W7 Primer Questions: Nutrition for Specific Disease/Conditions

Question 1

Acne occurs in 3 forms including (select all that apply)

a. Acne vulgaris
b. Acne rosacea
c. Acne conglobata
d. Acne bachongata

Answer 1

a. acne vulgaris - Pimples. The formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of hair follicles and their accompanying sebaceous gland. Acne develops on the face and upper trunk. It most often affects adolescents.
b. acne rosacea- Acne accompanied by a red rash, most commonly found on the face, often on women with fair white skin.
c. acne conglobata- A form of nodulocystic acne where cysts and nodules begin to grow together deep below the skin. This is a rare but very serious form of acne, primarily found on the face, back, and chest, often forming deep scars.

Question 2

Foods to avoid if one has acne include (select all that apply):

a. sugar
b. iodine
c. fried foods
d. milk
e. citrus fruits

Answer 2

a, b, c, and d.

iodine -It has been hypothesized that the association between acne and milk may be a result of the iodine content of milk which can vary with time of year, location, supplementation of animal feed and use of iodophor-sanitizing solutions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884775/. Excess excreted in urine, feces and sweat - link to acne.

Question 3

Nutrients to consider in an acne patient include (select all that apply):

a. zinc
b. chromium,
c. vitamin A
d. vitamin E
e. Selenium

Answer 3

All of the above. Zinc is anti-inflammatory, selenium aids in glutathione peroxidase production which reduces inflammation, chromium, vitamin A and E help to reduce scarring/wound healing.

Question 4

_____% of individuals with HIV will experience some sort of malnutrition from alterations in intake, absorption, and metabolism.

a. 10-15%
b. 30-50%
c. 50-80%

Answer 4

c. 50-80%.

due to this, muscle wasting is common and mortality is closely related to weight loss. Thus, immune system impairment is due to the HIV infection AND the resulting malnutrition combined.

Question 5

For individuals with HIV, protein intake should aim for:

a. 0.8 g/kg body weight
b. 1.1 g/kg body weight
c. 1.8 g/kg body weight
d. 2 g/kg body weight

Answer 5

d. 2 g/kg body weight.

Early nutrition assessment, attention to nutritional requirements, and prompt intervention can minimize muscle wasting and replete cell body mass.

Question 6

Daily use of _________ in an HIV infected individual can reduce the risk of declining CD4+ T lymphocyte counts, extend the latency period of the development of overt disease by years, and extend survival time.

a. Magnesium, zinc, and copper
b. a multi-vitamin
c. COQ10
d. Niacin

Answer 6

b. a multi-vitamin

Question 7

True or false? For patients with HIV and AIDS a focus should be on antioxidants, as these patients have high levels of oxidative stress.

Answer 7

True.

Question 8

Supplemental antioxidant/s to consider in an individual with HIV/AIDS include:

a. beta carotene
b. Glutathione
c. NAC
d. all of the above

Answer 8

d. all of the above.

beta carotene increases number of circulating CD4+ helper T-lymphocytes.

Glutathione and NAC reduce oxidative stress, extend latency period, and inhibit HIV replication.

All of the above can accelerate cellular apoptosis.

Question 9

Fiber should not be increased in the case of:

a. pancreatitis
b. Crohn’s disease
c. acute bowel inflammation
d. anal fissure

Answer 9

c. acute bowel inflammation.

Fiber can exacerbate this condition, therefore symptomatic relief should be obtained through a fiber-restricted diet until inflammation is resolved.

Question 10

Chronic alcoholism will produce fatty infiltration of the liver with excessive accumulation of ______ and hypersensitivity to _______ toxicity.

a. short chain fatty acids, vitamin A
b. vitamin A, vitamin A
c. vitamin A, long chain fatty acid

Answer 10

b. vitamin A, vitamin A

* however:https://academic.oup.com/ajcn/article/69/6/1071/4714859.

Question 11

Chronic alcoholism can produce _______ deficiency, leading to mental confusion, memory loss, delusions, and amnesia (Korsakoff syndrome) or apathy, delusion, and delirium (Wernicke disease).

a. Niacin
b. vitamin B12
c. Thiamin

Answer 11

c. Thiamin

* Korsakoff and Wernicke can occur simultaneously (a.k.a Wernicke Korsakoff syndrome, or alcoholic dementia).

Question 12

True or false. For individuals with anorexia and/or bulimia, the initial assessment should first rule out any unidentified or unspecified food sensitivities?

Answer 12

True.

Question 13

________ deficiency has been associated with loss of taste acuity sometimes present in individuals with anorexia/bulemia.

a. copper
b. zinc
c. magnesium
d. vitamin B6

Answer 13

b. zinc

Question 14

True or false. Electrolytes, fatty acids, zinc, folate, vitamin B12, and calcium are all nutrients at risk for deficiency in someone with anorexia nervosa AND bulimia?

Answer 14

True. Zinc deficiency loss of taste acuity can reinforce loss of interest in food.

Other markers to consider in anorexia nervosa:

1. glomerular filtration rate - decreased leading to inability to excrete nitrogen or concentrate urine.
2. ketosis
3. electrocardiographic abnormalities
4. intestinal atony (lack of tone)
5. Gallstones
6. osteopenia
7. brittle hair and nails
8. hypothyroidism
9. hypercortisolism
10. amenorrhea
11. bone marrow suppression
12. damage to teeth (bulimia)

Question 15

Bile production can be increased by the following:

a. taurine, choline, methionine, and inositol
b. beets, spanish black radishes, and aloe vera extract
c. dandelion root, peppermint tea, artichokes, and rosemary
d. all of the above

Answer 15

a and b

dandelion root, peppermint tea, artichokes, and rosemary do not increase production, however they do increase rate of bile flow.

Question 16

True or false? To nutritionally support burn injuries, a nutritionist should increase fluid intake, protein intake, vitamin A, vitamin C, vitamin E, and/or zinc.

Answer 16

True. Vitamin A, C, E and zinc accelerate healing.

Question 17

True or false? The best diet to reduce risk of cancer includes one without alcohol, reduced saturated fat, and increased consumption of high fiber foods, carotenoids and vitamin C?

Answer 17

True.

The addition of cruciferous vegetables is also important.

Antioxidant micronutrients including vitamin A, C, E, selenium, and beta carotene are chemoprotective.

Phytochemicals in plants also chemoprotective include: plant flavanoids, sulphorafane, ellagic acid, indoles, flavones, saponins, and triterpenoids.

Question 18

Soy phytoestrogens may be useful in cancer prevention and treatment due to being a weak agonist of _______.

a. testosterone
b. estrogens
c. progesterone

Answer 18

b. estrogens.

1 cup cooked soybean product or 150-200mg soy isoflavones have been found to be weakly anti-proliferative (slows spread of cells) with little estrogenic effect.

Much higher concentrations (virtually impossible to achieve with consumption) they can be estrogenic.

Question 19

The electrical activity of the heart is dependent on ________ ions to assure normal electrical and contraction activity.

a. sodium, potassium, and magnesium
b. sodium, potassium, and calcium
c. sodium, calcium, and magnesium
d. calcium, magnesium, potassium

Answer 19

d. calcium, magnesium, potassium

** blood fluid volume and pressure are dependent on sodium, potassium, and free water homeostasis.

Question 20

In celiac disease, malabsorption can occur of the following nutrients:

a. B vitamins
b. fats
c. sugars
d. iron, calcium, magnesium, zinc
e. all of the above

Answer 20

e. all of the above.

Symptoms secondary to the malabsorption of these nutrients include weight loss, edema, steatorhea, dermatoses, folate-deficiency seizures, anemias, and osteoporosis.

Other symptoms that can occur include bone pain, joint pain, autoimmune disease-like symptoms, and food allergies due to intestinal permeability, GI bleeding, and bacterial overgrowth into the ileum.

Question 21

Gluten is a plant protein complex containing____ prolamins and __ glutenins

a. 10%, 90%
b. 50%, 50%
c. 80%, 20%

Answer 21

b. 50/50

Prolamins induce sensitivity to gluten. Each gluten containing food has a prolamin (i:e wheat contains gliadin, oats contain avenin, barley contains hordein, and rye contains secalin), with all the prolamins sharing an amino acid sequence that is exposed when tissue transglutaminase digests the gluten complex. This exposure of the prolamin amino acid sequence resembles antigens presented by several viruses, bacterial toxins, or hallucinogenic peptides to which the individual has been previously exposed. T lymphocytes of the GALT previously sensitized to these antigens migrate into the intestinal epithelium to generate an inflammatory response (including enteritis and permeability, and IgG secretion). Continued antigenic mis-recognition can lead to chronic enteritis with loss of barrier function and permeability AND if IgG enters the blood, responses that mimic autoimmune disease.

Question 22

To restore intestinal permeability the use of _____ should be considered:

a. digestive enzymes
b. chromium
c. dietary fiber
d. pre/pro-biotic
e. a, c, and d
f. all of the above

Answer 22

e. digestive enzymes (20 min prior to meal), fiber, and prebiotics + probiotics

Question 23

True or false? Excess SCFA’s stimulate cell proliferation, increasing the risk for colorectal cancer, while SCFA deficiency retards cellular apoptosis, increasing the risk for colorectal cancer.

Answer 23

True!

Question 24

True or false? Normal glucose homeostasis requires coordination among insulin, glucagon, corticosteroids, growth hormone, and insulin-like growth factor I?

Answer 24

True.

Question 25

Dumping syndrome and lactose intolerance cause ________ diarrhea, while bacterial/viral diarrhea is known as ________ diarrhea.

a. osmotic, secretory
b. secretory, osmotic

Ulcerative colitis and radiation enteritis cause _______ diarrhea, while Crohn’s disease causes ______diarrhea.

a. Exudative, Limited mucosal contact
b. Limited mucosal contact, exudative

Answer 25

a. Osmotic, secretory

Osmotic - caused by presence of poorly absorbed solutes in the digesta. Secretory - caused by secretion of excess water and electrolytes into the intestinal lumen.

a. Exudative, limited mucosal contact

Exudative - occurs secondary to mucosal damage and is often accompanied by blood, mucus, and plasma proteins. Limited mucosal contact - results from inadequate mixing of chyme with the intestinal epithelium.
*Nutritional therapy for diarrhea is to replenish water with electrolytes such as chicken broth and rice water.

Question 26

True or false? Diverticula are extravaginations of the colonic wall caused by chronically elevated colonic pressures resulting from difficulty propelling small, dry, hard, fecal materials through the lumen of the bowel.

Answer 26

True.

*10-25% of individuals with diverticulosis (the presence of diverticula) develop diverticulitis (inflammation of the diverticula). Nutritional therapy should include a low fat/high fiber (45-55g/day) diet, 2-3 L water daily, and avoidance of nuts, seeds, and plant skins that may damage the extravaginated sections of the colonic wall.

Question 27

Loss of regulation of stomach emptying resulting in excessively rapid passage of incompletely acidified food into the small intestine causing maldigestion and diarrhea is otherwise known as________________.

a. SIBO
b. dumping syndrome
c. H.Pyloritis

Answer 27

b. Dumping syndrome.
* Reduction of meal size and frequency will be helpful for this syndrome, as well as high protein, moderate fat, low starch diet, lying down after eating, avoidance of ingesting liquids with food, and avoidance of simple sugars and milk (too osmotically active).
* Supplementation with MCT, pectin, digestive enzymes and multi-vitamin/mineral is also useful.

Question 28

Treatment for hypochlorhydria include (select all that apply):

a. HCL
b. betaine
c. proton pump inhibitors
d. fiber supplementation

Answer 28

a and/or b (consumed with food)

Question 29

Which of the following occur due to the autoimmune-like destruction triggered from IBD-induced intestinal inflammation?

a. damaged intestinal villi
b. nutrient malabsorption
c. intestinal permeability with pathologic translocation
d. all of the above

Answer 29

d. all of the above

• intestinal permeability remains even after inflammation subsides predisposing the individual to food sensitivities and nutrient intolerances. Increased sensitivity to commensal bacterial also can occur.
• Steroids suppress inflammation however exacerbate malabsorption. NSAIDS reduce inflammation however increase malabsorption, gut damage, and intestinal permeability.

Question 30

About 2/3 of GALT lymphocytes are Th1 T-helper lymphocytes that secrete ________ when activated.

a. IFN-γ
b. IL-1
c. IL-6
d. TNFalpha

Answer 30

IFN-γ

IFN-γ activates local phagocytes and is a chemoattractant for neutrophils. Active lesions in IBD are rich in all of the above (a., b., c., d.) as well as IL-8 and IL-12, all of which increase IFN-γ by Th1 T-helper lymphocytes. Meanwhile, anti-inflammatory IL-2, IL-4, IL-5, and IL-10 are absent.

Question 31

True or false - Butyrate enemas have have been reported to induce remission of symptoms and healing of lesions in IBD?

Answer 31

True.

Butyrate inhibits activation of NF-κB in macrophages and acute butyrate deficiency may predispose to disease activation.

*Oral butyrate has also induced symptomatic relief. Also effective are pre/probiotic combinations with Bifidobacteria, Lactobacilli, fructooligosaccharides, and pectin, which increases fiber fermentation.

• Pectin also stimulates recovery of damaged villi.
• bowel rest is contraindicated, as it will starve enterocytes and colonocytes leading to a delay in healing and exacerbation of lesions.

Question 32

True or false? L-glutamine is effective at accelerating healing in IBD?

Answer 32

True.

*L glutamine at a dose of at least 35g/day orally (in adults) stimulates and increase in glutathione and proliferation of “replacement” enterocytes and colonocytes, resulting in healing of lesions in IBD.

Other helpful remedies include: Omega 3 fatty acids (reduce pro-inflamm cytokines) 1800-2000 EPA with 900-1200 DHA. Herbals inc: Boswelia serrata, cat’s claw, and goldenseal. Also garlic, ginger, licorice root, onion, slipper elm bark powder, turmeric and white willow bark. To improve colonic microbial balance - artemesia, garlic, and goldenseal.

Question 33

Individuals with IBD should avoid foods that stimulate production of ______ .

a. hormones
b. soy
c. prostaglandin PGE2
d. isoflavones

Answer 33

c. prostaglandin PGE2

• Including meat, sugars, and allergenic foods.
• In addition - vitamin and trace mineral deficiencies occur in 50% of IBD cases. Correct calcium, magnesium, zinc, potassium, and antioxidant nutrients. Patients on sulfasalazine should take 800 mcg/day folic acid.

Question 34

True or false? Odorless gas and flatulence is secondary to aerophagia (swallowing air while bolting food) while fragrant intestinal gas is due to methane from fermentation of indigestible stachyose and raffinose (such as in legumes).

Answer 34

True. Digestive enzymes can help with “fragrant gas”

Question 35

True or false? Irritable bowel syndrome (IBS) is characterized by abdominal pain that is relieved by a bowel movement.

Answer 35

True.

In women - symptoms are often exacerbated around and during menstruation, and stress.
Initial onset often surrounds anxiety, traumatic stress, abdominal surgery, fibromyalgia, and/or clinical depression.
*helpful for IBS = frequent small meals, increased dietary fiber + water, psyllium, pectin (apples), peppermint oil, caraway oil, avoidance of caffeine, raw vegetables, and simple sugars.

Question 36

The major nutritional deficiencies causing anemia include (select all that apply):

a. iron
b. B12
c. folate
d. B6

Answer 36

a, b, c, and d

Question 37

True or false? Someone with osteoporosis should have a vitamin D intake of at least 600-800 IU/day?

Answer 37

True.

In addition, the individual should have a daily calcium intake of 1200-2000mg, in divided doses + obtained from diet)

Question 38

Steatorrhea is a result of malabsorption of dietary fats that can occur due to (select all that apply):

a. biliary insufficiency or obstruction
b. pancreatic insufficiency
c. mucosal damage (IBD; Celiac disease)
d. short bowel syndrome
e. bacterial overgrowth of the small intestine
f. gastrointestinal radiation therapy and medications

Answer 38

all of the above

*Short bowel syndrome results from the surgical removal of a portion of the small intestine, leading to an inability for LCFA’s to be absorbed (which can cause diarrhea), however MCT oil is able to be absorbed by the colon.