Domain II

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bmsoper
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228440
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Domain II
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2013-09-01 19:26:43
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MNT
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  1. Serum Albumin Normal Range
    3.5-5.0g/dl
  2. Hypoalbuminemia Indication
    • Edema
    • DOES NOT REFLECT CURRENT PROTEIN INTAKE --> LONG HALF-LIFE
  3. Serum Transferrin Normal Level
    >200mg/dl
  4. Serum Transferrin Indication
    • Rising levels indicate iron deficiency
    • -can also be determined by TIBC total iron binding capacity
  5. Hyperalbuminemia
    Dehydration
  6. Transthyretin (TTHY) aka Prealbumin (PAB) normal ranges
    16-40mg/dl
  7. Prealbumin/Transthyretin Indication
    • Better indicator of protein malnutrition.
    • -short half-life helps pick up changes in protein status quickly
  8. Retinol Binding Protein (RBP) Normal range
    3-6mg/dl
  9. Retinol Binding Protein indications
    Best indicator of current protein malnutrition. Travels with prealbumin/transthyretin with a 12 hour half-life.
  10. Hematocrit (HCT) Normal Levels
    Men 44%, Women 38%, Pregnant 33%
  11. HCT Indications
    Measure of cell number in whole blood
  12. Hemoglobin Hb Normal Ranges
    Men 14-17 Women 12-15 Prego < or equal to 11
  13. Hb Indications
    Hb is the iron containing pigment of RBC (which are produced in the bone marrow) -->anemia
  14. Serum Ferritin Normal Ranges
    Male 12-300ng/ml, Female 10-150ng/ml
  15. Serum Ferritin Indications
    Size of Iron Storage Pool
  16. Serum Creatinine Normal Ranges
    0.6-1.4mg/dl
  17. Serum Creatinine Indications
    • Measures somatic protein as related to muscle mass.
    • >Renal Disease OR
    • >Muscle Wasting
  18. Creatinine Height Index (CHI) Normal Level
    80%
  19. Creatinine height index (CHI) Indications
    • Creatinine Excreted / 24 hours OVER Height
    • >Estimates LEAN body mass - somatic protein
    • >@ 60-79% there is mild muscle depletion
  20. Blood Urea Nitrogen (BUN) Normal Range
    10-20mg/dl
  21. Blood Urea Nitrogen BUN Indications
    • Related to protein intake
    • >Indicates renal disease
  22. BUN:Creatinine ratio Normal
    10-15:1
  23. Urinary Creatinine Clearance Normal
    115+/-20ml/min
  24. Urinary Creatinine Clearance Indication
    A measure of GFR and Renal Funx
  25. Total Lymphocyte Count (TLC) Normal and Abnormal Ranges
    • Normal >2700 cells/cu mm
    • Moderate depletion 900-1800
    • Severe depletion <900
  26. Total Lymphocyte Count TLC Indication
    • Immunocompetency
    • Levels decrease with protein-energy malnutrition
  27. C-Reactive Protein Indications
    • Marker of Acute Inflammatory Stress
    • Low levels indicate need for nutrition therapy
  28. Free erythrocyte protoporphrin
    • Direct measure of toxic effects of lead on heme synthesis.
    • Levels increase with lead poisoning
    • Lead depletes iron --> ANEMIA
    • Displaces CALCIUM in the bone --> ZINC DEFICIENCY
  29. Prothrombin Time Normal Times
    • 11-12.5 sec
    • 85-100% if normal
  30. Prothrombin Time Indication
    • Prolonged PT with Anticoagulants 
    • Evaluates Clotting Adequacy
    • Vitamin K intake will alter PT
  31. Hair Analysis Indications
    • Not for nutritional analysis
    • Useful in measuring intake of toxic metals
  32. Assessment of energy requirements: busy BEE
    • Sedentary BEE X 1.2
    • Active BEE X 1.3
    • Stress BEE X 1.5
  33. Megestrol Acetate
    • Appetite Stimulant 
    • M.A. > Mega Appetite or megestic appetite or appetite fit for a king
  34. Orlistat
    Binds to LIPASE to decrease FAT absorption
  35. Marinol
    • Appetite Stimulant 
    • Same as megestrol acetate (M&Ms stimulate the appetite)
  36. Statins (HMG CoA Reductase Inhibitors)
    Decrease LDL & TG AND Increase HDL
  37. Chemotherapy
    Malabsorption (not only are they not hungry and in need of Marinol and Megestrol they also don't absorb well)
  38. Mineral Oil and Cholestyramine
    Decrease the absorption of fat and fat soluble vitamins 
  39. Glucocorticoids and Antibiotics
    • Protein deficits 
    • GCs treat diseases caused by an overactive immune system, such as allergies, asthma, autoimmune diseases, andsepsis.
  40. Oral Contraceptives
    Decreases Folate, B6, and C
  41. Loop Diuretics
    Deplete K, Na, Mg, Ca, Chloride
  42. Thiazide diuretics
    Decrease K, Mg BUT absorb Ca
  43. Antibiotics
    • Decrease Vitamin K
    • Depletes protein
  44. Steroids
    • Decrease Bone Growth
    • CHO intolerance
    • Raise Blood Sugars
  45. Methotrexate
    • Decrease FOLATE
    • Anti-cancer agent
  46. Lithium Carbonate (antidepressant)
    • Weight Gain
    • Increased appetite
    • Sodium and caffeine cause lithium excretion and prevent toxicity
  47. Anticoagulant (Warfarin sodium)
    • Diminishes Vit K (supplementation required)
    • Avoid Ginko Biloba, garlic, ginger and high doses of Vitamin A & E
  48. Propofol (anesthesia)
    • Administered in oil 
    • Consider Fat calories
  49. Phenobarbital (anticonvulsant)
    Decreased folic acid, Vit B12, D, K, B6
  50. Cyclosporine (immunosuppressant)
    Hyperlipidemia, hyperglycemia, hyperkalemia, hypertension (cyclosporin is psycho)
  51. Isoniazid (treats TB)
    • Depletes pyrodoxine (B6)
    • Peripheral neuropathy
    • Interferes with vitamin D
    • Don't take with food
  52. Elavil (antidepressant)
    • Sedative effect
    • Weight gain
    • Increased appetite
  53. B6 and protein decrease the effectiveness of what drug?
    Levadopa
  54. Calcium decreases the effectiveness of what drug?
    Tetracycline
  55. Tyramine can interact negatively with what drug? And how?
    • MAOI (monamine oxidase inhibitor) for parkinson's and depression
    • Tyramine is a part of tyrosine and is a stress hormone releaser.
    • Tyramine and MAOI together will release NE and elevate BP
  56. When taking MAOIs how should the diet be adjusted?
    • Eliminate dopamine and tyramine
    • Restrict aged, fermented, dried, pickled, smoked, and spoiled foods (bacteria release causes the formation of amines)
    • Avoid hard, aged cheese, sauerkraut, sausage, lunch meats, tofu, miso, chianti wine
    • Limit sour cream, yogurt, and buttermilk
    • BUY COOK EAT FRESH FOODS
  57. Demographic Information
    • Population by age
    • Ethnic groups
    • Sex
    • Birth rates
    • Deaths
  58. Socioeconomic Stratification Information
    • Census data
    • Housing statistics
  59. Incidence
    # of new cases of a dz over a period of time/total # of people at risk ALL X 100K
  60. Prevalence
    Total # of people with a dz during a period of time/Average # of people ALL X 100K
  61. Sources or assessment information for populations and community (11)
    • 1. Demographic Information
    • 2. Socioeconomic status
    • 3. Morbidity and Mortality ratios
    • 4. Incidence
    • 5. Prevalence
    • 6. Identify accessible services (dental, medical, etc.)
    • 7. Cultural factors, geographical, unemployment, environment
    • 8. School nutrition programs, educational achievement, language spoken
    • 9. Welfare programs, % on aid
    • 10. Transportation availability 
    • 11. Anthropometric, biochemical, clinical dietary intake data
  62. Food security
    • The access by all people at all times to sufficient food for an active and healthy life.
    • Ready availability of nutritionally adequate and safe foods
    • Assured ability to acquire them in a socially acceptable manner
  63. Community Food Security Initiative
    Ensures that all have access to culturally acceptable, nutritionally adequate food at all times
  64. Three strategies to strengthen local food systems
    • 1. Farmer's Markets
    • 2. Food recovery and gleaning programs - collect whole foods trash food and deliver to poor
    • 3. Prepared and Perishable Food Programs (PPFP) - unused cooked and fresh foods to the hungry
  65. Nutrition Survey
    • Examination of population at particular time
    • Cross-sectional
    • Prevalence of condition at specific time
  66. Nutritional Surveillance
    • Continuous collection of data
    • Associated with WIC, CDC, EPSDT (early periodic screening diagnosis and treatment)
    • Identifies needs and type of intervention needed
  67. Nutrition Screening Initiative (NSI)
    • Identify nutritional problems for elderly (above 80) early and improve care
    • DETERMINE checklist - determines nutritional risk
    • LEVEL I screen to see who needs more assessment
    • LEVEL II used with those at higher risk of medical and nutritional problems
  68. Focus Group
    • Means of nutritional surveying
    • 5-12 people talk about concerns, beliefs, problems
    • Advice, insights, info
    • Attitudinal data
  69. National Nutrition Monitoring and related Research Program (NNMRRP)
    • All data collection and analysis activities of the federal government 
    • DHHS and USDA
  70. Strong Heart Diet Study
    • Native American and Alaskan Natives
    • Tried to determine causative factors for obesity
    • Genetics or physical activity?
    • Consumed 12% less than the average american yet experienced increased heart dz and diabetes
    • Lack B vits and antioxidants 
  71. PedNSS Pediatric Nut Surveillance System
    Who Runs? What is it?
    • DHHS
    • Birth-17 yrs w/ emphasis on 0-5
    • Ht, wt, birth-wt, Hct, Hb, cholesterol, BF
    • Growth & Nut status
    • Infant Feeding
  72. PNSS Preggo Nutrition Surveillance System
    Who? What?
    • DHHS
    • Pregnant women
    • Maternal wt gain, anemia 
    • Identify and reduce risk factors (smoking, drinking) birth wt, # of women who BF)
  73. NHANES National Health and Nutrition Examination Survey
    • Ongoing to retrieve info on health of Americans in general
    • Clinical, chemical, anthropometric, nutritional data
    • NHANES III - Large sample over 65
    • NFNS + CSFII
    • Six one day food and nutrient intakes by individuals over one year
  74. USDA Nationwide Food Consumption Surveys NFCS
    • Info on intake of individuals and households all over US
    • Protein, calcium, iron, thiamin, riboflavin, C, A
    • Diet good if = or > RDA
    • Poor if < 2/3 RDA
  75. BRFSS Behavioral Risk Factor Surveillance System
    • DHHS
    • > 18 years in households with telephones
    • Ht, wt, smoking, alcohol, fat, fruits, veggies, preventable health problems, diabetes
  76. YRBS Youth Risk Behavior Survey
    • DHHS
    • Grades 9-12
    • Smoking, alcohol, wt control, exercise, eating habits
  77. WLPS weight loss practice survey
    • DHHS
    • > 18 trying to lose weight
    • BMI, diet hx, self-perception
  78. DHKS Diet and health knowledge survey
    • USDA
    • Assesses the main meal preparer of the house
    • Beliefs about food safety, labels, knowledge of nutrients
  79. TANF Temporary Assistance for Needy Families
    The state determines eligibility of needy families and their potential benefits and services
  80. USDA Commodity Food Donation Distribution Program
    • Provides food to meet the needs of children and adults
    • Supports American farmers
    • Food to School Lunch, Elderly feeding, supplemental food programs
  81. CSFP Commodity Supplemental Food Program
    • State
    • Monthly commodity canned, packed foods
    • Women (pregnant, BF, postpartum), infants, children up to 6 years, elderly, @ nutritional risk
  82. TEFAP the Emergency Food Assistance Program
    • Local, private nonprofit agencies
    • Quarterly distribution
    • Supplements diets
  83. National School Lunch Program 1946
    • USDA Food and Nutrition Service (FNS)
    • Utilize surplus production of food to feed children
    • grants and donations, schools reimbursed based on # meals served
    • DGs
    • Lunch must be 1/3 of recommended intake for calories, protein, A, C, iron and calcium
    • Amended 1977 NET Nutrition Education Training Program
  84. School Breakfast Program
    • USDA
    • Meals must meet DG
    • 1/4 of daily protein, calories, A, C, Iron, Ca
  85. After School Snack Programs
    • USDA
    • Healthy Snacks
  86. Special Milk Snack Programs
    • USDA
    • Encourage milk consumption
    • Subsidy for milk to children in school, and after school programs
    • Free milk to needy kids
  87. Summer Food Program
    • USDA School Lunch; FNS, state ed programs, summer camps
    • Encourage foodservice programs to children who are NOT in school
  88. Child and Adult Care Food Program (CACFP)
    • USDA
    • Supports public and nonprofit food service programs for day care and neighborhood house 
    • Reimburse for meal cost, commodity food, nutrition education
  89. WIC Special Supplemental Nutrition Program for Women, Infants, Children
    • USDA
    • Pregnant & Infants and children up to 5
    • Low income mothers at nutritional risk
    • REQUIRED health exam
    • Iron-fortified formula, cereal, milk, cheese, fruit
    • NOT entitlement program: fed $ caps out
    • Priority: preg, BF, infant <1yr
  90. EFNEP Extension Food and Nutrition Education Program
    • USDA
    • Grants to university that encourage community development
    • Nutrition aides to educate the public
    • Works with small groups, teaching skills needed to maintain a healthy diet
  91. Maternal and Child Health Block Grant
    • DHHS
    • Title V of SSA
    • Public Health nutrition programs @ state and local
    • Training consulting funding
    • Women of child bearing age, infants, children, state eligibility requirements
  92. Healthy Start
    • DHHS
    • Reduce infant mortality
    • Health of women, infants, children, fams
  93. NSIP Nutrition Services Incentive Program
    • USDA Older Americans Act Title III
    • Foster independent live
    • $ and commodity to state
  94. ENP Elderly Nutrition Program
    • DHHS
    • Offshoot of NSIP Nutrition Services Incentive Program
    • 1. One hot meal every day 5 days/week (1/3 of recommended intake)
    • 2. 60 and older + spouse
    • 3. Congregate meals - ambulatory for rural elderly
    • 4. Home delivered meals - Meals on wheels
    • 5. Counseling, nutrition education, social interaction
  95. SNAP Supplemental Nutrition Assistance Program
    • USDA
    • Low income with monthly benefits 
    • Not for non-food items
    • Thrifty food plan for June of preceding year
    • Least costly of 4 USDA food plans
  96. Medicare (CMS)
    • DHHS
    • Health insurance for >65
    • ESRD any age
    • Part A - Hospital insurance
    • Part B - Optional insurance for supplementary benefits
  97. Medicaid
    • DHHS
    • Federal law administered by state
    • Payment for medical care for all eligible needy: all ages, blind, disabled, dependent children
  98. Headstart
    • DHHS
    • Ages 3-5
    • New foods and good habits to kids (activities)
  99. NET Nutrition Education Training Program
    • USDA 1977
    • Amendment to School Lunch Act
    • Nutritional education to teachers and foodservice staff
  100. Acute Kidney Injury can be caused by...
    Burns, accidents, obstructions, severe dehydration
  101. Symptoms of ARF (Acute Kidney Injury)
    • Oliguria (urine output <500ml)
    • Azotemia (N in the blood)
  102. Initial treatment for ARF
    IV glucose, lipids, protein
  103. What are the phases of ARF?
    • Oliguric phase -> Edema (low salt, low fluid)
    • Diuretic phase (adequate salt to replace loss)
    • -Replace fluid output from the previous day + 500mL
  104. What is nephrosis?
    • Defect in the capillary membrane of the glomerulus 
    • Protein is allowed into the filtrate and tubules
  105. Symptoms of Nephrosis (4)
    • Albuminuria
    • Edema
    • Malnutrition
    • Hyperlipidemia: Inc synthesis and Dec clearance of VLDL
  106. Manifestations of Renal Dz
    • Anemia: decreased EPO
    • Blood pressure: upset
    • Vitamin D: Not activated & decreased Ca absorption
  107. What is Renal Solute Load
    • Solutes excreted in 1L urine
    • Measures NITROGEN (60%) and SODIUM/ELECTROLYTES
    • Daily Fixed: 600mOsm
  108. SIADH
    • Syndrome of inappropriate antidiuretic hormone
    • Hyponatremia: hemodilation
    • Fluid restriction
  109. Results of Chronic Kidney Dz
    • Anorexia
    • Weakness
    • Wt loss
    • Nausea
    • Vomiting 
    • Anemia: deficient EPO
  110. What determines End Stage Renal Disease (ESRD)?
    • BUN: >100mg/dl (normal 10-20mg/dl)
    • (related to protein intake and assoc with renal dz)
    • Cr: 10-12mg/dl (normal 0.6-1.4mg/dl)
    • (related to muscle mass/somatic protein and can indicate renal dz and muscle wastage)
  111. What diet is used with ESRD?
    Giovanetti diet (20g HBV protein)
  112. What is ESRD?
    Retention of Nitrogen Metabolites
  113. MNT ESRD
    • Giovanetti Diet (20g HBV protein)
    • Increase calories
    • Control Edema
    • Prevent deficiency
  114. What is CAPD?
    Continuous ambulatory peritoneal dialysis 4-5x/day
  115. Rapid Acting Insulin generic and brand names
    • Aspart (Novolog)
    • Lispro (Humalog)
    • Notes: When the LISPing Beaver's ASs PARTs a LOG leaves RAPIDLY 
  116. Onset time for Rapid Acting Insulin
    5-15min
  117. Duration of Rapid Acting Insulin
    • 4 Hours 
    • Note: 4 hours in between meals. Get you from one meal to the next.
  118. Short Acting insulin is AKA
    Regular Insulin
  119. Onset time of short acting insulin
    30-45 min before meal
  120. Duration of short acting insulin
    3-6 Hours
  121. Intermediate Acting Insulin AKA
    • NPH
    • Note: Neutral PH is INTERMEDIATE
  122. Long Acting Insulin Generic and Brand
    • Glargine (Lantus)
    • Determir (Levemir)
    • Note: Levemir and Lantus are the LONG bearded wizards. They are GLARGely DETremental.
  123. Onset for Long Lasting Insulin
    2-4 hours
  124. Duration of Long-Lasting Insulin
    18-24 hours
  125. Dawn Phenomenon
    Increased need for insulin at Dawn due to increased glucagon action breaking down glycogen to battle fasting hypoglycemia
  126. Regular + NPH 2x/day
    • Pre-breakfast - Reg:NPH 1:2
    • Pre-supper - Reg:NPH 1:1
  127. Regular + NPH 3x/day
    • Pre-breakfast: Regular + NPH
    • Pre-supper: Regular
    • Pre-bedtime: NPH (a little longer than short acting to battle the Dawn surge)
  128. MDI (NPH + Regular) IDDM insulin regimen (5x/day)? What does MDI stand for?
    • Multiple Daily Injections
    • Before meals (3x): Regular
    • 1-2X/day: NPH
  129. Insulin Pump Therapy
    • Basal, Rapid-Acting, or Short Acting pumped continuously
    • BOLUSES of insulin given before meals
  130. Long-lasting + Rapid-acting IDDM insulin regimen
    • Bedtime: Glargine (Lantus) offers basal insulin
    • Meals: Rapid Acting BOLUS
  131. Insulin Secretagogues are also known as...
    • Sulfonylureas, meglitinides (Gluctorol)
    • Note: Mega Glucosaurs Troll Secretly in the Sulfur pools of Yellowstone
  132. Biguanides Brand and Generic
    • metformin (Glucophage)
    • Note: The BIG one. Macrophage is the BIG bacteria eater. Glucophage is a BIG sugar eater.
  133. Action of Secretagogues
    Promote Insulin Secretion
  134. Action of Biguanides
    • Enhance insulin action
    • Suppress Hepatic Glucose production
  135. Thiazolidinediones are also known as...What do they do?
    • Actos
    • Note: Thia...blah blah blah is a long word that is represented by Big Fish arms. It ACTS on peripheral insulin sensitivity
  136. Alpha glucosidase inhibitors Brand names (2)
    • Acarbose, Precose
    • Note: verbOSE and PREtentious honors society members
  137. Alpha Gluc Inhibitors action
    • Inhibit enzymes that digest carbohydrates
    • Delay absorption
  138. Exenatide Brand
    • Byetta
    • Note: Princess Byetta EXists in a far away land
  139. Action of Exenatide
    • Enhances insulin secretion 
    • Suppresses postprandial glucagon
  140. Amylin agonist Generic and Brand
    pramlintide (Smylin)
  141. Action of Amylin agonist
    Decreases glucagon production
  142. Treatments for uncontrolled diabetes aka Acute Ketoacidosis
    Insulin and rehydration (polyuria/polydypsia)
  143. What is postprandial or reactive hypoglycemia?
    • The pancreas releases too much insulin OR Insulin excessively sensitive
    • Blood glucose falls <50mg/dl 2-5 hours after eating
  144. Goal of PP or Reactive hypoglycemia
    To prevent rapid rise in blood glucose that might stimulate excessive insulin
  145. Addison's Dz?
    • Atrophy of the Adrenal Cortex
    • Decreased Cortisol: glycogen depletion, hypoglycemia
    • Decreased Aldosterone: NA loss, K retention, dehydration
    • Decreased Androgenic: tissue wasting, wt loss
  146. Hyperthyroid?
    • Excess secretion of thyroid hormone
    • Elevated T3 and T4
    • Increased BMR = Wt loss
  147. Hypothyroid?
    • Thyroid hormone deficiency
    • Low T4 with Low or Normal T3
    • Decreased BMR = Wt Gain
  148. Endemic goiter
    Inadequate iodine intake leading to insufficient thyroid hormone
  149. MNT for endemic goiter
    • Iodized salt
    • Foods without GOITROGENS (inhibit synthesis thyroid hormone)
  150. What is Gout
    • Dysfunctional purine metabolism
    • Increased serum URIC ACID (deposits in joints)
  151. What are high purine foods (gout)?
    • broth
    • anchovies
    • sardines
    • organ meats
    • sweetbreads
    • herring
    • mackerel
  152. Meds for Gout and why do we care?
    • Urate Eliminate
    • Colchicine
    • May cause nutrient loss
  153. Galactosemia
    • Missing enzyme that metabolizes galactose
    • TREATED SOLELY BY DIET
  154. Galactosemia NO foods
    • Organ meats
    • MSG extenders
    • Milk
    • Lactose
    • Galactose
    • Whey 
    • Casein
    • Dry milk
    • Solids
    • Curds
    • Calcium
    • Sodium caseinate
    • Dates
    • Bell peppers
  155. Galactosemia YES foods
    • Soy
    • Hydrolyzed casein
    • Lactate
    • Lactic acid
    • Lactalbumin
    • Pure MSG
  156. Urea cycle defects
    Ammonia accumulation
  157. Symptoms of urea cycle defects
    • Vomiting
    • Lethargy
    • Seizures
    • Coma 
    • Anorexia
    • Irritability
  158. Example of Urea Cycle defects
    OTC Ornithine transcarbamylase deficiency
  159. Phenylketonurea (PKU)
    • Missing phenylalanine hydroxylase
    • Unable to convert phenylalanine into tyrosine
    • Poor intellectual function
  160. How is PKU detected?
    Guthrie blood test
  161. MNT for PKU
    • Formulas low in phenylalanine:
    • Phenex 1,2
    • Phenyl-free 1,2
    • No aspartame
  162. Glycogen storage dz
    • Deficiency of glucose-6-phosphatase in liver
    • Impaired gluconeogenesis and glycogenolysis

    Hypoglycemia: liver can convert glycogen to glucose
  163. Homocystinurias
    • Inherited disorder of amino acid metabolism
    • Elevation of methionine and homocysteine (w/ high homocysteine in the urine)
  164. Maple Syrup Urine
    • Cannot metabolize BCAA (LIV)
    • Poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of seat and urine
  165. What is MSUD powder?
    Formula with BCAA for maple syrup urine
  166. MNT for Maple syrup urine
    • High CHO and fat to save Amino Acid
    • Restrict BCAA
    • Small amounts of milk for growth
    • Gelatin (No BCAA)
    • Avoid eggs, meat, nuts, dairy

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