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What do you suspect if your patient chronically has canker sores in her mouth?
gluten enteropathy

What is the biggest difference between modern human diets and that of paleolithic humans?
we eat more grass family foods now
(wheat, corn, barley, oats, rice, ie: grains, agriculture)

What is the natural expiration age for humans?
somewhere between 110 and 120 years of age

What are the top five causes of death in the US?
CV dz, CA, medical care, DM, stroke

What is the ideal fiber intake for humans?
35-50 grams

Restriction of what in the diet increases longevity in all animals??
calories!
calorie restriction cron diet: calorie restricted optimal nutrition (Roy Walford)

Since 1909, has American carbohydrate consumption gone up or down?
This is somewhat of a trick question, because the trends in the last 40 years have been upward. Overall in the last century our carb consumption is lower, because at the turn of the century we were eating almost entirely grains, and as our prosperity increased especially after the world wars, we began to eat meat much more regularly. Now we are eating more carbs (especially simple carbs, like HFCS) than we were forty years ago, but less than 100 years ago.

How about the chance in fat consumption, has it gone up or down since 1909?
Up: we eat more fat now, but the percentage of calories from fat has gone down, because we are eating so much more sugar.

Why do vegans have higher homocysteine levels than meat eaters?
Because vegans are commonly deficient in B12 and folate. Folate is the commonest nutrient deficiency across the board, and the most important nutrient for moderation of homocysteine, with B12, B6, and B11 ??? in the running.

Summary of Ideal Diet basic tenants:
Carbs: 60-75% of total calories
Types of carbs: complex 90%, simple 10%
Proteins: 10-30% of total calories
Fats: 20% of total calories
Types of fats: 80% unsaturated fats, omega 6:omega 3 = 5:1
Total Calories: minimal to maintain body weight
Fiber (mixed & insoluble): 5-100 grams
Sodium: 500mg-1g
Potassium: 8-10g
Flavinoids, Antioxidants: very high levels and a broad spectrum
Ellagic acid, Crucifers: daily servings when in season
Soy bean products(if tolerated) 4-5x per week
Processed foods: NONE
Ideal blood parameters:
cholesterol 125-175 mg/dL:
HDL over 60
glucose (fasting) 70-90 mg/dL
uric acid 5-12

Avoid the big killers: heart dz, cancer, medical care, diabetes, stroke.

Know hemochromatosis, ferritin, and % transferrin levels.
Ideal levels:
ferritin 100 ng/dL
transferrin 40% (25-30% is ideal)
Hemochromatosis: ferritin 1,000 mg/dL; transferrin 60%
omnivorous folks typically have higher iron levels than vegetarians

Who lives the longest in the world? How does their diet compare to the ideal?
Okinawans (most centenarians) and Andorrans live the longest
Okinawan dietary make up:
Carbohydrates 60%
Protein 15% (mostly plant source)
Fats 25% (high % of omega 3 fatty acids)

What nutrient deficiency might elevate blood pressure?
potassium
magnesium

What toxin supposedly increases blood pressure?
lead (??? have never heard this anywhere else)


Causes of orthostatic hypotension include? hypoadrenalism, anemia, hypovolemia, dehydration

What nutrients concentrate in the adrenals?
B5
vitamin C
vitamin E

What nutrients are associated with macrocytic anemia?
B12, folate

What nutrients are associated with microcytic anemia?
iron, B6, copper, maybe B1

What minerals or vitamins are associated with asthmatic bronchial wheezing?
deficiency of magnesium and molybdenum
vitamins B6 and B12 esp in children
quercetin and flavonoids may be used to tx asthma, to stabilize the mast cells

Besides bronchial constriction, what else might be seen in molybdenum deficiency?
sulfite intolerance---headaches with consumption of wine, preserved meats

Name the condition presenting with chest pain worse on deep inspiration?
Costochondritis
also worse on direct pressure to costochondral joints

Scaling, crusting, scabbing skin is associated with what nutrient deficiencies?
zinc, vitamin A, vitamin E, and EFAs

Excoriation of the skin, especially in infants, is associated with what? Acrodermatitis enteropathica
an inborn error of metabolism which causes zinc malabsorption

Skin itching generalized around the body may be associated with?
deficiency in vitamin K
parasites
cancer
chlorine in the water
maybe vitamin A

Babies with atopic dermatitis maybe successfully treated with?
topical zinc
oral GLA (Gama Linolenic Acid- an omega 6 FA)
biotin
vitamin E

Slow wound healing maybe associated with?
diabetes or pre-diabetes

Easy bruising maybe associated with deficiencies in what?
vitamin E
vitamin C
flavinoids- responsible for stabilizing capillaries

Most skin conditions are associated with what?
excess consumption of simple carbohydrates
allergies
increased candida

What can cause a person to have pigmented skin tags on the neck and upper trunk?
elevated blood glucose
impaired glucose tolerance
insulin resistance

Sensitivity to skin rolling is an indication of what?
panniculofibrositis -- subdermal adhesions
skin rolling breaks myofascial adhesions

What in the diet encourages the development of panniculofibrositis?
coffee (caffeine and other methylxanthines)

What vitamin may be deficient in a patient with Paniculofibrositis?
myofascial adhesions form when there is a deficiency of vitamin B6

What are the two ways to measure bowel toxicity?
bowel transit time (using charcoal or other bowel marker)
urinary indican (obermeyer test)

What is the ideal bowel transit time?
13-17 hours

What is the American average bowel transit time (BTT)?
26 hours

Under what conditions is a person likely to have tinea?
diabetes
increased simple carbohydrate intake
moist skin

What's on the differential for a person with numbness and tingling of the feet?
(5 things, two diseases and three vitamin B related)
multiple sclerosis
diabetes
B6 and B12 deficiency
B6 toxicity

A nutritional physical exam of a child with allergies may find what signs?
Denies Lines- swelling under the eyes
Salute Sign- wrinkle on nose from rubbing it
Allergic shiners- dark circles under eyes
Hx of ear infections, sore throats due to mouth breathing

What sort of disease would you expect in
an elderly Caucasian male with diagonal creases in his earlobes?
heart disease

What vitamin is likely deficient if the gums bleed easily, and what's the dz?
Vitamin C deficiency: Scurvy

Cracking and redness around the corners of the mouth are associated with a deficiency of what? What is the dz?
Riboflavin (B2); Angular Stomatitis

In evaluation of the mouth of a young teenage girl, you find chronically enlarged tonsils, erosion of enamel especially behind the front teeth, chronic canker sores and gum damage. What do you suspect?
Bulimia or chronic vomiting (estimated 25% of females age 11-14 are bulimic) also may see scabbing of the back of finger from forcefully attempting to vomit

An enlarged, red tongue is called? and is associated with deficiency of what? Glossitis
Deficiency of iron, B12, folate, zinc

Spooning or cupping of the finger nails is a sign of deficiency of what?
Iron

White spots on the fingernails along with inflamed cuticles and cracking at finger tips, is usually an indication of what kind of deficiency? Which disease might you want to rule out?

Zinc deficiency
Rule out: Acrodermatitis Enteropathica

Tenting of the skin on the posterior hand may be due to?
Dehydration
insufficient EFA intake
free radical adhesions

What is Follicular Hyperkeratosis? What might cause it?
skin condition characterized by excessive development of keratin in hair follicles, resulting in rough, cone-shaped, elevated papules whose openings are often closed with a white plug of sebum. Often these are on the backs of people's arms.
This may be caused by:
Vitamin A deficiency
Hypothyroidism
Zinc deficiency
def of EFAs

What food makes most skin conditions worse?
sugar

What skin condition may also be considered diabetes of the skin?
Acne

For musculoskeletal issues such as arthritis and Carpal Tunnel, what dietary changes might you recommend?
supplementing B3 and B6
eliminating nightshades
eliminating grass family

Inflammation of tissues may be due to what?
excess arachidonic acid
deficiency of flavonoids

What do you want to rule out in a patient with Epigastric tenderness?
H. pylori
dairy sensitivity
hiatal hernia

What deficiencies may be associated with stomach ulcers?
Vitamin A
Zinc

For abdominal tenderness, hepatitis, NASH, and diverticulosis what might be in excess in a person's flora?
yeast

For IBS consider what type of dietary change?
eliminating dairy

For GI allergies and malabsorption, what would you want to rule out?
gluten enteropathy Celiac

For patients with Gall Bladder Disease, which foods might they want to eliminate?
Chicken Onion Eggs Dairy

Abnormal PAPs may have to do with a deficiency of what vitamin(s)?
B6 Folate (esp related to birth control pills) Zinc Vitamin A

Chronic bladder infections may be related to what?
excess sex
excess carbohydrate consumption (esp simple CHOs)
poor urination (hygiene)

BPA mb associated with what deficiencies?
Zinc EFAs vitamin A

What are the two most common types of kidney stones?
uric acid or oxalates

What dietary item can cause fibrocystic breast disease?
coffee--(caffeine, methyl xanthenes)
(also hypothyroid)

What compound in broccoli and other crucifers inhibits breast cancer?
sulforaphane

Eating 7 or more eggs per week increases all cause mortality by what percentage?
23%

What specific disease process was found to be related to egg eating?
diabetes

Why do chickens contain high concentrations of xenobiotics?
because they're in the feed

What are the top four GMO foods in the US today?
canola, corn, cotton, soy

Recall the basics from the movie the Future of Food. Problems concerning GM foods- rBGH injected into cows

What is the optimal human intake of POTASSIUM in grams/day?
8-10 if you go by what paleolithic humans consumed

What's the average daily in take of potassium today in the US?
2g/day

What is the ideal amount of Magnesium per day for humans?
~6-18 mg/day

What is an ideal vitamin B12 consumption level?
~200-900 ng/day

What amino acid is used to make homocysteine?
methionine

What's the ideal sodium intake?
approx 2,300 mg/day

How much sodium do Americans eat, on average?
4-6 GRAMS/day

What could cause a positive results on an Obermeyer test for urinary indican, besides slow bowel transit time and general bowel toxicity?
supplementation with tryptophan

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