W9: ADHD/Autism, Alcohol Disease, Alzheimers, Anxiety

Question 1

Risk drinking for men is defined as having an average of ____ or more standard drinks in a week and/or ____ or more drinks per occasion.

a. 10, 5
b. 15, 5
c. 8, 5
d. 5, 4

Answer 1

b. 15
* Hark, pg. 311.

For women, risk risking is 8 or more drinks weekly and/or 4 or more per occasion.

Question 2

Alcohol intake over 3g/day (2 drinks) has been associated with increased mortality due to (select all that apply:

a. hypertension
b. pancreatitis
c. GI malignancy
d. stroke
e. cardiomyopathy
f. cirrhosis
g. all of the above

Answer 2

g. all of the above

Alcohol is a carcinogen. Even light drinking is associate with esophageal, oropharyngeal, and breast carcinomas.

Question 3

True or false? Chronic alcoholism is considered the most common cause of malnutrition in the western world.

Answer 3

True. Alcohol provides 7kcal/g however no protein, vitamins, or minerals.

High concentrations of alcohol can disrupt the gastric and duodenal mucosa, affect digestion and absorption, and reduce absorption of vitamins.

Question 4

Chronic alcohol consumption has been associated with _________ deficiency.

a. vitamin C and vitamin E
b. vitamin E and vitamin K
c. thiamin and folate

Answer 4

c. thiamin and folate
* Even in healthy individuals alcohol interferes with thiamin. Thiamin pyrophosphate (active form) is a coenzyme for pyruvate dehydrogenase, which converts pyruvate to acetyl CoA. Inadequate thiamin intake forces pyruvate to be converted to lactate, further contributing to development of lactic acidosis (Hark, pg. 312).

Thiamin deficiency manifests as anorexia, irritability, fatigue, and decreased memory, leading in severe cases to peripheral neuropathy, confusion, and tachycardia.

Folate - Folate deficiency alters RBC production resulting in enlarged, oval erythrocytes, manifested as megaloblastic anemia (elevated MCV on iron panel). Note - megaloblastic anemia can also be caused by b12 deficiency, however alcoholics are usually not b12 deficient. That said, run a b12 lab as well as folate, as supplementing with folate could mask a b12 deficiency if there.

Question 5

_____ is associated with thiamin deficiency due to prolonged alcohol abuse (select all that apply)

a. Decreased lower extremity reflexes
b. Decreased lower extremity vibratory sensation
c. Parasthesis

Answer 5

a, b, and c. These are neurologic signs and symptoms that can manifest.

Question 6

Low serum albumin may reflect moderately depleted protein status and overall nutritional status however may not be accurate in patients with ______________.

a. severe liver disease
b. renal failure
c. gall stones

Answer 6

a. severe liver disease.

* this is because albumin is synthesized in the liver and is also influenced by hydration status.

Question 7

True or false. Neurologic impairments due to vitamin B12 deficiency do not respond to folate supplementation alone and are not reversible.

Answer 7

True. However, hematologic abnormalities respond to both folate and to vitamin b12.

Question 8

The cause of weight loss and subsequent malnutrition in Alzheimer’s disease patients is:

a. Taste dysfunction
b. Smell dysfunction
c. Cytokines effect on appetite
d. a and b
e. all of the above

Answer 8

e. all of the above.

Question 9

The _____ system appears to be most vulnerable to toxic exposures because 90% of toxins are lipophilic, fat-loving.

a. renal
b. cardiovascular
c. immune
d. neurologic

Answer 9

d. neurologic. Neurons in the central nervous system are high-fat cells and tissues.

Question 10

Low ______ is associated with Alzheimers disease:

a. copper
b. vitamin E
c. folate

Answer 10

c. folate * higher folate levels (at or above 400mcg RDA) are associated with a 50% reduction in the risk for developing AD. However, some studies have shown a U shaped curve where very high folate levels are associated with higher homocysteine levels and a greater risk for developing AD.

Question 11

True or false? Brain tissue is one of the few tissues outside of the pancreas that produces insulin?

Answer 11

True. glucose is the fuel brain cells commonly use. If insulin resistance is present, glucose cannot enter the brain cells and the cells starve/cannot function. Due to this, remedies to reduce amyloid include:

1. cut back on sugar
2. cut back on saturated fast
3. increase fiber
4. increase exercise

Question 12

Increasing _________ in the diet can fuel the brain in Alzheimers patients while bypassing insulin resistance.

a. ketones.
b. lactose
c. protein

Answer 12

a. ketones.
* Ketones can be increased by adding approximately 7 tsp a day of coconut oil to the diet or even more effectively MCT oil.

Question 13

As well as folate, the following nutrient/supplements should be considered for Alzheimer’s disease (select all that apply):

a. multi-vitamin
b. B12
c. vitamin D
d. vitamin E
e. Pre-biotic and probiotic support

Answer 13

a-e.

• A mulit-vitamin with higher than RDA doses of vitamin B1 and 400-1000mcg/day of folate is recommended.
• B12 - low B12 can affect the risk for developing AD and dementia.
• Low levels of vitamin D have been implicated in playing a major role in AZ
• vitamin E may help slow progression but must be form of mixed natural tocopherols containing gamma tocopherol. Most vitamin E supplements are synthetic alpha tocopherols which increase risk of deficiency in other tocopherols and do not help AD. Because of this, supplementation with vitamin E at doses more than 100 IU is not recommended, unless a natural mixed tocopherol is used.
• Pre- and Probiotic support important as microbiome influences aging, AZ, and dementia. Certain bacteria can proliferate leading to TNFalpha overproduction. This can compromise the BBB.

Question 14

The following should be considered in MNT for Alzheimers Dementia:

a. AGE’s
b. Omega-3 fatty acids
c. Curcumin
d. Alpha-lipoic acid
e. all of the above

Answer 14

e. all of the above.

High levels of AGE’s in tissues and circulation can become pathogenic.

Low levels of DHA have been found in those with dementia.

AD is 70% less common in India, thought to be due to curcumin (trial underway now). Important to use form BCM-95 which has a 693% higher absorption than 95% pure curcumin. Combining curcumin with vitamin D has been found to increase amyloid clearance by macrophages.

Question 15

The structure in the brain thought to generate anxiety is the:

a. hippocampus
b. amygdala
c. thalamus
d. cerebral cortex

Answer 15

b. amygdala
* The amygdala processes fear-related stimuli then sends signals to other parts of the brain (especially the locus ceruleus) to fire and release norepinephrine; corticotropin-releasing factor (CRF), which ultimately stimulates elevated cortisol levels and other excitatory components of the sympathetic NS. Glutamate is being recognized as playing an increasing role in anxiety disorders (and depression).

Question 16

_______ deficiency can cause anxiety and anxiety can cause increased _______ loss from the body.

a. iron
b. copper
c. magnesium

Answer 16

c. magnesium

In hospitalized pts two studies have shown parenteral magnesium (2g IV over 1 hr then 1 gm per hour for 1-3 days) significantly decrease severe anxiety and agitation in agitated psychiatric inpatients.

*Kraus, 852

Question 17

MNT for anxiety should include (select all that apply):

a. assessment for vitamin D, magnesium, and B vitamin status.
b. Reduce caffeine intake
c. Reduce intake of sucrose/sugar
d. Increase high quality protein throughout the day
e. add a MV containing high doses of B vitamins and minerals including copper, chromium, zinc, and selenium, plus 200mg day magnesium.

Answer 17

a-e

Treatment with doses of B vitamins above RDA recommendations has been shown to help a number of different types of anxiety regardless of deficiency.

3-4 week elimination of caffeine recommended. Switching from coffee to green tea also a possibility as there is less caffeine and green tea contains theanine, a calming amino acid.

Question 18

Complementary therapies for anxiety include (select all that apply):

a. Theanine
b. Passion flower extract
c. Magnolia
d. Lavender
e. Inositol
f. GABA

Answer 18

a-f

Theanine - Derived from green tea. Doses of 200mg- 1-4x daily L-theanine is involved in the formation of the calming neurotransmitter GABA (gamma amino butyric acid) and also stimulates the release of serotonin and dopamine.

Passion flower extract - doses of 100-500mg 1-4x/day.

Magnolia - Magnolia bark has a long hx of use in Chinese formulas to relieve both anxiety and depression without feeling sedation.

Lavender - small is calming, can also be used in capsule to reduce the need for tranquilizers.

Inositol - Can be helpful in treating anxiety/panic disorders, very safe. High doses may be helpful for mental health disorders including panic disorder, OCD, agoraphobioa, and depression.

GABA - deficiency is associated with anxiety, with GABE being the primary counterbalance for the excitatory neurotransmitter glutamate.

Question 19

True or false - children with autism spectrum disorder (ASD) often refuse fruits and vegetables and may eat only a few foods from other food groups?

Answer 19

True. this leaves them at risk for nutritional deficiencies.

Question 20

Various dietary factors have been suggested as a cause of ADHD including:

a. artifical flavors and colors, food preservatives
b. sodium benzoate
c. sugar
d. a and c
e. all of the above

Answer 20

e. all of the above

* Exposure to pesticides and fatty acid deficits are also being reserached.

Question 21

ASD is ____ x more common in boys than in girls.

a. 10
b. 4
c. 2

Answer 21

b. 4.
* Autism Spectrum Disorder are diagnosed by the presence of qualitatively impaired reciprocal social interactions; impaired communication skills; and restricted, repetitive, stereotypical interests and behaviors.

Question 22

Asperger syndrome describes children with the problems of ASD but who have ___________ cognitive levels.

a. normal to high
b. low to normal
c. low
c. high

Answer 22

a. normal to high

Question 23

Dietary ________ upregulates genes that protect cells against oxidative stress, inflammation, and DNA damage, all of which are prominent and possibly mechanistic characteristics of ASD:

a. Chromium
b. Sulforaphane
c. Magnesium

Answer 23

b. sulforaphane
* a RCT found sulforaphane improved social interaction and verbal communication and reduced abnormal behavior in ASD (29 males aged 13-27).
* Other therapies that could help include mineral and vitamin therapy, elimination diet, fatty acid supplementation, and megavitamins.

Question 24

The recommended amount of artificial food dyes for children has been set to _____mg/day, however high usage of beverages, colored cereals, and candies can result in _____ mg per day:

a. 100, 150
b. 50, 100
c. 12, 100
d. zero, a lot of

Answer 24

c. 12, 100.
* These food dyes can exacerbate hyperactivity in some children and include FD&C Blue 1 and 2, FD&C green 3, Orange B, FD&C Red 3, Red 40, FD&C Yellow 5 and 6.

Question 25

The most effective treatment for an individual with ADHD is a diet based on ____________

a. The Mediterranean diet
b. Paleo
c. Low Glycemic Index
d. Wholesome foods with foods served at regular times, undistracted.

Answer 25

d. Wholesome foods with food served at regular times, undistracted.

In addition, removal of artificial food coloring/dyes, caffeine, and the addition of vitamins is prudent. Children with ADHD may also proper levels of EFA’s thus supplementation with n-3, n-6 plus zinc and mg could be considered.