FINAL EVER NUTRITION EXAM!

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  1. 1. What is the 'Honeymoon Period' in T1 diabetes?
    This is the period of time shortly following diabetes diagnosis when the pancreas is still able to produce a significant amount of insulin to aid blood glucose control. 

    T1 diabetes develops because the body begins to kill off its own insulin-producing cells - known as beta cells (a form of islet cell, in the pancreas).

    When a patient starts on insulin injections, the pancreas is under less pressure to produce insulin.

    This period of rest, afforded by the injections, stimulates the remaining beta cells (a type of islet cell) in the pancreas to produce insulin.

    However, after a period of months, the vast majority of these remaining beta cells will also be destroyed, and the honeymoon period ends when the pancreas stops producing sufficient insulin to aid blood glucose control anymore.
  2. What are Estradiol and Estrone?

    Which is the most potent?
    Estradiol and Estrone are both forms of oestrogen.

    In pre-menopausal women, Estradiol is converted to estrone.

    Estradiol is more potent than estrone.

    (*note they can also be spelled Oestrone and Oestradiol)
  3. What is conjugation?

    What is de-conjugation?
    Conjugation refers to the Phase II pathway (the conjugation pathway) where substances are converted to water soluble ready to excrete from the body.

    De-conjugation is the opposite of this process, where the substances are deconverted and therefore cannot be excreted.
  4. When clearing excess oestrogen from the body, what two things do we need?
    Probiotics - a healthy bowel flora keeps oestrogen conjugated

    Fibre - to add a certain bulk for the urge to defecate/eliminate the oestrogen, which also feeds probiotic bacteria, keeping a healthy cycle going on of maintaining oestrogen conjugation and elimination of oestrogens.

    *fibre = pectin, rice bran, slippery elm, psyllium husks
  5. Which probiotic strains are known as beneficial for oestrogen clearance? (ARB ST)
    • L. Acidophilus
    • L. Rhamnosus
    • L. Bifidobacterium
    • Streptococcus Thermophilus
  6. What is PCOS?
    Characterised by multiple small cysts on the ovaries and excess androgen (male sex hormone) production in a female. 

    ANDROGENS and INSULIN RESISTANCE are the main factors... insulin resistance causes high levels of androgens (testosterone etc).

    Causes anovulation, acne, excess weight and body hair.


    *causes high levels of estrone, too.
  7. What naturopathic recommendations would you make in PCOS?
    Increase insulin sensitivity and decrease insulin resistance:

    • Low GI diet
    • Chromium (improves IR)
    • Myoinositol (improves IR)
    • Lipoic acid (improves IR)



    *LOOK AT DEALING WITH LIVER AND MANAGING INSULIN RESISTANCE*

    • - Milk thistle (liver herb to increase Phase II)
    • - Cruciferous veg (phase II)
  8. In PCOS when we say people are oestrogen dominant, it is often that they have too much _______ flying around.
    ESTRONE

  9. Can you use D Mannose and Cranberry together in cystitis?
    YES
  10. Who would you NOT give cranberry supplements to?
    Renal Insufficiency - there is a theoretic concern regarding the use of cranberry juice and kidney stone formation. This is because it is an oxalate-containing food, and this may encourage oxalate-rich kidney stone formation.

    Pregnancy - you are not supposed to give high levels of astringents during pregnancy, because it can cause the uterus to contract.

    Warfarin - cranberry contains salicylic acid, which is known to have the same effect as warfarin (prevents blood clotting). Thus, combining the two could be dangerous by having an additive effect on the Warfarin medication.
  11. When would you NOT use D-mannose?
    In Diabetes - because its a sugar!
  12. Would you call Asthma an allergic reaction or an intolerance?
    ALLERGIC REACTION - because it is igE mediated!
  13. What are the two most important things to consider in dehydration and exercise?
    Glucose and sodium
  14. Give 5 common causes of male infertility:
    • HPA Axis Dysfunction
    • Marijuina
    • Alcohol
    • Smoking
    • Orchitis (inflammation of the vas deferens)

    *
    testicular cancers, poor sperm count (Oligospermia - deficiency of sperm in the semen) (Azoospermia - absence of sperm in the semen), temperature dysregulation, varicocele
  15. What are the vas deferens and the epididymis?
    Two ducts.


    The epididymis sits behind the testes, along which sperm passes to the vas deferens.

    The vas deferens is where sperm travels from here to the urethra.
  16. What is creatine?
    The is the energy currency exchange in muscles.

    It is formed in protein metabolism and can help in high intensity, quick lifting, muscle building.

    • *part of the phosphate energy system in anaerobic respiration.
    • *produced in the liver
  17. What are the precursors/cofactors of creatine?
    • Glycine
    • Arginine
    • Methionine

    Think GAM!
  18. Which cells are the only cells in the body that can absorb iodine?
    Thyroid cells.
  19. In Hypothyroidism, what is it called when there is an overproduction of reverse T3?
    Wilson's Syndrome
  20. What are the two thyroid hormones?
    Tetraiodothyronine (T4) = aka Thyroxine

    Triiodothyronine (T3)

    *T3 is the active form: it has x4 times more strength than T4, which is why only a small amount of it is secreted.
  21. Thyroid cells combine _______ and the amino acid _______ to make T3 and T4.
    IODINE and the amino acid TYROSINE
  22. What is another name for TSH (Thyroid Stimulating Hormone)
    Thyrotropin!
  23. What are goitrogens?
    Substances in foods that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid.

    And if we cannot absorb iodine, then we cannot combine with Tyrosine to make T3 and T4 can we?!
  24. Give examples of goitrogen foods:
    • Soybeans
    • Peanuts
    • Pine nuts
    • Millet

    *cooking usually inactivates goitrogens
  25. What is reverse T3?
    Reverse T3 (RT3) is a metabolite of T4 (thyroxine).

    Typically, when T4 loses an atom of iodine—a process known as monodeiodination, or T4 to T3 conversion—it becomes triiodothyronine (T3), the active thyroid hormone.
  26. What is an androgen?
    Male sex hormone
  27. What is GnRH?
    Gonadotropin-releasing hormone


    We have increased GnRH release in PCOS, which results in higher levels of LH, which, alongside high insulin, causes increase androgen production.
  28. What is anovulation?
    When a woman does not ovulate / have a period (can happen in PCOS)
  29. What leads to anovulation in PCOS?
    Lower FSH levels
  30. What pathogen has been implicated in asthma pathogenesis?
    Candida Albicans (the acid PROTEASE that they produce is the responsible antigen)
  31. What is a substance or exposure that can lead to cancer called?
    Carcinogen
  32. How might a carcinogen incite a cancer?
    • - interfere with mitochondrial function
    • - cause DNA damage
  33. What food sources would you find D-Mannose?
    • Redcurrants
    • Blackcurrants
    • Gooseberries
    • Tomatoes
  34. How does D-Mannose work?
    Helps to prevent the pili of E.coli and other bacteria from adhering to the bladder wall. 

    Bacteria produce lectins, which cause the bacteria to bind to sugar residues, such as D-mannose, on host cells.

    Supplemental mannose can therfore bind the bacteria and prevent its attachment to the urinary tract lining.
  35. How much D-mannose would you supplement?
    2,500 - 5,000mg every four to six hours or more.
  36. Where is creatine produced?
    In the LIVER

    it is then transported to muscle cells where it combines with Phosphate Producing Phosphocreatine (PC), so it can quickly be used for maximum energy bursts by breaking the phosphate and creatine bond using phosphate to regenerate ADP producing ATP.
  37. What are food sources of creatine?
    • Herring
    • Salmon
    • Tuna
    • Beef

    *adequate vitamin E status may also be needed to optimise creatine uptake.
  38. List four common lifestyle cancers:(generally speaking)
    • Oesophageal cancer
    • Breast cancer
    • Lung cancer
    • Pancreas cancer
  39. List four common environmental carcinogens:
    • Pesticides
    • Motor-vehicle exhaust
    • In-door air pollution 

    *all cause childhood leukemia

    *Nitrates (drinking water) and chlorinated drinking water also cause adult leukemia
  40. Which cancers can be caused by pesticides?
    • Childhood leukaemia and lymphoma
    • Brain tumours
    • Ewing's Sarcoma
    • Germ cell tumours
  41. Which bacteria is linked with stomach/gastric cancer?
    H Pylori
  42. Give 4 virus/or bacteria that are implicated in cancer
    • Epstein-barr virus
    • Retro Virus
    • Papilloma
    • H Pylori
  43. Give four dietary carcinogens
    • Aflatoxins (found in mouldy food)
    • Heterocyclic amines (meat cooked at high temperatures)
    • N-nitroso compounds (in some foods, protein foods, cured meat).
    • Polycyclic aromatic hydrocarbons (PAH) - products of combustion found in cooked foods, smoked foods, dark beer.

    *others: red meat, fats and sugars, sodium chloride, artificial sweeteners.
  44. What supplemental recommendations would you make to someone with male infertility?
    • Zinc
    • Selenium
    • Fish Oil (EFA's)
    • L-Carnitine
  45. Which heavy metal has been shown as problematic in male infertility?
    Lead

    - it produces toxic effects on the germinal epithelium and alters quality of semen
  46. In women's health, what might elevated insulin levels lead to?
    Through complex metabolic pathways, elevated insulin levels lead to increased ovarian androgens (PCOS), increased adrenal androgens, increased triglycerides and increased HDL cholesterol.
  47. Phase II conjugation of oestrogen can be either _________, ________, or __________.
    • Sulfation
    • Methylation
    • Glucoronidation - this is the main one.
  48. What is hyponatremia?
    When the level of sodium in the blood is abnormally LOW (think HYPO).

    This can be caused by drinking too much water, because the body sodium levels tend to get diluted.
  49. What is sodium?
    Sodium is an electrolyte and it helps to regulate the amount of water thats in and around cells. It is primarily found in our extracellular fluid.
  50. What are the main electrolytes?
    • Sodium
    • Potassium
    • Chloride
    • Magnesium
    • Phosphate
    • Calcium

    In sports, esp. endurance sports, a depletion of electrolytes can occur causing severe problems in performance.
  51. How do we lose electrolytes?
    • Sweat
    • Heat
    • Exhaustion

    this can cause cramping, pain, fatigue, so we therefore need to REPLENISH OUR ELECTROLYTES!!!
  52. What is the difference between a hypotonic, isotonic and hypertonic sports drink?
    Hypotonic - contains a lower concentration of salt and sugar than the body's cells and holds a low osmotic pressure. Taken up by the cells faster than water and used for recreational shorter sports.

    Isotonic - contains similar concentration of salt and sugar than in the human body and has the same osmotic pressure. It is taken up by the cell about as quickly as water and is ideal for endurance sports.

    Hypertonic - contains a high concentration of salt and sugar than the body's cells, and holds a greater osmotic pressure than the other two types of drink. It is taken up by cells slowly and so taken up slower than water. It is good for pre and post exercise (for energy).
  53. Why will water get into your bloodstream faster when its part of a sports drink?
    Glucose helps the sodium get absorbed via GLUT transporter proteins in the small intestine. Because water follows sodium, this means that using glucose with sodium electrolytes helps us to rehydrate much faster than just water alone.

    Another reason our body needs electrolytes is because sodium minimises urination. By drinking electrolytes (sodium) in our sports drinks, we are holding onto fluids to keep us hydrated.
  54. What is asthma?
    A respiratory condition marked by attacks of spasm in the bronchi of the lungs, causing difficulty in breathing. 

    It is usually connected to allergic reactions of or other forms of hypersensitivity.

    Characterised by:

    • -Spasm of the bronchi
    • -Swelling of the bronchial mucosa
    • -Excessive excretion of a viscous mucous
  55. Give 4 symptoms of asthma
    • Chest tightness and shortness of breath
    • Neck muscles tighten
    • Wheezing
    • Coughing
  56. What are the two types of asthma?
    Extrinsic or atopic asthma - considered an immunologically mediated condition with an increase in IgE antibodies (think Extrinsic IgE)

    Intrinsic asthma - a bronchial reaction that is due, not to antigen-antibody stimulation, but rather to such factors as chemicals, cold air, exercise, infection and emotional upset - however recent evidence suggests IgE may also be involved in these, particularly in exercise-induced asthma.
  57. What are the most powerful chemical mediators in asthma?
    Lipoxygenase enzymes (LOX) - leukotrienes that are 100 times more potent as stimulators of bronchial constriction than histamine

    *Asthmatics have an imbalance in arachidonic acid metabolism, leading to a relative increase in LOX products.
  58. Give 4 possible causes of asthma
    Food allergy

    Candida albicans - due to the acid protease.

    Salt - an increased uptake of salt increases bronchial reactivity and mortality from asthma. 

    Obesity -  Obese people have differing breathing patterns that predispose them to asthma.
  59. What T helper cell is involved in asthma and other atopic conditions like allergies?
    T helper cells
  60. What are LOX enzymes?
    They are involved in Leukotriene synthesis, thus they are pro-inflammatory compounds

    In asthma, LOX inhibitors are a key part of the therapeutic process, as we want to reduce inflammation constricting the bronchioles
  61. Give 5 dietary recommendations for someone with asthma
    1) Consume onions and garlic  - they inhibit LOX and COX enzymes, which can reduce inflammation.

    2) Consume cold water fish (for Omega 3) - increasing the omega 3:6 ratio can reduce availability of arachidonic acid which leads to a significant shift in leukotriene synthesis from the extremely inflammatory 4-series to the less inflammatory 3-series.

    3) Remove or reduce food sources of arachidonic acid (meat, dairy, omega 6 oils)

    4) Increase fruits and veg - antioxidants like vitamin C and E can inhibit leukotriene formation and histamine from mast cells. Antioxidants also increase the integrity of the epithelial lining of the respiratory tract, protect the lung against free radicals the may trigger bronchial constriction.

    5) Eliminate food allergens - these may be triggering a response
  62. What sources of arachidonic acid are there?
    • Meat (red meat, poultry)
    • Dairy (egg yolk)

    Omega 6 fats (oils) - vegetable oils contain linoleic acid, which is a precursor to ARA synthesis, so these can be an indirect source of arachidonic acid.
  63. What supplements would you recommend in asthma?
    • Quercetin - inhibits LOX enzymes
    • Vitamin C - inhibits LOX enzymes
    • Turmeric* - inhibits LOX enzymes
    • Magnesium - natural bronchodilator
    • Omega 3 fish oil (EPA & DHA)
  64. What is arachidonic acid?
    Arachidonic acid (ARA) is an omega-6 polyunsaturated fatty acid required by our body for the pro-inflammatory immune responses in healing and repair process.

    Too much of this inflammation can be a problem!
  65. What lifestyle recommendations would you make to someone in asthma?
    - "Buteyko" breathing method

    - Advise client to avoid environmental allergens
  66. True or false: most medical professionals consider Type 1 diabetes as a genetic disorder
    TRUE
  67. What would you do to help lengthen the Honeymoon period in T1 diabetes?
    Nicotinamide (niacinamide) - a member of the vitamin B (B3) NIACIN family, it can help to lower glycosylated hemoglobin (HbA1c) in T1 diabetics, improving metabolic control.

    Epicatechin - a flavonol found in certain plants such as green tea and cocoa (powerful antioxidant), helps to control inflammation.
  68. What diet & lifestyle factors would help in T1 Diabetes?
    Low GL / carb diet

    Regular aerobic exercise - shown to stimulate non-insulin dependent glucose transport into cells.

    Stop smoking!

    Diet high in antioxidants, EFAs to help control inflammatory processes
  69. What are beta cells
    A type of islet cell (in the pancreas), which stops functioning and producing insulin in type 1 diabetes.
  70. Why must care be taken when using iodine supplements in thyroid disease?
    Because too much iodine can have an additive effect in thyroid hormone production, leading to hyperthyroidism (or goitre) if not careful.

    *the same rule applies to tyrosine
  71. What protein synthesises T3 and T4 hormones.
    The precursor protein thyroglobulin.
  72. What type of T helper cell is dominant in Hashimoto's Thyroiditis? (hypothyroidism)
    Th1 dominant.
  73. What type of T helper cell is dominant in Grave's disease (hyperthyroidism)
    Th2 dominant.
  74. In which thyroid condition would you reccommend eating goitrogen foods?
    Hyperthyroidism (Grave's disease)

    Hyperthyroid disease is an excess of thyroid hormones. Goitrogen foods inhibit the uptake of iodine in the thyroid, which stops the production of T3 and T4. This is a good thing in hyperthyroidism, because we do not want to produce any more thyroid hormones in this condition.

    Note that in hypothyroidism (Hashimoto's thyroiditis), we would avoid goitrogen foods. this is because we want to facilitate the intake of iodine in order to produce more thyroid hormones (because hypothyroid is a deficiency of T3 and T4).
  75. Which is the 'active' thyroid hormone?
    T3
  76. What will lengthen the Honeymoon period in T1 diabetes?
    • Niacinamide/ nicotinamide (niacin)
    • Epicatechin
  77. What is the main pathway in detoxifying excess oestrogens?
    Glucoronidation
  78. What is primary, secondary and tertiary hypothyroidism?
    Primary hypothyroidism - thyroid produces too little thyroid hormone.

    Secondary Hypothyroidism - 
    a lack of thyroid hormone secretion due to a lack of TSH secretion from the pituitary gland.

    • Tertiary Hypothyroidism - a lack of thyroid hormone due to a lack of TSH-releasing hormone (TRH) from the hypothalamus.
  79. What autoantibodies are involved in Hashimoto's Thyroiditis?
    anti-TPO (anti-thyroid peroxidase)

    anti-Tg (antithyroglobulin)

    TSH receptor-blocking antibodies
  80. What autoantibodies are involved in Grave's Disease?
    anti-TPO (anti-thyroid peroxidase)

    anti-Tg (antithyroglobulin)

    TSI (Thyroid-Stimulating Immunoglobulin)

    ^^*the most important autoantibody! 
    it acts as a TSH-receptor agonist. TSI binds to the TSH receptor to activate thyroid hormone synthesis and incite thyroid growth.
  81. What 4 supplements would you give for someone with Hashimoto's?
    • - Turmeric
    • - Selenium
    • - Coleus (a leafy plant) - stimulates thyroid function by increasing cAMP (TSH required cAMP as a second messenger)
    • - EFAs


    *thyroid replacement, desiccated thyroid replacement, address heavy metal toxicity
  82. What 4 diet/lifestyle recommendations would you make for some with Hyperthyroidism (including Grave's disease)?
    Increase calories to compensate for increased metabolism (small, frequent meals)

    Reduce risk factors (stress, smoking, excess iodine intake) and increase rest. Stress control is the single most important action to take to normalise the thyroid.

    Consume goitrogens (raw soy milk) - to inhibit further iodine uptake which causes more thyroid hormone.

    Avoid iodine supplements and foods (kelp, seaweed, iodised salt)

    *antioxidants, Zinc, L-carnitine, CoQ10, omega 3s for inflammation
  83. What supplements would you give in Hyperthyroidism?
    • Zinc
    • L-Carnitine
    • CoQ10
    • Omega 3s (for inflammation)
    • Antioxidants (vits C and E etc)
  84. What supplements would you recommend in Non-Immune Hypothyroidism?
    • Iodine
    • Tyrosine
    • Zinc
    • Copper
    • Selenium
    • Antioxidants (Vits C and E)
    • Iron
    • Ashwaganda
  85. What 2 diet/lifestyle recommendations would you make in hypothyroidism?
    Limit / Remove goitrogens - those foods should be cooked to breakdown the goitrogenic constituents

    Exercise - stimulates thyroid gland secretion, aids thyroid function and metabolic rate
  86. What is the main mediator in asthma?
    LEUKOTRIENE and IgE mediated!
  87. What is Extrinsic (atopic asthma)
    An immunologically mediated condition with a characteristic increase in serum antibodies - IgE.

    think Extrinsic IgE
  88. What would you creatine with to help prolong the effects of it (and also increase lean body mass)?
    HMB (Beta-hydroxy-beta-methyl butyrate)

    • It is able to inhibit the creatine phosphokinase enzyme that catalyses the breakdown of creatine phosphate, thus prolonging the effects of supplemental creatine.
  89. Give 4 symptoms of dehydration
    • Fatigue
    • Sluggishness
    • Headache
    • Nausea
  90. What are the 2 types of sports drinks?
    Fluid Replacement Drinks

    Carbohydrate energy drinks (contains more CHO than fluid replacement)
  91. What lifestyle factors can cause cancer?
    • Smoking
    • Diet
    • Alcohol
    • Obesity
    • Environmental pollutants
    • Stress
    • Infectious agents
  92. Give 4 dietary promoters of cancer
    • High fats
    • Excess calories
    • Excess sugar
    • Omega 3:6 imbalance
  93. Give 3 dietary protectors of cancer
    Indole-3-carbinol

    Sulphoraphane

    Kolaviron

    These are all phytochemicals - they block the metabolic activation of a pro-carcinogen, increase detoxification of carcinogens, prevent them interacting with DNA and RNA.
  94. So what diet can we do to protect against cancer promotion?
    • Increase fibre
    • Adequate calories
    • Whole plant foods
    • Omega 3:6 balancing
    • Exercise more

    *the above will decrease oestrogens, insulin, growth factors, inflammation, down-regulation of oncogenes, up regulation of tumour suppressor genes.
  95. What would diet/lifestyle things would recommend as treatment for male infertility?
    • Stop smoking cigarettes and marijuana
    • Diet high in antioxidants (vits C and E) can improve sperm quality by reducing free radicals
    • Avoid spermatotoxic lubricants
    • Limit testicular damage - minimise cycling, tight jeans or any conditions with excess heat to the testes
    • Stress-relief therapy
    • Perform intercourse every 2 days at mid cycle
  96. What supplements would you give in male infertility?
    Zinc- deficiency associated with low sperm quality. protects against lead and cadmium poisioning.

    Selenium

    Fish Oil

    L-Carnitine - plays role in sperm metabolism and motility
  97. Which thyroid hormone is primarily synthesised from iodine?
    T4 (Thyroxine)

    "Approximately 80% of iodine is sequestered by the thyroid gland for the synthesis of thyroxine (T4)"

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Laurenwindas
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Filename:
FINAL EVER NUTRITION EXAM!
Updated:
2017-06-11 18:11:04
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