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Nutrition Midterm Study Guide

Test will be case based multiple choice and matching.
The test will be for 30% of your grade. Lecture will start at 9:10 on GI health.

2010 Midterm study guide Nut 622 – Dr. Seibert

WEEK 1

Patients at risk for food-nutrient interactions include:
pts w/ chronic dz, elders, fetus, infant, pregnant, malnourished

NUTRIENT ROLES

Thiamine = B1
synthesis of acetylcholine
carbohydrate energy metabolism
from old biochem notes: carbonyl transfers (2x in pentose pathway, transketolase) and decarboxylation, PDH complex (forms acetyl CoA btw glycolysis & krebs), alpha-KGDH (Krebs), BCAADH (degrade branched chain aa's val, leu, iso), not stored but is concentrated in muscle tissue, deficiency-->beriberi, alcoholics-->transketolase problem-->Wernicke-Korsakoff syndrome

RIBOFLAVIN = B2
“activation of B6/tryptophan to B3”- cell energy and glucose metab
catabolic process of tryptophan to serotonin involves two steps:
1. tryp-->5HTP (enzyme catalyzing this rxn uses tetrahydrobiopterin)
2. 5-HTP-->serotonin (catalyzing enzyme uses PLP = active B6)
metabolic process of tryptophan generates NAD = coenzyme form of vitamin B3
[more: Stipanuk pg402-407]
biochem notes: synthesis of FAD (liver) and FMN (intest mucosa) (active forms), single e- transfers, forms covalent bond to enz to prevent ox damage, light sensitive, in ETC, limited manufacture from gut bugs, easily absorbed from milk, cheese, leafy green vegetables, liver, legumes, yeast and almonds, stored in liver, subclinical deficiency common esp in females on BC pills,

NIACIN = B3
all facets of metabolism (carbs, fat, protein)- cell energy production
B3=Niacin==>nicotinamide (anti-inflam), nicotinic acid (vasodilator, gastrointestinal, hepatic, and hypolipemic)--precursor of NAD+, NADH, NAD and NADP+ (active forms), used 3x in Krebs cycle (1. 2&3. isocit-->alphaKG-->suc CoA), coenzymes in redox, can be synthesized from aa: tryptophan (inefficient), corn is deficient, deficiency-->pellagra, 4D's: dermatitis, diarrhea, dementia, death, also very toxic at high levels, not stored, involved with detoxification of xenochemicals, DNA repair, and production of steroid hormones in the adrenal gland.

PANTOTHENIC ACID = B5
--constituent of CoA (active), acyl group carrier, gut bugs make some, used in chol biosyn, Krebs, pyruvate ox, fa syn (long arm) & degrade. (NOT in glycolysis). Best dietary sources: whole-grains & eggs. deficiency ex rare-->paresthesia. unstable: not stored.???

PYRIDOXINE = B6
neurotransmitter synthesis:
1) tryp/serotonin/GABA
2) Ach/histamine/norepi
hemoglobin: PLP involved in 1st rxn and rate limiting step of heme synthesis
as a cofactor for δ-aminolevulinate synthetase
PLP in over 100 metabolic steps as cofactor: transferases and decarboxylases
from biochem: amino acid metabolism
(transamination, decarbox, deaminate, racemize)
this form in supplements, some gut bug synthesis, absorbed in upper GI
convert to PLP in liver, brain, kidney
deficiency-->limits heme syn
(1st step can't add succCoA & glycine to make delta-amino-levulinic acid-->sideroblastic anemia (similar to iron deficiency anemia but w/ normal serum iron)
meds that decrease B6 incl: isoniazid (for TB) and penicillamine (for lead)
Pyridoxal phosphate = PLP--active circulating form of B6, some gut bug syn
Pryidoxamine = active circulating form of B6, some gut bug syn

VITAMIN B12
Cobalamin
methyl donor- DNA synthesis, homocysteine conversion (to methionine), carbohydrate metabolism, and myelin synthesis
from biochem: heme synthesis, use of propionyl CoA (odd fa chain anabolism) and methylation of homocysteine to methionine, cyanide can replace cobalt in corrin ring?, absorbed in ileum w/ intrinsic factor from gastric mucosa, stored in liver, depletes in 6-8 years, deficiency-->pernicious anemia.

FOLATE
DNA synthesis and cell division, homocysteine and neural tube development
1 carbon transfers (methyl cycle)
storage in bod lasts 4-6 mo
lack in preg causes megoblastic anemia
absorbed as monoglutamate but exists in cells as polyglutamate

BIOTIN = B7 = Vitamin H
normally in gut flora, metabolism of carbs/fat/protein, utilization of glucose
cofactor in the metabolism of fatty acids and leucine, and in gluconeogenesis
Coenzyme in carboxylation (carries CO2)
(gluconeo: pyruvate-->OAA, propionic a-->methymalonyl CoA, also fa syn: malonyl CoA-->?)
1/2 of our requirements come from gut bugs (antibiotics bad), absorbed in jejunum made in colon, links to lysine on enyzme
EGG white protein avidin binds biotin, destroyed in cooking
deficiency-->priopionic acidemia, decreased gluconeogenesis
pts w/ DM2 often have low levels
mb involved in synthesis and release of insulin
preliminary studies (animals & humans): biotin may improve blood sugar control in DM2
no science backs up hair growth claims
does seem to help kids with PKU
don't eat lots of raw egg whites-->def
too much increases siezures

VITAMIN C
Ascorbic acid
collagen synthesis (hydroxylation of proline & lysine)
antioxidant (cofactor in re-activating vit E)
antihistamine
tyrosine conversion of norepi to epi (synthesis of catecholamines)
manufacture carnitine
incr Fe2+ intake in gut
conversion of chol to bile acid
we can't make it but many critters can
deficiency-->scurvy

CALCIUM
bones/ teeth, muscle contraction, blood clotting, neurotransmitter regulation

MAGNESIUM
heart muscle contraction, smooth muscle relaxant
“balancer of calcium- bone/teeth integrity”
(“approximately 99% of the body’s calcium, 80-90% of the phosphates, 70% of magnesium, and 40-50% of sodium are found in bone”-Stipanuk pg 893)

POTASSIUM
acid/ base balance, muscle contraction, “convert glucose to glycogen” (???), nerve conduction

IRON
heme, O2 transporter (iron sulfur proteins of electron transport chain)

ZINC
immune fxn
hormones(dopamine??-Cu used here, reproductive organ growth)
taste, prostate, vision
would healing (cofactor in collagen enzymes)

SELENIUM
detox (from class- antioxidant?), conversion of T4 to T3, O2 transporter

COENZYME Q10
potent antioxidant for lipid peroxidation, mitochondrial energy

L-CARNITINE
synthesis from Lysine and Methionine
fat metabolism (carnitine shuttle)
ascorbic acid involved in 2 enzymes of carnitine synthesis => carnitine utilization in fatty acid metabolism, regulates cardiac and muscle energy production

FOODS THAT INTERFERE WITH MAOI
avos, bananas, fava beans/broad beans, chocolate, aged cheese, sausage pepperoni, salami, sauerkraut, soy sauce, tap beer, red wine

FOODS THAT INTERFERE WITH COUMADIN THERAPIES
green leafies, crucifers, frozen peas, okra
chamomile tea, fish oil, garlic, ginger, ginkgo
3G's: ginkgo, garlic, ginger
what about cranberries??? not on her list but it is on mine

KEY CYP ENZYMES AND IMPACT OF NUTRIENTS/FOODS
over 90% of oxidative drug metabolism occurs via six CYP enzymes: 1A2, 3A4, 2D6, 2C19, 2E1, 2C9

TOP RX-SUPP INTERACTIONS

CYP3A4
induction: St. John’s Wort, garlic/allicin-->reduced efficacy of OCPs, protease inhib, cyclosporins
reduces: Grapefruit
(TOP 3)
DHEA also changes enzyme but which way?

COUMADIN doesn't go with Ginkgo
Incr bleeds w: pomegranate too

BITTER ORANGE CONTAINS SYNEPHRINE, THE NEW EPHEDRA
citrus aurantium contains synephrine
w/ drugs that prolong QT interval-->possible Ventricular arrhythmias


CALCIUM BINDS SEVERAL KINDS OF DRUGS
binds drugs forming insoluble and non-absorbable complexes
or may cause wrong deposition of drugs in bones, weakening them and other CT (abx)
antibiotics: quinolones, tetracycline
bone builders: bisphosphonates (fossamax, boniva)
thyroid hormone: levothyroxine (synthetic T4)(take hormones min 4 hours away from Ca+)

NONI JUICE IS HIGH POTASSIUM
Noni juice (Morinda citrifolia) rich in potassium
potassium daily intake recommended: 4700mg/day for adults
-->poss hyperkalemia in pts on ACE inhib or K+ sparing diuretics (Amiloride, Triamterene, , Eplerenone), also renal dyxfx

KAVA
hepatotoxicity?

COMMON NUTRIENT DEPLETIONS WITH RX

ESTROGENS AND PROGESTINS
-->def: B2/6/12/folate, C, Zinc-->decr serotonin and niacin
Est/prog-->depletes Magnesium from system (how?)
est + Mg+-->bone building-->according to siebert less mg in soft tissue-->incr clots

ACID BLOCKERS
PPIs and H2 inhib-->def: B12/folate, Fe, Zn
Cimetidine/Tagamet-->decr vitamin D conversion in liver
hypochlorhydria-->decr beta carotene absorption

CORTICOSTEROIDS
deplete Ca/Mg/K
deplete Zn/Cu/Se (RA pts)
mb vit C uptake inhib
give vit D to prevent bone loss

Aspirin: C, Fe dt gastric bleeds, folate
Anti-diabetics: Metformin depletes B12/folate-->incr homocysteine-->incr CVD
Statins: CoQ10 deficiency

ANTIHYPERTENSIVES
Vasodilators-->B6 deficiency
ACE inhibitors-->potassium excess (Siebert says "K def" we can't find vit K)
Beta-blockers: CoQ10, same as statins
Diuretics:
--Thiazides (potassium and other wasting)-->def K+/Mg+/Na+/Zn+
--Loop diuretics (potassium and other wasting): Ca/K/Mg/Na/Zn, B1/6, vit C

ANTICONVULSANTS
-->def Ca+/D, poss low folate (folate supp incr siez? not)
vitamin D conversion is blocked
long term use-->biotin excretion incr
Valproate (anticonvulsant, blocks transamination of GABA): L-carnitine
Phenobarbitol: deplete vitamin K-->do they bleed? I haven't heard this SE
Phenytoin (for epilepsy or neuralgias): B1/12/folate, vit K, D

ABX
Antibiotics
--Tetracycline binds multivalent cations (ca/mg/fe/se/cr/etc)
-->insoluble/poorly absorbed complexes
Dysbiosis affects levels of B vitamins and vitamin K

WEEK 2

Know folic acid metabolism pathway & dz linked to epigentics


First dz linked to epigenetic mechanism: colon cancer
DNA is inactivated by methylation
“Methylation dzs are common in about 25% of the population”

DZ LINKED TO METHYLATION
cardiovascular: CHD, DVT
CA (CRC, pancreatic), birth defects, neuropathy, endometriosis
AI: pernicious anemia, lupus, RA, IBD
psych: schizo/bipolar, Autism, ADHD, Park/alz/dementia, depression, bipolar

NUTRIENTS TO SUPP IF HOMOCYSTEINE IS HIGH
B2 liver, crimini mushrooms, yogurt (brewer's yeast for all B's), sup 10-50g
B3 chicken, tuna, halibut
B6 tuna, meat, bananas, supp 10-30mg
B12 meat, eggs, seaweed, fermented food, supp 800-1000 mcg
serine: egg whites
betaine: wheat bran, wheat germ beets, spinach
trimethylglycine: supp
magnesium: buckwheat, oatbran, almonds, spinach, pumpkin seeds
folate: supp both forms, 5-formyl and 5-methyl THF

ANEMIA THERAPEUTICS
oral iron salts
oral iron chelated with amino acids
oral sustained-release iron
iron-dextran by parenteral administration
increase heme in diet
increase absorption of heme and non-heme by having vitamin C with every meal
include meat/ fish/ poultry at every meal
decrease tea and coffee consumption (black tea here, not talkin' bout your peppermint)

FOODS THAT INTERFERE WITH NON-HEME IRON ABSORPTOIN
phytates (soak your grains)
oxalates (high in spinach and some other foods, don't eat at every meal)
carbonates/phosphates
calcium (Ca+ supplements stop you from absorbing just about anything else, but you are supposed to take calcium throughout the day: what gives?)
coffee/tea
*note to world: some people with high iron levels might decide that coffee is therapeutic for this reason and others

nice article here from livestrong, some notes:
soy has iron but also phytates which lower the body's absorption of all Fe forms
fermentation of soy degrades the phytates and the iron becomes soluble & absorbable

Whole Grains
A report issued by the American Dietetic Association in June 2003 states that the phytates found in whole grains and brown rice lower the body's absorption of non-heme iron, the form of iron found in fruits, vegetables, eggs, legumes and nuts. The body absorbs non-heme iron poorly to begin with; therefore, eating whole grains in combination with iron-rich food sources can lower iron absorption even more. While refining whole grains has the effect of reducing phytates, the refining process also removes iron, fiber and other nutrients essential for healthy nutrition. Drink a glass of orange juice or eat other foods high in vitamin C whenever you eat foods containing phytates. Doctors at the Mayo Clinic point out that vitamin C helps to increase iron absorption in the gastrointestinal tract.

Polyphenols
Beverages such as red wine, coffee, black tea, herbal teas and cocoa are rich in polyphenols, which lower the absorption of non-heme iron from foods. Polyphenols are chemical compounds found in plants. Known for their antioxidant properties that may be beneficial to health, these substances bind with non-heme iron decreasing the amount of iron the body can absorb. Polyphenols bind with iron while food is still being digested in the small intestine. This occurs before the mineral can be absorbed into the bloodstream. For this reason, you should not drink these beverages in high amounts. Avoid drinking them at mealtime so that your body can absorb iron from the foods you eat. Studies show that ingesting foods containing ascorbic acid can help reduce the negative effect of phytates and polyphenols on iron absorption, this according to the American Dietetic Association.


FOODS THAT INCREASE ABSORPTION
fermented soy
vitamin C, citrus
other acids? vinegar???

ORAL HEALTH

DENTAL CARIES
eat fermentable carbs
-->Strep mutans et al grow
-->salivary pH goes under 5.5
-->demineralization of bone and susceptibility to caries

FLUORIDATION
don't swallow it, not a good supplement
in dental products
may be added to city water
interferes with thyroid function

PERIODONTAL DISEASE
caries-->gingivitis-->periodontitis
TX: thyme rinse

GINGIVITIS TX
vitamin C 3-5gms DD
vitamin E
selenium 400-800IU/400mcg
Zinc picolinate 30mg
quercitin 500mg TID
CoQ10 60-100mg
daily folic acid rinse (0.1% soln)

STOMATITIS TX
zinc sulfate 20mg daily with 2mg Cu for 30days
B complex
treat iron deficience if present (30mg until replete)
powdered DGL 200mg in 200ml H2O gargle QID
L. acidophilus oral rinse BID
topical vitamin E
avoid food sensitivities or sodium lauryl sulfate

CANDIDIASIS
elimination diet (no sugar, mold, yeast foods)
oregano oil emulsified 50mg TID
caprylic acid 500-1000mg TID
antifungals (oral Nystatin 1/8 tsp QID)
L.acidophilus oral rinse QID
correct mineral deficiency (Cu/Fe/Mg/Se/Zn)
correct hypochlorhydria (B vits)

XEROSTOMIA TX
biotene rinse
xylitol lozenges
water
anhydrous crystalline maltose 200mg lozenges po TID for up to 24wks

LEUKOPLAKIA TX
cessation of tobacco and EtOH use
vitamin A 100,000 IU 2X per week for 6 wks
beta-carotene 50,000IU
green tea 3g po painted on lesions TID for 6mos
vitamin E mixed 800IU X 24wks

IMMUNE FUNCTION

VITAMIN A
maintain sfcs of skin, resp, GI, tissues & secretions
enhances WBCs, Ab’s, anti-tumor activity, antiviral, antibacterial, antioxidant
promotes thymus fxn by preventing shrinkage

VITAMIN C
antiviral, antibacterial, antioxidant
enhances WBCs
strong CT and respiratory lining
incr thymus fxn
incr interferon
quickly depleted during stress or infection

B VITAMINS
WBC/AB production
B6 deficiency => depressed immune fxn, thymus affected
B12/folate deficiency => impaired WBC fxn, thymus/node shrinks
B1/B2/B5 deficiency => same

ZINC
antiviral, antibacterial, antioxidant; increases T cells; increases thymus fxn and interferon; quickly depleted during stress or infection

IRON
promotes thymus fxn, prevents atrophy of thymus and lymph nodes
underdiagnosed problem in elderly/children/menses
antibacterial, increases T cells and WBC fxn/response

SELENIUM, GLUTATHIONE
antioxidant: glutathione peroxidase affects every component of immune system
involved in development and activity of WBCs

SPLEEN EXTRACTS
stimulation of WBCs and NK cells
contain proteins: tuftsin (stimulates macrophages in liver/nodes/spleen)
splenopentin (stimulates WBC production and NK cell mobility)- excellent for cancer pts and ITP or splenectomy pts

THYMUS EXTRACTS
aid in tx of chronic viral infections and low immunity
used to increase tone, fxn, and activity of thymus gland
normalizes the ratio of T helper to suppressor cells

POLYSACCHARIDES
mobilize neutrophils more efficaciously
upregulates phase 2 conjugation via glutathione
improves macrophage destruction of invaders
increases NK, T and B cells, cytokines; excellent for immune and inflammatory dz
Sources: aloe vera, arabinogalactans (Larix spp.), bread molds, breast milk, mushrooms

KEY HIV SUPPS
Hi Potent Multivitamin A-Z - up to 50-100,000 Carotene complex
Good digestive enzymes with betaine/pepsin
Calcium Carbonate supplements 500mg bid in cases of RX induced diarrhea
L- Carnitine 2-3gm DD – great for peripheral neuropathy or lipid disturbances
Whey Protein 1 gm/kg body wt/NAC – for Glutathione
Lipoic Acid 150mg tid /CoQ10 200mg for antioxidant
Maitake mushrooms
Curcumin 2000mg qd DD with bromelain ac
Licorice root 1-2 gm tid (watch for hypokalemia)
Vit C 500 mg tid
Vit E 400-800 IU qd
MethylB12 2 mg bid
Thymus extract 750mg crude polypeptide fraction
DHEA 25 mg
Silymarin 100-200mg bid

TXS FOR INFLAMMATION
Curcumin- acute inflammation
Ginger- inhibits prostaglandin synthesis, antioxidant
Boswellia-anti-inflam for arthritic conditions, inhibits 5-lipoxygenase
Proteolytic enzymes- bromelain, papain, trypsin, protease, lipase, amylase, pancreatin- better digestion???
Flaxseed/ fish oil
EPO/ black currant/ borage
Flavonoids, quercitin- reduce allergens, improve collagen
OPCs/ grape seed extract
Methionine, SAMe
Niacinamide
Glucosamine sulfate
Magnesium glycinate
Creatine monohydrate combined with pyruvate- restores ATP, removes lactic acid
B complex
CoQ10
alpha lipoic acid
daily supplements- high potency multi, vit c with esters, vit e from natural source, copper, zinc
vitamin D

WEEK 3
Know methylation pathway & nutrients formed
lots of things get methylated, turns SAM to SAH in cycle
cysteine is generated from homocysteine, both steps require B6
cysteine is part of glutathione peroxidase
TH4 tetrahydrofolate is generated
ATP is used making SAM
nutrients formed: cysteine, methionine, THFA-->DNA synthesis

SOME RXNS REQUIRING METHYLATION
detox of xenobiotics and E2 in liver
formation of phasphatidylcholine-->myelination
norepi-->epi conversion
serotonin-->melatonin conversion
manufacture of amines: acetylcholine, catecholamines
deactivation of histamine

LINKS BETWEEN AUTISM, GI, BRAIN, IMMUNE SYSTEMS AND DETOX
toxin burden- coal burning plants (lead, mercury), in foods/water
nutrient depletion- from highly processed foods
vaccinations- link to mercury/ aluminum preservatives?
detox pathway probs: methylation (mercury), sulfation removes mercury toxins, blocks free radicals
viruses
peptide proteins “opioid excess” theory- gluten, casein
chronic inflammation- food sensitivities, fungal/ yeast infxns
impaired immune system- overuse of Abx, autoimmune- “attack of brain myelin basic proteins”
low serotonin/ l-tryptophan levels
porphyria- affects heme needed to make RBCs and tryptophan
excess dopamine metabolites and low glutamate

DIET RESTRICTIONS AND TX FOR AUTISM AND ADHD
Diet: watch for diet/nutrient deficiencies from pickiness and/or dietary restrictions
66% of pts on restrictive diets had deficiencies (protein malnutrition)
more likely deficient in valine, leucine, phenylalanine, lysine, and tryptophan
(increasing or decreasing tryptophan is a question- theory that some sxs of autism is from hyperserotoninemia which mb lowered by tryptophan)
gf and casein free diets, low salicylate diets

AUTISM TX
GI TX
probiotics, capryllic acid, olive leaf, garlic, oregano oil, L-glutamine, activated charcoal
digestive enzymes (dipeptidase)
BRAIN TX
N-A-carnitine, DMAE (dimethylethanolamine for memory probs also), phosphatidylcholine, NAC, omega 3, carnosine (for antioxidant and chelation of heavy metals), individual “AA”(amino acid? Ascorbic acid?) therapies
GENERAL TX
folinic acid, vit C, zinc, pyridoxine, magnesium, TMG/DMG (tri and dimethyl glycine = methyl donors derived from betaine/beets), vit A/D/E/calcium, methylated B12, active B6 pyridoxal phosphate
PHARMACEUTICALS
nicotinic cholinergic agonists amel sx of ADHD
nicotinic antagonists may amel sx of autism

ADHD DIET
FEINGOLD DIET
salicylate and additive free, no yellow dye #5; see list of restricted foods slide 26
low refined sugars, many protein snacks between meals
amino acid precursors (tyrosine, phenylalanine)
ADHD TX
correct zinc, iron def
magnesium, B6,
EFA 3:2 ratio of DHA:EPA
phosphatidylserine(incr. production, release and effectiveness of Dopa…)
multivitamin with D
SAMe: transulfation of neurotransmitters and detox support
calming herbs

SX OF LOW SEROTONIN
afternoon/evening carb/alc/drug cravings
depression, anxiety, low self esteem, OCD, SAD, PMS, irrit, rage, panic, phobic, suicidality
fibromyalgia, TMJ
insomnia
heat intolerance
hyperactivity

TX FOR LOW SEROTONIN
5HTP or L-tryptophan, melatonin
vegans fortify diet with brewer’s yeast, nuts/seeds, banana, pumpkin
inhibited by caffeine, EtOH, aspartame, pregnancy

SX OF LOW CATECHOLAMINES
stimulant cravings
apathetic depression; lack of energy; lack of focus, concentration; easily bored

TX FOR LOW CATECHOLAMINES
L-tyrosine, fish oil
check thyroid and adrenal fxn
sex hormones interact with neurotransmitters: low T2/E2, PMS mood probs linked to low catecholamines

SX OF LOW GABA
crave carbs, alcohol, drugs for relaxation
stiff and tense; stressed and burned out
unable to relax/loosen up; overstimulated, wired; adrenal burnout
PMS dt low P4 which affects GABA release
men who have this may experience insomnia
PTSD = low GABA/cortisol/serotonin

TX FOR LOW GABA
supplement GABA
test salivary cortisol
taurine/glycine/and/or inositol
to end carb/sweet cravings- glutamine, chromium, 5HTP, tryptophan, StJW

SX OF LOW ENDORPHINS
“love” of certain food, behaviors, alcohol, drugs
very sensitive to emotional pain, cry/tear easily
crave pleasure, comfort, reward, addiction, numbness

TX FOR LOW ENDORPHINS
DL-phenylalanine (or D-phenylalanine)

SEROTONIN RX INTERACTIONS
KP found nothing in notes and I haven't looked there yet
(relationships found here are with hormones, however drugs impact hormones)
relationship with estrogen not clear: http://bcn.sagepub.com/cgi/content/abstract/4/1/43
with vasopressin (this one's interesting): http://www.ncbi.nlm.nih.gov/pubmed/7938357
with dopamine in ADHD: http://www.ncbi.nlm.nih.gov/pubmed/18772050
with corticosteroids in depression: http://www.springerlink.com/content/mmj4yk1xlkykkwrw/

CONTRAINDICATIONS FOR BIPOLAR PTS
L-tyrosine, L-phenylalanine to incr endorphins
DLPA, L-glutamine, SAMe
StJW, High dose fish oils
**Do not give inositol, omega 6, 5HTP- may contribute to mania
**L-phenylalanine CI with MAO inhibitors

NUTRITION AND SUPPS FOR BIPOLAR DISORDER
folate (enhances lithium effects)
vitamin C(esp in mania)
vanadium toxicity (inhibits Na/K-ATPase which is linked to bipolar; tx with vit c, lithium, EDTA)
phosphatidylcholine(for mania or rapid cycling)
L-glutamine (not more than 2g daily)
L-phenylalanine (for depression)
L-tryptophan (mania)
lavender and lemon balm (effects on GABA)

NUTRITION AND SUPPS FOR DEPRESSION
L-tryptophan (5HTP): give with carbs and 90minutes before or after proteins
L-phenylalanine (PEA): give with PLP, may have stimulatory effect, check urine PPA levels to measure PEA level
L-tyrosine: may have stimulatory effect
B complex: need a coenzyme B vitamin (e.g. NADH = coenzyme form of niacin)
PLP: for decarboxylation of amino acids into neurotransmitters; conversion of tryptophan to niacin(coenzyme form); tryptophan=>serotonin, glutamate=>GABA; D-phenylalanine=>dopa
methylated B12: injectable- series of 4-8 injections over 2-4wks
not cyanocobalamin form if smoker
Vitamin C, calcium, iron, magnesium, potassium deficiency (weakness/fatigue, dysmorphic mood)
zinc sulfate
Vitamin D, omega 3, st johns wort (not with SSRIs), acetyl-carnitine, SAMe (esp with low B12/folate pts), tyrosine/phenylalanine (raise norepi levels)
treat Low HCl
Aluminum or lead toxicity
Food sensitivities

SCHIZOPHRENIA
def common in: riboflavin, PLP, vitamin C, niacin, magnesium, selenium, folate
(use methylfolate with B12)
possible excesses- copper, zinc, EFAs especially EPA

B VITAMINS IN ANXIETY
Niacinamide: benzodiazepine-like action, esp if anxiety is secondary to hypoglycemia
Thiamine: if sxs of deficiency in anxiety
PLP: Conversion of tryptophan to niacin
PLP: Tryptophan-->serotonin, glutamate-->GABA, D-phenylalanine-->Dopa


WEEK 4

NUTRITION FOR AGE-RELATED MACULAR DEGENERATION
high Zinc alone may cause damage – this is avoided when zinc is combined with antioxidants
genetic abnormalities in Vitamin A metabolism may play a role in development
Foods:
Leafy greens – spinach and collard greens
Vitamin A rich fruits and vegetables
Food sources of lutein and zeaxanthin: Corn???, egg yolks, broccoli, green beans, green peas, brussel sprouts, cabbage, kale, collard greens, spinach, lettuce, kiwi and honeydew
also found in nettles, algae and the petals of many yellow flowers
Chicken egg yolks are a rich food source of lutein and zeaxanthin.
Average amount of lutein: approximately 290 micrograms per yolk
Average amount of zeaxanthin: approximately 210 micrograms per yolk.

SELENIUM AND SELENIUM DEPENDENT ENZYMES
glutathione peroxidase

Taurine – needed for normal eye function
Rule out gluten sensitivity:
May cause progressive vision loss if not treated
Cataracts/ glaucoma:
Dietary risks for:
Excessive calorie intake assoc w/ risk
Obesity + hyperglycemia + hypertriglyceridemia
Low fruit and vegetable intake
Lactose if predisposed to accumulation in lens, but yogurt okay

Herbal helpers:
Ginkgo (120-160mg tid) can help glaucoma/ARMD
Bilberry (240mg SD) may stop progression of cataracts, glaucoma, ARMD
Coleus forskoliin 2% topically helpful in glaucoma
Lutein and zeaxanthin may be helpful, not great performers in studies yet

NUTRIENTS FOR LENS DEFENSE
Antioxidants: C, E, A (1-2gm/400-800IU mixed/10,000 IU DD)
Selenium 200 mcg
CoQ10 20-150mg DD
Magnesium 350mg
Beta-carotene 15-60mg – (25,000-100,000 IU)
Alpha lipoic acid (25-50mg ->150mg –glaucoma)
Riboflavin necessary for regeneration of glutathione in lens– check if presenile cataract then use:
Intake below 10mg – due to photosensitizing
For diabetics block sorbitol pathways-
Use Quercitin/bioflavonoids – foods great source!
Watch HgA1C
Antioxidation is the key!!

NUTRITION FOR MIGRAINES
triggers: histamine containing foods: Wine, dark beers, aged cheese, chocolate, cashews, processed meats/ MSG/food intolerances/aspartame
Caffeine w/drawal
R/o reactive hypoglycemia
SUPPS
Magnesium – Oral potassium Mg aspartate* (500-1000mg hs),
IV (2 gm in Myer’s 30ml in 15 mins), * use Mg gluconate if problems with diarrhea
Riboflavin – 200 mg bid cc, s/e Yellow urine, Compounds nicely with Ibuprofen/ginger/caffeine
B6 – Def. causes rise in histamine levels –food intolerances, 25 mg tid
5-HTP – helps to increase serotonin & endorphins, 100-200 mg tid cc
EFAs/Arach. Acid – help decrease platelet aggregation (2 gm EPA/DHA)

NUTRITION FOR ALZHEIMERS
Supplements: best set is multi, extra B's, zinc, niacin for memory
Thiamin – 3-8 gram improved mental function
Niacin – helps memory
Folate – lowers homocysteine
Methyl B12 – 1000mcg bid
Zinc to Think! 30mg, Balance with Cu 2mg
L-Acetylcarnitine – (500mg tid) Mito booster
Vit E 400-800 IU ( for membrane integrity) combined with:
Phosphatidylserine (PS) 300mg
C0Q10 – 100mg
Gingko – (SE 24% gingko flavonglycosides) -240mg*
DHA- 10mg
Huperzine A (Chinese clubmoss) – up to 200 mcg
Vinpocetine (periwinkle) – 2.5-10mg
Check blood hormone levels

SWANK DIET AND SUPPS FOR MS
http://www.swankmsdiet.org/
Low-fat diet, very low in saturated fats and polyunsaturated oils
Low in red and other fatty meats, high in grains, fruits and vegetables
All dairy products must be non-fat or contain no more than 1 gram of saturated fat per serving. The recommended daily amount is two (2) servings.
SUPPS W/ SWANK DIET
1 tsp. cod liver oil or 4 capsules (equals 5 grams oil to be counted in your daily allotment)
restrict additional A & D to 1 therapeutic multiple vit/mineral capsule/day
Multiple vitamin with minerals
1,000 mg. vitamin C
400 IU vitamin E
ALSO HELPS
Glutathione 600-800mg IV dil sterile H20 15mins 3x/wk (watch for overheating pt)
NAC (precursor for glutathione)– 1 gm bid
Alpha Lipoic Acid – 200-300mg
Vit D 800-4000IU * watch hypercalcemia- weakness/fatigue
Calcium – take with Vit D 800-1200 mg DD
Magnesium – 600-1200 mg DD –muscle spasticity
B vits 50-100mg
Methylcobalamin B12 PO(1000-2000mcg qd)
Pancreatic enzymes- Malabsorption & reduce circ. Immune-complexes – 350-700 mg ac tid
BOTANICALS
Ashwaganda – Anti-inflam & tonic effect for nervous sys (1-2gm)
Ginkgo – Anti-ox/neurotransmitter enhancement (120-240mg)
Hormonal therapies: E3: Shift from Th1 -> Th2
(decr sx noted during pregnancy) 4 mg bid - protect uterus add 20mg P4
T2- Compound micronized for men -10-30mg/women 2-5mg
Monitor PSA in men & S/e – acne/aggression in women; DHEA – low levels may cause MS relapse

PARKINSONS: KEY ANTIOXIDANTS
Evening protein meals – avoid interference w/carbidopa & levodopa:
Limit Protein: 0.5-1.0 gm/kg on RXs
Green Tea (EGCG) – great anti-ox – chelates iron accumulation w/in Substantia nigra
Omega 3 & Fiber – help with constipation (O-3- anti-inflam)
NADH - (10mg) Help with tyrosine production - > dopamine
Glutathione – IV 600-1200 mg -
Lipoic acid (400-800mg) Pro- glutathione pathways, improves mitochondrial fxn, amphoteric anti-ox
Vit C & E – Early PD dx- (3000mg/3200 IU) may delay initiating drug therapy for 2.5 yrs
CoQ10 (1200mg DD) – fat soluable anti-ox –slows deterioration.
Magnesium/gingko- dilate vessels – (400mg/240mg DD)
Amino acid therapies:
L-Tyrosine – 1500mg DD
D-Phenylalanine 500mg – shown to improve rigidity, speech, walking, depression
L-Tryptophan 500mg
OR
5-HTP 50mg/bid- Low levels seen in PD pts & helps with depression

TX GOALS FOR ANOREXIA/BULIMIA AND ROLE OF BRAIN CHEM IN WT ISSUES
ANOREXIA TREATMENT GOALS
Start with 800 to 1200 kcal
Nutritionally balanced meals
Dietary fiber from grains to aid constipation
Progress to goal within 2 weeks
Small, frequent feedings to avoid bloating
Link contingencies to calorie intake, not weight gain
BULIMIA TX GOALS
Regularly planned, balanced meals
Adequate but not excessive exercise
Adequate dietary fat and fiber for satiety
Minimize food avoidances
Dietary record keeping
Weigh at scheduled intervals only

BRAIN CHEM AND GUT HORMONE KEY PLAYERS IN WT MANAGEMENT
NOR and DOPA—released by sympathetic nervous system in response to dietary intake
Fasting and semi-starvation lead to decreased levels of NOR/DOPA causing adrenal gland to respond – releasing Epi – to stimulate gluconeogensis
Low Serotonin – stimulates carb consumption
Endorphins – Sweet high fat food cravings in Bulimics/Obese
Neuropeptide Y increases appetite after food deprivation – Weight gain after restrictive dieting
Gut peptides: Cholecystokinin, Bombesin, Enterostatin - promote satiety
Thyroid hormones— Lower T3 affects SNS’s NOR/DOPA effects - >Weight gain
Insulin—increases food intake
Ghrelin – Stimulate feeds/slows metabolism/oxidation- Highest in lean people/dieters; low in obese/Gastric bypass
Leptin – Secreted by adipocytes – suppress appetite- High Leptin levels may create resistance to loss weight
Adiponectin – Secreted by adipocytes- Modulates glucose and fatty acid metabolism- Inverse level to BMI


WEEK 5

PMS TX
Diet rich in fiber, whole foods, fruits/veggies
Decrease fat, salt, sugar
Avoid caffeine/alcohol
Exercise
Yoga/relaxation therapy
Acupuncture
Topical progesterone
SUPPS
EPO/Black Currant (up to 3000 mg) *mixed trial results
Calcium citrate(600 mg)
Vit E (400-800 IU) - blocks PGE2-pro-inflam, Inc. PGE1
Chaste tree (vitex)– Helps with disturbance of corpus luteum insufficiency- Raises LH & Inhibits Prolactin
Prolactin interferes with corpus luteum development
Block Prolactin restores P4 levels
VITEX DOSE 3-5ml or 500-1000mg qd – best taken ½ hr after awaken
Best used with B6 vitamin 50 mg
Black Cohosh– Helps with anxiety, tension, & depression, PMS discomfort, dysmenorrhea
Dose: Standardized to triterpene glycosides, 20-80mg bid, Crude herb 250-500mg qd
St. John’s wort– Helps with depression/irritability
Dose: Standardized to 0.3% hypericin/4-5% hyperforin, 20-80mg bid, Crude herb 250-500mg qd ** Watch Rx interactions/OCP & photosensitivity
Ginkgo– Helps with breast pain/tenderness & fluid reduction
Dose: Standardized to 24% ginkgoflavones/6% terpenes 80mg bid Day 16 to Day 5 of next cycle** Watch Rx interactions/anticoagulants
Valerian & Kava– Helps with anti-anxiolytic effects
Valerian dose – 10-15ml or 2 gm - 1 hr q hs
Kava – 5-15 gtt
** Watch Rx interactions/sedatives

ENDOMETRIOSIS TREATMENTS
EFA (3000 mg) w/Vit E– reduce inflam.* Neptune Krill Oil - better for pain
Vit C 1-6 gm – auto-immunity
B vits – 50-100mg – help liver process Estrogens
Selenium 200-400mcg –Liver detox/cell mediated immunity
Lipotropics – 1 gm tid (methionine, choline, cysteine) Help rid Estrogens via stool
DIM 150-300mg
Magnesium – 300-600mg qd- higher with menstrual pain
Same herbal protocols for Dysmenorhea & PMS
Add Turska Formula – Interferes with ectopic seeds? TOXIC - 5 gtt tid
Same food/lifestyle as DUB
Topical progesterone up to 21 days

FIBROCYSTIC BREAST DISEASE
EPO 1500 mg bid x 6 months
Flaxseed oil 1 tbsp qd or Grd Flax seeds 2 tbsp
Iodine – Aqueous/diatomic versions only 3-6 mg qd
Iodoral – combined Iodine/Iodide product 12.5mg
Vit E 200-600 IU d-a-tocopherol?? Uncertain
B vits – 50-100mg – help liver process Estrogens
Lipotropics – 1 gm tid (methionine, choline, cysteine) Help rid Estrogens via stool
Diuretic herbs (cleavers, yarrow, uva ursa)
Phytolacca oil – apply hs 2 weeks; then 3x/wk
DIM 75-300 mg
Cut out all caffeine & chocolate
Eat a whole food->Low fat & High fiber
Topical progesterone on breast tissue Days 14-28

DYSMENORRHEA
NSAIDS, OCPs
Alpha-tocopherol (Vit E) 50mg tid for 14 days prior to 10 days before menses
Omega 3 – 1080 mg EPA/720mg DHA with Vit E (50mg)
Helped reduce amt of NSAIDs needed – See NKO study
EPO 500-1000mg tid
B1 – 100mg qd reduced spasmotic pains
Mg – 300-600mg start at Day 1 – 5
Reduced inflammatory PGE1 & PGE3
Antispasmotic/relaxes uterine tissue:
Crampbark (Viburnum opulus) -3 ml or 1 cap q 2-3 hrs
Black Haw (Viburnum p.) – 2ml or 1 cap q 2-4 hrs
Valerian – 1 tsp or 1-2 caps q 3-4 hrs
Black Haw, Mitchella repens, Black cohosh, Wild yam, Dong quai are combined to act as an antispasmodic effects on uterus possible by blocking PGEs, promotes blood circulation.
Diet rich in fish, fiber, whole foods, fruits/veggies
Decrease dairy, red meats, poultry, salt, sugar
Avoid caffeine/alcohol
Exercise
Relaxation therapy
Acupuncture
Topical progesterone
DIM 75-300 mg

DYSFUNCTIONAL UTERINE BLEEDING
Vit A 60,000 IU qd 1-3 months; 10,000-25,000 ongoing
Give with Vit E & Zn
B complex 100mg
Vit K 150-500mcg (Chlorophyll) – helps clotting
Alpha-tocopherol (Vit E) 50mg tid for 14 days prior to 10 days before menses
Vit C w/ Bioflavonoids – 2-4 gm/1-2gm
Fe def/capillary fragility/anti-E affect on uterus E2 receptor sites-> reduce bleed
Chaste tree – help normalize menstrual cycle, 175-215 mg qd - Can take 4-6 months
Ginger – inhibit Prostaglandin 2 – Anti-inflamm, 1-4 gm powder qd
DIM 150-300mg

UTERINE TONICS
Blue Cohosh – regulate menses flow
Combine with Yarrow/pennyroyal/squaw vine 20 gtt q 2-3 hr
Astringents
High tannins – Cranebill – prompt results w/o side effects
No tannins – Shephard’s purse – coagulate blood
Combine with Yarrow/greater periwinkle/life root, 20-30 gtt q 2-3 hrs
Diet rich in fish, fiber, whole foods, fruits/veggies
Add Fe rich foods
Decrease dairy, red meats, poultry, salt, sugar
Avoid caffeine/alcohol
Exercise
Relaxation therapy
Acupuncture
Topical progesterone
DIM 75-300mg

MENOPAUSE
Diet rich in fish, fiber, whole foods, fruits/veggies
Decrease red meats, salt, sugar – modest dairy
Avoid caffeine/alcohol
Weight bearing Exercise/Strength training
Yoga
Acupuncture
Soy – ??Safety??? 1-2 gm Isoflavones/gm Soy, 160mg Isoflavones
Ground Flax – 2 tbsp
Calcium Citrate – 600mg
B Complex (B6) -50-100mg
Vit C -1-1.5gm DD
Bioflavonoids*- 1 gm DD in the form of hesperidin methyl chalcone
EPO – 1.5-3 gm DD
Fish oils 1-2 gm
Vit E – 400-800IU- Hot Flashes
Magnesium 400-600mg
Boron – 3mg - Raises E2
Gamma-oryzanol 100mg tid
Improves Vasomotor:
Black Cohosh* - Remifemin™ Standardized 1 mg of terpene glycosides per 20-mg tablet (40-80 mg DD) * Possible interaction with Tamoxifen
Red Clover – Promensil (shown Vasomotor/bone/CV/Vag dryness) Standardized 40 mg Isoflavones (40-160mg DD)
Sage liquid 5 ml in 1L H20
DIM 75-300 mg

PROGESTERONE
Licorice – can raise P4;lower E2 improves ratio E2/P4, ½-1 tsp
Chaste tree - Raise P4, 175mg

ADRENAL SUPPORT
Panax Ginseng – 200mg
Rhodiola - 100-200 mg



*****************************************************************************
old biochem notes:

5. Which vitamins can be synthesized by humans? One form of D in the skin with UV, from dietary precursors: vitamin A from beta carotene, niacin from tryptophan.

Which vitamins are supplied by intestinal bacteria? Vit K and biotin (B7)

6. Characterize the best understood functions of vitamins A, D, E, K. ALL FAT SOLUBLE.

Vit A=retinal (active), retinol (active) and retinoic acid (lipid-sol hormone in bone metabolism), imp in cell differentiation, bone metabolism, converting cholesterol to vit D, 90% stored in liver as retinol esters (retinyl palmitate), intestine converts carotenoids (beta carotene) to retinol (we synthesize vit A), deficiency-->epithelial cells that should have bene cuboidal, columnar or goblet are squamous, eye lens cells become keratinized-->cataracts

Vit D=cholecalciferol is active D3, imp in bone metabolism, mobilizing Ca++, syn in skin w/ UV, melanin absorbs in same wavelength, hydroxylated in liver, activated to 1, 25 form in kidney, becomes sterol hormone that can diffuse through membranes, bile is required for absorbtion in GI, not stored: short halflife.

Vit E=alpha-tocopherol and others--unmetabolized in the body, prevents free radical formation in polyunsaturated fa's, bile required for absorbtion, we don't make it

Vit K--imp in synthesis of blood clotting factors, cofactor in carboxylation of clot factors, plant form = phylloquinones, bile required for absorbtion, supplied by gut bugs

7. Which vitamins are stored and where?
A--90% in liver
B1--not stored, concentrated in muscle
B2--stored in liver
B3--not stored, can synthesize from tryptophan, toxic in high doses
B5--not stored (pantothenic)
B7--not stored

8. What is the bioactive form of vitamin D? 1, 25-dihydroxycholecalciferol, aka 1, 25-(OH)2D3. Where is this form synthesized? in the kidney. What role is played by ultraviolet light in vit D synthesis? UV light converts 7-dehydrocholesterol to cholecalciferol in the skin. Cholecalciferol is converted to 25-hydroxycholecalciferol in the liver. These two forms have half lives of about 30 days, and are the form that is stored longest. Once activated the 1, 25 hihydroxy form has a half life of about 4 hours.

9. Identify enzymes and processes associated with each of the following trace elements: copper, zinc, molybdenum, selenium, cobals, manganese.

COPPER: cytochrome oxidase, ceruloplasmin, dopamine beta-hydroxylase, tyrosinase, cytosolic SOD

ZINC: carbonic anhydrase, cytosolic SOD, carboxypeptidase

MOLYBDENUM: xanthine oxidase

SELENIUM: glutathione peroxidase, (antioxidant)

COBALT: vitamin B12, heme synthesis and synthesis and maintenance of myelin

MANGANESE: pyruvate carboxylase, mitochondrial SOD

ISOPENTENYL PYROPHOSPHATE (IPP) is an intermediate in the classical, HMG-CoA reductase pathway used by organisms in the biosynthesis of terpenes and terpenoids. IPP is formed from acetyl-CoA via mevalonic acid. IPP can then be isomerized to dimethylallyl pyrophosphate by the enzyme isopentenyl pyrophosphate isomerase.

Comments

(Anonymous)
Feb. 7th, 2010 03:29 am (UTC)
Feingold diet
Feingold diet: www.feingold.org

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