which regulate the release of digestive fluids from accessory organs.
Hormones.
28
The endocrine cells of the duodenum secrete which two primary digestive hormones into the bloodsteam?
Secretin and cholecystokinin (CCK).
29
Secretin helps regulate the _______ of the intestines by inhibiting the production of _______ in the stomach and stimulating the _______ to release _______ into the duodenum.
Secretin helps regulate the pH of the intestines by inhibiting the production of HCL in the stomach and stimulating the pancreas to release bicarbonate into the duodenum.
30
What does bicarbonate released by the pancreas into the small intestine do?
It helps to alkalinize the chyme to neutral (about 7.0) to prevent irritation to the intestinal lining and optimize the function of pancreatic enzymes.
31
Cholecystokinin (along with other neurological, hormonal and mechanical cues) stimulates _______.
Stimulates the pancreas to release pancreatic enzymes.
32
What is the purpose of the pancreatic enzymes initiated by the CCK?
They continue the chemical digestion of carbohydrates, fats and proteins.
33
What are the three pancreatic enzymes and what do each of them help breakdown?
Proteases help breakdown proteins, amylase helps breakdown carbs, and pancreatic lipase helps breakdown fats.
34
CCK also ________.
Stimulates the gallbladder to contract and release bile into the small intestine to aid in the digestion of fats.
35
Bile is first produced in the ______ and then concentrated and stored in the _____.
Liver, gallbladder.
36
Bile is necessary for ________.
The emulsification and absorption of dietary fats and fat soluble vitamins.
37
Bile also promotes _______ in the colon and helps ____________.
Peristalsis, helps transport waste products from the liver out through the intestines and into the toilet for elimination.
38
Define peristalsis.
Involuntary constriction and relaxation of the muscles of the small intestine or another canal, creating wave-like movements, helping to push contents foward.
39
The inner surface of the intestines is comprised of a single-cell deep layer of _________ covered by a __________ layer.
Epithelial cells, covered. by a protective mucosal layer.
40
These epithelial cells are spread over a terrain of ______ and ______ called ______.
Terrain of peaks and valley called villi.
41
Along the epithelial cells are _________.
Enterocytes.
42
Definite enterocytes.
Numerous columnar, absorptive, epithelial cells that line the villi.
43
On each of the enterocytes are another set of smaller peaks and valleys called ______.
Microvilli.
44
What is the purpose of the microvilli.
They help increase the surface area of the intestine, allowing for more nutrient absorption.
45
The microvilli also produce additional enzymes called ______________.
Brush border enzymes.
46
Nutrients can move from the small intestines into the bloodstream via what two routes?
Transcellular and paracellular.
47
Define how nutrients move into the bloodstream transcellular.
Through the cell body of the enterocytes.
48
Define how nutrients move into the bloodstream paracellular.
Between cell bodies.
49
The majority of nutrients are absorbed via the _________ transcellular route.
Transcellular.
50
The enterocytes are held together by zipper-like structures called _______ that regulate ______.
Zipper-like structures called tight junctions that regulate intestinal permeability.
51
In the presence of food, ________ moves chyme through the small intestine. In a fasted state, another system of motility called _______ becomes active to help clean up between meals.
Peristalsis, the migrating motor complex becomes active to help clean up between meals.
52
Whatever has not been absorbed in the small intestines passes through the _____________ and into the large intestine.
Ileocecal valve.
53
The large intestines houses much of the _________________ we think of as the ______________, that includes _____, _____, and ____.
The large intestines houses much of the microbial life we think of as the gut microbiome including bacteria, viruses, and fungi.
54
What are the three main roles of the intestinal microbiome.
1. Supports the structure and function of the mucosal lining.
2. Suppresses the growth of pathogenic organisms. 3. Promotes immune tolerance to food.
55
By the time the chyme reaches the large intestines it is largely comprised of ____________.
Undigestible fiber and food particles, water, sloughed-off cells, products the liver has sent out for elimination.
56
What are the three main roles of the large intestines.
1. Absorbs water and electrolytes.
2. Concentrates and transports waste into the feces for elimination. 3. Produce and absorb some vitamins.
57
What nutrients are absorbed or synthesized in the colon?
Short-chain fatty acids, vitamins K2, B1, B2 and B12.
58
How are short-chain fatty acids produced?
They are produced by the gut microbiota through the fermentation of the undigestible fiber and resistant starch that are body has not been able to breakdown.
59
Waste formed in the colon moves to the ______ where it is held until elimination.
Rectum.
60
The time it takes to complete the north-to-south journey is referred to as ______.
Transit time.
61
How long does transit time take, what is the average.
10-73 hours, with an average of 36 hours.
62
For all of the north-to-south process to happen we have constant cross-talk between the _________ and the _________.
Central nervous system, enteric nervous system.
63
The enteric nervous system is referred to as the _____ or _____.
"Second brain" or "gut brain."
64
There is an intricate system of _________ hormones produced in the intestines that help balance things like ________. Give some examples....
Neuro-endocrine hormones, appetite, food intake, and energy balance. Examples include ghrelin, peptide YY, glucagon-like-peptide-1 (GLP-1), and leptin.
65
Define prebiotics in terms of the microbiome.
Carbohydrates that preferentially feed bacteria strains.
66
Define probiotics in terms of the microbiome.
Living microorganisms known to confer health benefits.
67
Define synbiotic in terms of the microbiome.
A combination of pre and probiotics.
68
Define postbiotics in terms of the microbiome.
The metabolic byproducts from microbes.
69
Define resident/indigenous in terms of the microbiome.
Stable calories in gastrointestinal tract that are established early in life, provide "colonization resistance" against pathogenic infections.
70
Define commensal in terms of the microbiome.
A relation between the two kinds of organisms in which one obtains food or the other benefits from the other without damaging it.
71
Define transient in terms of the microbiome.
Consumed in food or supplements, remains in the gastrointestinal tract for 2-3 weeks.
72
Define opportunistic in terms of the microbiome.
Not typically considered pathogenic in normal situations/levels, becomes problematic after expanding number or location.
73
List the north-to-south process of digestion.
Brain > mouth > esophagus > LES ? stomach > pyloric valve > small intestine > ileocecal valve > large intestine/colon > rectum.
74
In the brain, _______ dominance can reduce _____.
Sympathetic/stress dominance can reduce salivary, gastric, and pancreatic secretions.
75
Inadequate chewing means ______.
The initial breakdown of food is comprised.
76
Negative effects of poor chewing.
The rest of the digestive system has a more limited surface area to work upon, and lower levels of amylase and lipase are released as there is less time to prepare for digestion before food is consumed.
77
Issues in the stomach can arise when we have insufficient or excessive levels of ______.
Hydrochloric acid.
78
What are the three questions to ask in regards in insufficient or excessive levels of HCL.
Where? (What tissues is it in contact with?) When? (Are levels being regulated appropriately rising during mealtimes and lowering between meals?) What? (What is driving it? Infections, diet, lifestyle issues, etc.)
79
Define hypo vs. hyperchlorhydria.
Hypochlorhydria is an insufficient amount of HCL, hyperchlorhydria is excessive HCL.
80
What health concerns can hypochlorhydria lead to?
Reduced immunity, reduced nutrient absorption, and poor north-to-south signaling.
81
What are some of the risk factors of hypochlorhydria?
Older age, chronic stress, fatigue, overuse of acid-blocking medications etc.
82
What does H. Pylori stand for?
Helicobacter pylori.
83
Low stomach acid increases the risk of developing ______.
Pathogenic H. Pylori
84
Typically inflammation from acute infection can stimulate _______ production in the stomach to fight overgrowth.
HCL
85
H. Pylori produces ______ to protect itself and can damage ______ cells, eventually causing ______ .
H. Pylori produces bicarbonate to protect itself and can damage parietal cells, eventually causing hypochlorhydria.
86
When H. Pylori penetrates the gastric mucosa, it allows stomach acid and _____ to degrade tissues leading to ___________.
Pepsin, leading to peptic ulcers.
87
What is the normal ph range of gastric secretions.
1.5-3.5
88
What can lead to hyperchlorhydria?
Acute stress, elevated histamine, infections, and certain medical conditions.
89
In the stomach, histamine stimulates _______ pf the parietal cells that secrete acid.
H2 receptors.
90
Why are some acid-blocking medications anti-histamines?
Because they work by blocking H2 receptors in the stomach.
91
What is acid reflux?
The movement of acid into the esophagus.
92
What is the heartburn?
A symptom of reflux, the pain that comes from it.
93
What is GERD?
Gastroesophageal reflux disease, chronic and associated with acid reflux.
94
Acid reflux is closely related to the function of the _______ .
LES
95
What are all the things that LES function can be affected by?
1. Muscle/sphincter atrophy.
2. Excessive intra-abdominal pressure.
3. Hiatial hernia (when the upper portion of the stomach protrudes)
4. Food allergy/sensitivities/intolerance.
5. Relaxants (alcohol, peppermint, caffeine)
6. Overeating.
7. Medications - Antihistamines, pain relievers, anti-depressants, sedatives, and some blood pressure medications.
8. Damage to the vagus nerve.
9. Hypo/hyperchlorhydria.
96
Low stomach acid can impair _______ function and delay _______ gastric emptying because ______________.
Can impair LES function and delay gastric emptying as the LES gets the signal to tighten in part by the pH of the stomach.
97
Hychlorhydria also cause weaker activation of pepsin which leads to ____________.
Extended presence of maldigested food in the stomach that can increase gas, cause back pressure on the LES, and worsen reflux.
98
Reflux from hypochlorhydria may produce more intense symptoms of __________ .
Heartburn.
99
Reflux stemming from low acidity that produces less heartburn is known as ___________.
Silent reflux.
100
GERD is diagnosed when reflux occurs more than _______.
Twice a week and damage to the esophagus has occurred.
101
Why do you want to be cautious when supplementing with HCL?
GERD can overtime lead to a condition called Barrett's Esophagus in which tissue damage leads to an increased risk of esophageal cancer.
102
What is delayed gastric emptying? And what are some of the symptoms it causes?
When more than 10% of a meal remains in the stomach after 4 hours. Can cause symptoms like belly aches, bloating, reflux, belching, and dysbiosis.
103
What are some of the top contributing factors to delayed gastric emptying?
Damage to the vagus nerve (common in diabetes), hypo or hyperchlorhydria, duodenum dysfunction and medications that slow gastric motility.
104
What can cause the signaling to the pancreas to be compromised? And what can this cause?
Anything that impairs upstream signaling such as hypo and hyperchlorhydria, vagal nerve dysfunction, infections, etc. This can compromise the release of bicarbonate and enzymes.
105
General suboptimal pancreatic function may improve by ___________.
Supporting digestive function, short-term enzyme supplementation, reducing gastric inflammation, etc.
106
What does EPI stand for?
Overt Exocrine Pancreatic Insufficiency.
107
What is cholestasis?
The slowing or stalling of bile flow through the biliary system.
108
Bile congestion can develop in the gallbladder due to _________ and can lead to _________.
Can develop from impaired/delayed contraction and emptying of bile. And it can lead to gallbladder inflammation and gallbladder stones.
109
Low bile viscosity and clearance can be due to __________?
Nutrient deficiencies, physical obstructions, elevated cholesterol, blood sugar dysregulation, hormones, and more.
110
Impaired bile secretion for the gallbladder can lead to _________?
Impaired dietary fat digestion, microbial overgrowth in the intestines, and a build of toxins and metabolic waste.
111
Define dysbiosis.
A broad term referring to an imbalance in the intestinal microbiome.
112
What are some of the common patterns of dysbiosis?
1. Loss of beneficial bacteria/diversity. 2. Overgrowth of harmful or opportunistic species (Candida & SIBO) 3. Parasitic/Viral 4. Protein putrefaction.
113
Dysbiosis of ___________ bacteria is common.
Gram-negative bacteria.
114
What does gram-negative bacteria cause?
Their cell walls contain lipopolysaccharides (endotoxins) that when released into the digestive system at high levels can elicit severe inflammation, degradation of the mucosal membrane, and increase intestinal permeability.
115
Ongoing inflammation in the small intestine can lead to _______.
Increased production of antibodies known of immunoglobins to food particles.
116
What is one of the markers for increased hyperpermeability?
Increased zonulin.
117
What is zonulin?
A protein that plays a role in regulating the permeability of the intestinal tract. It is produced by the cells lining the small intestine and acts as a "molecular gatekeeper" to control what substances can pass from the gut into the bloodstream.
118
What happens when there are elevated levels of zonulin in the SI?
It disassembles the tight junction proteins loosening control over what is absorbed into circulation.
119
What are the two main categories of food reactions and describe each.
Immunologic and non-immunologic. Immunologic reactions are characterized by the production of antibodies including IgE (classic allergies) and IgG4 (food hypersensitivities). Non-immunologic reactions are functional intolerances related to the body's ability to digest certain dietary components.
120
Give an example of immunologic vs non-immunologic food reactions?
Someone could have IgG driven hypersensitivities to the protein casein in milk (immunologic) vs. someone is lactose intolerance due to a lack of lactaid enzymes needed to digest the lactose (non-immunologic).
121
What happens if the ileocecal valve is stuck closed?
Chyme remains in the small intestines too long, leading to an increase of waste product reabsoprtion and then leading to liver congestion.
122
What happens if the ileocecal valve is stuck open?
It can allow microbes and waste to back flow into the small intestines causing SIBO.
123
What are some of the contributing factors to ileocecal valve dysfunction?
Stress, constipation, poor signaling from the vagus nerve, infections, and alterations to the appendix.
124
What does the fiber do in the large intestines?
Feeds beneficial bacteria, pulls water into the stool, adds bulk to stimulate peristalsis, and binds toxins and metabolic waste that came in via bile.
125
What can a lack of fiber contribute to?
Reduced SCFA production, increased risk for diverticulitis, increased risk of IBS/IBD, and lower intestinal serotonin production.
126
What are some things that increase gut motility?
Bacterial fermentation that produces compounds such as SCFAs, bile acids, and methane.
127
What are two things that are key for preventing constipation?
Hydration and mineral balance.
128
What are some other contributing factors to constipation?
Bile stagnation, low thyroid function, sedentary lifestyles.
129
What is diarrhea a symptom of?
Irritation and inflammation in the intestines.
130
What causes diarrhea?
When the body pulls water into the intestines to speed defication.
131
What are some of the triggers for diarrhea?
Viral/bacterial infections, dysbiosis, adverse food reactions, malabsorption of dietary fats or certain sugars such as lactose, medication, visceral hypersensitivity, and stress.
132
What is the name of the stool chart?
Bristol Stool Chart
*Review notes of what each could indicate.
133
What are the foundations of a nutrient dense diet?
High fiber foods, high polyphenol foods, organic/pasture-raised/grass-fed/wild caught foods, eating nose-to-tail, fermented foods, herbs/spices, and connection/community.
134
Stress can impair digestion in what ways?
Motility, secretions, permeability, and microbial balance.
135
Disrupted sleep can impact digestion on what ways?
General inflammation, tissue repair, constipation, microbial perturbations, central nervous system, and hormones.
136
Blood sugar dysregulation = a higher incidence of digestive symptoms due to its effect on _____________.
The vagus nerve, migrating motor complex, and dysbiosis.
137
What is GALT and where is it located?
GALT stands for gut-associated lymphoid tissue. It can be found in the small and large intestines and in the appendix within the mucosa and submucosa layers.
138
What is the primary function of the GALT?
GALT's primary function is to regulate the immune response to antigens in the gut, which helps protect against infection.
139
What percent of immune cells does the gut contain?
70-80%
140
What is SlgA, where is it found, and what is its primary function?
It stands for secretory immunoglobin A. It can be found in various secretory fluids, including saliva, breast milk, and nasal, gastrointestinal, bronchial, and urogenital secretions at high levels of concentration. It serves as the first line of defense in protecting the intestinal epithelium from enteric toxins and pathogenic microorganisms and can neutralize pathogens and toxins before they breach the body's barriers.
141
What role does beneficial bacteria play in regards to immune function?
Reduce the antigenicity of the chyme, nourish epithelial cells/SCFAs, crowd out pathogens, and increase regulatory T cells.
142
What is autoimmunity?
When the immune system becomes autoreactive and forms antibodies against self tissue.
143
What are the three aspects of the three legged stool of autoimmunity?
Genetic predisposition (human leukocyte antigen genes or HLA), environmental triggers, and intestinal permeability.
144
What are some of the connections between the digestive system and autoimmunity?
Autoimmune conditions and altered microbiomes. Hypochlorhydria and autoimmune conditions. Infections/H. Pylori and autoimmune conditions.
145
What is T cell polarization?
The process by which T cells become specialized to fight specific infections.
146
What is the primary function of T regulatory cells and what stimulates their production?
They work to maintain immune balance, tolerance and prevent autoimmune diseases. Beneficial bacteria has been shown to stimulate them.
147
What are T17 cells and what are they associated with? Also, what stimulates their production?
They are a subset of immune cells that play a role in the immune response and inflammation as they produce cytokines that promote inflammation and tissue damage. They are found to be elevated in people with auto-immune conditions. They are stimulated by dysbiosis.
148
Explain the imbalance between TH1 and TH2 cells.
An imbalance between Th1 and Th2 immune responses, where Th1 cells are involved in cell-mediated immunity and Th2 cells in humoral immunity, can lead to various diseases, including allergies, autoimmune disorders, and increased susceptibility to infections.
149
What is the livers function regarding hormones in terms of immunity?
The liver can activate, clear, and/or secrete hormones.
150
What is the relationship between hypothyroidism and digestion?
Thyroid conditions such as hypothyroidism can slow gastric secretions, impair peristalsis, impair motility, impair gastric emptying, and increase intestinal permeability.
151
People suffering from _________ have an increased risk for developing autoimmune disorders.
Dysbiosis.
152
What is the two way street between the adrenals and digestion?
Intestinal dysbiosis can lead to an overreactive HPA Axis and vice versa.
153
What supplements may help normalize the HPA Axis?
Prebiotics and probiotics.
154
Digestive disorders are associated with an increased rate of male infertility due to?
Nutrient malabsorption and poor microbiome health affects sperm health.
155
How is digestion related to the health of the female reproductive system?
The digestive system absorbs needed cofactors and building blocks.
156
Reproductive disorders go hand in hand with ___________? Give some examples.
Inflammatory/autoimmune disorders. Examples include endometriosis, PCOS, irregular menstruation, infertility, and pregnancy loss.
157
Insulin resistance can contribute to ________ dysfunction and _________ can contribute to insulin resistance.
Ovarian dysfunction, poor digestive health/dysbiosis.
158
Define the estrobolome.
The collection of bacteria and other microorganisms in the gastrointestinal tract that play a role in the metabolism and regulation of estrogen.
159
_______________ producing bacteria in the digestive system can reverse estrogen clearance and increase circulating estrogen levels which can lead to _______________.
B-Glucoronidase Producing Bacteria. Can lead to conditions related to estrogen dominance.
160
Define atherosclerosis.
Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls.
161
What is the link between bile acids and atherosclerosis?
Bile acids help break down fat and help regulate cholesterol by promoting its secretion, reducing risk for atherosclerosis. Some beneficial bacteria strains have been shown to increase BA production and to in turn lower bad cholesterol levels.
162
What are lipopolysaccharides and what is there relationship to cholesterol?
Lipopolysaccharides (LPS) are complex molecules found in the outer membrane of Gram-negative bacteria. They play a crucial role in maintaining the structural integrity of the bacterial cell wall and protecting it from external threats. They have been shown to increase LDL "bad" cholesterol.
163
What condition is considered pro-atherogenic?
Oral dysbiosis/peridontal disease/gingivitis.
164
What are short-chain fatty acids?
Short-chain fatty acids (SCFAs) are small fatty acids, containing less than six carbon atoms, produced primarily by gut bacteria through the fermentation of dietary fiber and resistant starch in the colon.
165
What are the three main SCFAs and what role do they play in the body?
The main SCFAs are acetate, propionate, and butyrate, which play a vital role in maintaining gut health and influencing various aspects of metabolism and immunity.
166
What are some of the key health benefits of SCFAs?
They help maintain the integrity of the gut barrier. They lower blood lipid levels. Bacteria strains that produce SCFAs have been found to lower risk for heart disease and hypertension.
167
What is TMAO? What can elevated levels lead to?
Trimethylamine-N-Oxide is a chemical compound produced in the gut by bacteria that metabolize choline, betaine, and carnitine. It is naturally occuring and non-problematic at low levels. However elevated levels are proinflammatory and a marker for atherosclerosis.
168
Elevated dysbiosis such as SIBO increases the risk of developing _____________?
Cardiovascular disease.
169
Describe the gut brain axis?
The vagus nerve connects the CNS to the ENS, meaning the gut and the brain are direct connected via a two way street.
170
What percentage of signals travel down from the brain to the gut and what percentage travel up from the gut to the brain?
10-20% of signals travel down to the gut and 80-90% travel up to the brain.
171
Beneficial bacteria in the gut produce _________. Give some exmaples.
Neurotransmitters such as serotonin, dopamine, noradrenaline, etc.
172
Enteric endocrine glands and beneficial bacteria in the gut produce up to __________% of neurotransmitters.
50-90%
173
Some neurotransmitters will ___________ but majority will stay in the __________ impacting mental function.
Some will get absorbed in the bloodstream, but majority will stay in the gut/enteric nervous system.
174
What are the benefits of SCFAs for the brain?
SCFAs move from the gut to the brain where they play a protective role against many neurological conditions. They also increase neurotrophic factors (BDNF).
175
What are the benefits of neurotrophic factors?
PROMOTES THE GROWTH MATURATION, AND BRAIN PLASTICITY. They protect neurons from degeneration and apoptosis (cell death). They stimulate neuronal growth:
encourage the extension of new neurites (axons and dendrites) and the formation of synapses (connections between neurons).
They enhance synaptic plasticity:
NTFs regulate the strength and function of synapses, contributing to learning and memory.
They support neurogenesis:
promoting the production of new neurons in the brain and peripheral nervous system.
176
Low levels of BDNF are associated with?
Neurodegenerative diseases.
177
BDNF are increase by serum SCFAs from ________ and ________.
Dietary fiber and beneficial microbes.
178
The ________ barrier and the _______ have similar structures and functions.
Intestinal barrier and blood brain barrier.
179
Systemic inflammation leads to _________.
Brain inflammation.
180
What is leaky brain?
When the tight junctions of the blood brain barrier are impaired.
181
How can trauma and adverse childhood events (ACEs) effect the digestive system.
It can lead to HPA Axis dysregulation which can compromise the git lining and change the composition of the gut microbiome.
182
What are cofactor vitamins and minerals? Give an example in relation to digestion.
They supply the require nutrients for form and function, including the activation, regulation, and building blocks for enzyme reactions. For example, zinc is a cofactor for the production of HCL.
183
What are the benefits of mucus membrane support and what are some examples?
Soothe tissues and bolster the protective mucus coating of the upper GI and intestines. Examples include demulcent herbs such as marshmallow root, slippery elm bark, aloe vera.
184
What are the benefits of tissue repair support for the digestive system and what are some examples?
They speed the processes of cell renewal and tissue repair. L-Glutamine is an example as it promotes enterocyte proliferation, regulates tight junction proteins, and lowers inflammation.
185
What are some of the benefits of digestive stimulants and give some examples.
They help elicit the body's own digestive secretions. Examples include bitters, specifically gentian root.
186
What are digestive replacements and give some examples.
They are digestive or hormonal compounds either synthetically produced, animal or plant based. Examples include Betaine HCL, OxBile, Digestive Enzymes, etc.
187
What do immune modulators do and give some examples.
They directly inhibit, stimulate, and modulate the production of transcription factors on immune related genes, immune signaling compounds and functions of immune cells. Examples include quercetin, nettles, mast cell stabilizers to reduce histamine release.
188
What are glandular extracts and give an example.
Extracts derived from glands of animals that may exert hormonal, enzymatic, and nutritive effects in the corresponding glands of people taking them. An example is freeze dried adrenal tissue.
189
What do microbiome modulators do?
They directly alter microbial populations via inoculation, prebiotics, or antimicrobials. Examples include probiotics, oregano.
190
What are adaptogens? Give an example.
Plants containing unique phyto chemicals which normalize the stress response, which in turn can support digestion and microbiome health. An example include red ginseng.
191
Define a toxin.
A poisonous substance that is a specific product of the metabolic activities of a living organism and is usually very unstable, notably toxic when introduced into the tissues, and typically capable of inducing antibody formation.
192
What are some other examples of toxins?
Some synthetic chemicals, environmental pollutants, and pharmaceutical medications.
193
Define body burden of toxins?
The concentration of an amount of a chemical/toxin present in the body at a specific moment.
194
What is the biological half-life of toxins?
The time it takes for the body to reduce the chemical concentration by half, assuming there are NO further intakes.
195
What factors all impact clinical relevance of toxin exposure?
Reactivity to the compound, half life of the toxin, total exposure, and genetics.
196
Define bioaccumulation of toxins.
Increased body burden that occurs when the interval between exposures is short compared to the biological half-life.
197
What is biotransformation in terms of toxins?
The biochemical processes that convert potentially harmful foreign compounds and metabolic waste into harmless forms that can be safely expelled from the body.
198
Biotransformation and elimination of toxins is ______ driven and ______ dependent.
Enzyme driven and nutrient dependent.
199
What are the three phases of biotransformation and elimination.
1. Activation 2. Conjugation 3. Elimination
200
Define phase I activation of biotransformation.
Modifying the original chemical shape of the target molecule or toxin.
201
Define phase II conjugation of biotransformation.
Adding another (more friendly) chemical group.
202
What two phases are considered to be biotransformation?
Activation and conjugation.
203
Elimination is _______.
The removal of the toxin from the body.
204
Some toxins/compounds don't need both phase I and II and can _______.
Be eliminated after just phase I or just phase II.
205
What do phase I enzymes of biotransformation do?
Alter the chemical structure of toxins through oxidation, reduction or hydrolysis.
206
Phase I enzymes can increase the ___________ of toxins making them less able to ___________?
Water solubility, making them less able to cross the cellular membranes and deposit in tissues and be more likely to be excreted through the urine or sweat.
207
Phase I enzymes are used to activate and metabolize ______.
Endogenous compounds like hormones.
208
Phase I enzymes can produce _________?
More reactive/intermediate toxins.
209
What are two examples of phase I enzymes?
Cytochrome P450 Enzymes (CYP450) and Paraoxonases 1 (PON1)
210
Define Cytochrome P450 Enzymes (CYP450) .
The primary workhorse enzymes of phase I. They are membrane bound enzymes found in cells of the liver, kidneys, pancreas, adrenals, intestines, skin, and placenta. They Work on different toxin substrates like drugs, hormones, etc.
211
Define Paraoxonases 1 (PON1)
Are attached to high density lipoproteins (such as HDL cholesterol particles) and act on environmental toxins and help break down and metabolize oxidized lipids.
212
In phase II, the _________ of toxins is enhanced making compounds more _______.
Water solubility, hydrophilic.
213
What occurs in phase II?
Enzymes conjugate toxins and modified phase I intermediates with another chemical group in order to neutralize toxins and prepare them for phase III elimination.
214
What are the two types of nutrient based cofactors required for phase II?
Those that are transferred to the toxin and those that allow transferase enzymes to function.
215
List all of the phase II processes.
Glutathione conjugation, amino acid conjugation, glucuronidation, sulfation, methylation, and acetylation. *See notes on each of these.
216
What does the elimination process rely on to carry out its primary function?
Enzymes, hydration, transport proteins, genes, and circulation.
217
What is gluten intolerance? Give some examples.
The body's inability to process and metabolize glucose effectively. Examples include prediabetes and type II diabetes.
218
What is glycation?
The process that occurs when glucose molecules in the bloodstream bind to proteins or lipids. They form advanced glycation end products (AGEs)
219
Describe reative hypoglycemia.
A state of low blood sugar (<70 mg/dl) that occurs within a few hours after eating typically resulting in excessive insulin release in response to a high glycemic meal or beverage.
220
What are some of the symptoms of reactive hypoglycemia?
Headaches, brain fog, hunger, cravings, anxiety, mood swings, disrupted sleep, feeling jittery between meals.
221
What is insulin resistance or hyperinsulinemia?
A metabolic condition in which the body's cells become less responsive to the hormone insulin, leading to elevated blood sugar levels. Loss of sensitivity specifically in the muscle, fat, and liver cells.
222
What are some of the symptoms associated with insulin resistance?
Elevated blood pressure, dyslipidemia, inflammatory conditions, fatigue, weight gain, hormonal imbalances.
223
Define metabolic syndrome.
A cluster of interconnected metabolic abnormalities in which someone meets 3 out of 5 criteria. 1. Abnormal obesity 2. Elevated triglycerides 3. High blood pressure 4. Elevated fasting glucose 5. HDL below 50 mg/dl
224
What are the metrics for prediabetes?
Fasting blood glucose 100-125 mg/dl and a two hour postprandial reading of 140-199 mg/dl.
225
What are some of the symptoms of prediabetes?
Increased thirst, frequent urination, fatigue, blurry vision, and increased hunger.
226
What is Type II Diabetes?
A chronic condition characterized by insulin resistance and insufficient insulin production, resulting in elevated blood sugar levels above 200 mg/dl and a HbA1c above 6.4.
227
What are some of the symptoms of T2D?
Extreme hunger or thirst, persistent hunger even after meals, frequent or increased urination, tingling sensations in the hands and feet, chronic fatigue, frequent infections.
228
Define Type I Diabetes.
Autoimmune destruction of pancreatic beta cells. There is a genetic predisposition (HLA Class II Genes) but there is also some identifiable environmental factors that can contribute to its onset such as early exposure to A1 beta casein in cow's milk.
229
What are the four main ways in which blood sugar dysregulation impacts the digestive system?
Increased GI complaints, vagal nerve and gastric motility issues, non-alcoholic fatty liver disease and dysbiosis.
230
How does blood sugar dysregulation lead to gastric motility issues?
Chronically elevated blood sugar levels reduce the cycle length of the MMC.
231
Non-Alcoholic Fatty Liver Disease is often caused by _________ intake and is associated with an increased risk for __________.
Excess sugar, GERD and other digestive complaints.
232
How are stress and reactive hypoglycemia related?
The body views blood sugar crashes as an emergency, placing a burden on the hypothalamus-pituitary-adrenal axis or HPA axis.
233
Hyperinsulinemia actives the _________.
The sympathetic nervous system.
234
Chronic stress and elevated cortisol lead to __________?
An increase in blood glucose as glucose is released from storage to help with the emergency and an increase in insulin resistance.
235
Foods high on the glycemic index scale increase the likelihood of ________?
Depression, anxiety, and stress.
236
What ways does blood sugar dysregulation effect mental health?
BSD elevates cortisol, it disrupts the balance of neurotransmitters as serotonin and dopamine activity is reduced, it disrupt's the brains energy supply, and it alters the gut microbiome.
237
Proteins and lipids of the vascular endothelium are vulnerable to _________?
Glycation.
238
What ways can hyperinsulinemia increase blood pressure?
Increases sodium retention, activates the sympathetic nervous system,
239
What is hyperinsulinemia?
Is a condition characterized by elevated levels of insulin in the bloodstream, causes endothelial dysfunction.
240
In what ways does BSD lead to endothelial dysfunction?
It impairs nitric oxide production and low nitric oxide = poor vasodialation. It increases vasoconstrictors and adhesion molecules.
241
What is endothelial dysfunction?
Endothelial dysfunction is a condition where the inner lining of blood vessels (endothelium) does not function properly.
242
What four things can hyperglycemia and hyperinsulinemia promote in regards to lipids?
Dyslipidemia, hyperlipidemia, dysregulated lipid storage, and impaired lipid oxidation.
243
What is dyslipidemia?
An increase in LDL production (atherogenic) and a decrease in HDL production (cardio protective).
244
What is hyperlipidemia?
An increased lipid production from the conversion of glucose into fatty acids/triglycerides for storage.
245
Describe dysregulated lipid storage.
Insulin resistant adipocytes have impaired lipid uptake leading to lipids being redirected to ectopic and visceral fat. An example is NAFLD.
246
Describe impaired lipid oxidation.
Insulin blocks the enzymes needed to convert lipids into energy.
247
What are the characteristics of AGEs?
They deposit in nerve tissue, myelin-reducing nerve function, and promote neuronal cell death.
248
What is peripheral diabetic neuropathy?
The most common diabetic complication. When hands, toes, fingers, and feet are swollen. Can effect the heart, enteric nervous system and vagal nerve.
249
What is diabetic retinopathy?
Damage to the retina and optic nerve due to diabetes.
250
Hyperglycemia damages ______________.
Blood vessels in the brain.
251
Insufficient oxygen leads to __________?
Brain atrophy and cognitive problems.
252
What conditions are seen higher in those with diabetes?
All-cause dementia and Alzheimers.
253
Alzheimer's is sometimes referred to as ___________?
Type III Diabetes
254
What percentage of Alzheimer's patients have impaired fasting glucose levels?
80%
255
BSD is linked to Alzheimers because insulin dysregulates the expression and clearance of amyloid beta and tau.
256
How does BSD effect the immune system?
It leads to persistent inflammation. This is a two way street because chronic inflammation impairs insulin's signaling and elevated glucose and free fatty acids stimulate inflammation.
257
Describe the impaired immune response seen in patients with metabolic syndrome/T2D?
Infections can thrive off high glucose, impaired ability to recognize and combat infections, and impaired wound healing.
258
When consuming ____________ you are at a greater risk for developing T2D than if you consumed the same total volume of sugar from other foods.
Sweetened beverages.
259
What are the four main categories of sweeteners?
1. Caloric 2. Natural Non-Caloric 3. Sugar Alcohols 4. Artificial Sweeteners
260
Diets that contain low ______ and high ______ have been show to improve insulin resistance, glucose levels, HbA1c, triglycerides, and aid weight loss. What is the name for this diet?
Low carb, high fat. Ketogenic diet.
261
What is the breakdown of carbs, protein and fats within the keto diet?
10% carbohydrates, 25% protein, and 65% fat.
262
On a keto diet what should your net carbs stay around?
Your daily net carbs should be around 20-50 grams.
263
What are the benefits to a cyclical ketogenic diet?
Metabolic flexibility and diet diversity.
264
What are some BSR benefits of Omega-3s?
They increase insulin sensitivity and are anti-inflammatory.
265
List all of the metabolic benefits of protein?
1. High protein foods have lower glycemic loads. 2. They take longer to digest than carbs 3. They have the highest satiety value 4. High protein breakfasts lower blood sugar levels and reduce appetites later in the day 5. Have a higher thermic effect as converting protein to energy requires more energy.
266
What are branch chain amino acids? Give three examples.
Branched-chain amino acids (BCAAs) are a group of three essential amino acids: leucine, isoleucine, and valine.
267
What are the pros and cons of BCAAs?
BCAAS stimulate insulin. It is a pro when building muscle as it can help clear blood glucose more quickly. But high levels of BCAAs can contribute to insulin resistance in those who already have metabolic conditions.
268
What are some examples of protective amino acids? What are some cons of these?
L-Carnitine, glycine, and plant-based proteins. Some of the plant-proteins can cause GI issues and heavy metal accumulation.
269
What all the metabolic benefits of fiber?
Slows the absorption of sugar in the intestines. Improves insulin response. Improves serum lipid profiles (cholesterol). Promotes a sense of fullness and reduces cravings. Supports healthy blood pressure. Supports body weight regulation.
270
What are the two types of fiber and which is most beneficial for blood sugar regulation?
Soluble and insoluble are both beneficial. But soluble has been deemed more effective in helping regulate blood sugar.
271
What is one lifestyle habit show to positively effect blood sugar levels?
Time restricted eating.
272
When restricting eating at night rather in the morning showed?
Improved glucose intolerance, insulin function, and lower BMI
273
For healthy blood sugar levels it is best to stop eating _____>
3-4 hours before going to bed.
274
What is the ideal therapeutic fasting window?
6-10 hours
275
What does PAALS stand for?
The five key peripheral organs that are involved in blood sugar regulation. Pancreas, adrenals, adipose tissue, liver and skeletal muscle.
276
What two hormones are produced in the pancreas that relate to BSR?
Glucagon and insulin.
277
What is the primary role of glucagon?
It helps catch the lower range of blood sugar levels and brings glucose back to normal by pulling glucose out of storage.
278
What is the primary function of insulin?
Helps to bring blood sugar levels down by bringing glucose out of the circulating bloodstream and move it into the cells.
279
What hormones are produced in the adrenals?
Cortisol, adrenaline and noradrenaline.
280
Both _____ and _____ kick in when stressed and pull glucose from storage.
Adrenaline and noradrenaline.
281
______ works alongside glucagon to make sure we don't get hypoglycemic.
Cortisol
282
During fight or flight, but also when we aren't stressed, cortisol __________?
Pulls glucose from storage.
283
What are triglycerides?
Packed glucose.
284
__________ is the primary storage site of triglycerides and effects BS by secreting _____ controlling appetite.
Adipose tissue, leptin.
285
The _____ is the mast in commend of BSR
The liver.
286
The liver does the bulk of the conversions from one fuel form to another, such as in ___________, and is also the storage site for __________.
Gluconeogenesis, glycogen.
287
Skeletal muscle is a storage site for _________ .
Glycogen
288
Glycog =
Stored glucose (glycogen)
289
Genesis =
To create.
290
Lysis =
To break apart.
291
Lipo =
Lipid/fat.
292
Neo =
New
293
Define gluconeogenesis.
Creating glucose from non-carbohydrate sources, occurring in the liver.
294
Define glycolysis.
Breaking glucose down to create ATP
295
Define glycogen.
Storage forms of glucose that are stored in liver and muscles.
296
Define glycogenolysis.
Breaking glycogen down into glucose.
297
Define glycogenesis.
Creating glycogen from glucose.
298
Define lipogenesis.
Creation of new fatty acids and triglycerides from glucose.
299
Define lipolysis.
Liberating stored fat to then be oxidized as fuel.
300
What is a normal blood sugar level after not eating for several hours?
70-90 mg/dl
301
Simple carbohydrates include? They are ______ to digest.
Monosaccharides and disaccharides. They are easier to digest.
302
What do complex carbohydrates include? They take ______ to digest.
Oligosaccharides and polysaccharides. They take longer to digest.
303
Monosaccharides will be directly absorbed into the _______?
Upper portions of the SI
304
Give some examples of monosaccharides?
Glucose, fructose and galactose.
305
Dissacharides will be broken down into monosaccharides by the ____________ .
Brush border enzymes of the small intestines.
306
Give some examples of disaccharides.
Sucrose, lactose, and maltose.
307
Some polysaccharides such as _________ and _______ will resist digestion and pass into the colon.
Resistant starch and fiber.
308
Once we consume a carbohydrate meal our blood sugar gradually rises to the upper normal range of about _________?
120-140 mg/dl
309
As blood sugar rises in signals the __________ to prepare for the incoming macronutrients and help maintain glucose homeostasis.
PAALS
310
PAALS is activated by ________?
Neurological and hormonal signals from the brain and CNS
311
What are some other signaling compounds from the digestive tract?
Incretins, GLP1, and glucose-dependent insulinotropic peptide.
312
What does GLP-1 stand for?
Glucagon-like-peptide 1
313
As blood sugar rises the pancreas secretes ________ to stimulate the movement of glucose from the blood into the cells.
Insulin
314
How does insulin move glucose into the cells?
It docks on cell receptors which then trigger the movement of transporter proteins to the cell membrane, which act as a channel for the glucose.
315
What are GLUTs?
Glucose transport proteins.
316
Once glucose is inside the cells, _______ takes place and splits glucose into two ______ molecules leading to cellular respiration.
Glycolysis, pyruvate molecules.
317
Define cellular respiration, where it takes place and what it produces?
The process that breaks down food to produce energy for cells. It takes place in the mitochondria using the citric acid cycle and electron transport chain. ATP energy is produced.
318
If there is already enough energy supply, _______ will tell the body to ________?
Insulin, to store the surplus glucose as glycogen in the liver and in the skeletal muscles.
319
Once the storage sites of the liver and skeletal muscles are full, surplus glucose will then be stored in ________ as triglycerides.
Adipose tissue.
320
The storage surplus of glucose as glycogen is known as _______ and the storage surplus of glucose as triglycerides is known as _________.
Glycogenesis, lipogenesis.
321
Once we stop consuming carbs and proteins and insulin achieves its goal of moving glucose into the cells for energy and storage ______?
Our blood sugar levels decline back to normal ranges.
322
What factors determine the time it takes for blood sugar levels to return to normal ranges following a meal?
Meal composition, time of day, body composition, and activity levels.
323
What are the three metabolic pathways through glycogen and adrenal hormones help raise blood glucose levels?
Glycogenolysis, glyconeogenesis, and lipolysis.
324
Define glycogenolysis.
Converts glycogen in the live and muscles into glucose.
325
Define gluconeogenesis.
Converts non-carbohydrate sources (protein, lactate, glycerol) into glucose.
326
Define lypolysis.
Utilizes adipose stores for energy through fatty-acid beta oxidation.
327
If dietary carbs and glycogen levels are depleted long enough the ______ can increase the use of fatty acids and ketogenic amino acids ______ and _______ to produce _________ as a primary fuel source.
The liver, ketogenic amino acids leucine and lysine to produce ketone bodies as a primary fuel source.
328
What are the three main ketone bodies?
Acetoacetate, acetone, and beta-hydroxybutyrate.
329
Define metabolic flexibility?
The body's ability to use both glucose, amino acids and fatty acids as fuel sources.
