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Nutrition III Final Exam Study Guide


2010 Final study guide Nut 622 – Dr. Seibert

Week 6

Be able to identify examples of phenol, terpene, lignan, thiols foods and their nutritional function within the body

PHENOLS: blue, purple, red; isoflavones: phytoestrogens, genestein, flavonoids: anthocyanins (anti-ox) and quercetin (mast cell stabilizer)
TERPENES: yellow, orange, red; lycopene (decr CA of prost, lung, stomach), limonids (incr p450 fx)
LIGNANS: flax, wheat bran, rye, oat, buckwht; incr bifidobact, anti-mitotic, anti-ox, may prevent hormone sensitive CA
THIOLS: crucifers, indoles (incr p450); allyl sulfides in garlic (incr phase 2, decr mutagenesis, incr macrophage and T-cell activity)

GI – know bifidobacteria role with Short chain Fatty Acid, its byproducts role in Gut,
Bifido breaks down indigestible carbs to SCFAs; propionate and acetatae go to liver to make glutamine, glutamate, acetoacetate which are good for the SI; butyric acid direction feeds enterocytes

GI – know which bacteria colony increase sIgA levels
bifidobacteria

Identify GI trt for diarrhea from antibiotic therapy
??? didn't see answer in notes so this from my head: probiotics (Sarcomyces boulardii, Bifido and lactobacilli), glutamine, butyric acid, grape seed extract, all directed at keeping microbial population from shifting to the pathogenic, and at supporting healthy enterocytes

Be able to identify foods that activate Phase II conjugation reactions
from notes: crucifers, garlic/onions, citrus (limonoids)
from previous notes: fish oil, dill
also need: glutathione, glycine, glucuronic acid, cystein, methionine, taurine

Week 7

Know pros/cons of using capsules, powders, tablets, liquids and gel caps
capsules: pro: more pure, con: may not dissolve, less per cap
powders: pro: lots/dose, cons: messy, taste bad
liquids: pro: already liquid, con: taste, smell
gel caps: pro: easy to swallow, no taste, cons: mb large but still less dose than liquid

Be able to calculate in mg elemental calcium from calcium carbonate given in mgs
CaC03 contains 40% elemental Ca+

Know folate’s role in vascular function and its end product formed
5MTHF is converted to NO using BH4 and vitamin C
also presence of folate reduces homocysteine, less MI, stroke, miscarriage, depression
serotonin-->melatonin is another pathway dependent on folate

Be able toidentify what supplement industry’s cGMPs guarantee
consistency but not quality
content, strength, potency, purity

Identify most common “other ingredient” used in supplements – HINT :experiment done in class
magnesium stearate

Know definition of a phytosome
a composite of a botanical extract and a phospholipid that has the extract on the outside
opposite of a liposome
botanical is usually a flavonoid
phospholipid is usually phosphatidyl choline
composite increases absorption of the botanical by 5-20x

Know key Mech Of Action (MAO) for curcumin
which one is key? they are all key.
some mechanisms of curcumin:
inhibits NF-kB, TNF alpha, IL-1, 2, 6, 8, 12, decr Cox2 and Lox pathways, upregs p53

Know methylation pathway & nutrients formed
she always wants us to know this and I have studied it 100x now and still don't know what she thinks she has taught us.
SAM-CH3 donates the methyl group to proteins and DNA
also forms adenosine
results in homocyteine which can with the addition of serine be used to make glutathione
or MTHF-CH3 can donate a methyl group to it, cofactor is B12-->becomes methionine
methionine acted on by ATP becomes SAM, that's the cycle
folic-->DHF-->THF-->methylene THF is from my notes taken in guest lecture class
all these things with TH in them depend on folate

Week 8

Celiac’s dz – what in diet pt should avoid
duh. gluten: wheat, barley, rye, tamari (mb cow's milk, soy)
OK: buckwheat, oats

Know Primary Malabsorption nutrients for supplementation
EFAs
vitamins: all fat soluble and B's esp PLP if depressed, and folate
minerals: Fe+, Zn+, Ca+, Mg+

Role of Glutamine
fuel source for enterocytes

Constipation – what in diet pt should avoid
dehydration, processed grains, refined sugars, dairy
overeating, snacking all the time

Use of primary supplements and duration
fiber ok to use longterm: flax, psyllium
cathartics short term only: cascara, aloe, senna

Know secondary nutrients used
Vit C 1gm/20mins w/ 1/2 cup water and repeat until BM (this is her fave)
Mg up to 800mg/day
FOS 4-15g/day-->incr butyrate

Diarrhea - what in diet pt should avoid
sugars: fructose, sorbitol, lactose
Mg+, vit C
coffee, dairy, food sensitivities

Use of primary supplements
probiotics: S. boulardii, bifidobact, active yogurt
secondary: brewer's yeast (why?), bovine colostrum, carob in applesauce for kids
psyylium is non infectious
charcoal to remove toxins

IBS– what in diet pt should avoid
sugars: mainly lactose, also: fruct, sorb
is that all she says???

Use of primary/secondary supplements
primary: psyllium
secondary: enteric coated peppermint, other carminatives, chamomile
EPO during menses
GSE
reduce stress, avoid coffee

Crohns- what in diet pt should avoid
sugar, fat, proteins, allergies

Know foods that trigger histamine release
chocolate, spinach, nuts
shellfish
fruit: strawberries, bananas, papayas, pineapple
nitrates: sausage, wine
eggs, milk

Use of primary/secondary supplements
primary: EPA/DHA 3-5g, vit D
secondary: multi, Fe, Zn, vit D, B12/folate, S.boulardii, lipase, vit A (if not preg)

UC- what in diet pt should avoid
sugar, fat, allergies

Use of primary/secondary supplements
no primary listed but I think it's a mistake in the notes
maybe these are primary in her mind tho slide says secondary:
butyrate suppository, fish oil 3-5g, folic
secondary: probiotic, multi, psyllium, boswelia

Week 9

Know ND nutritional trt for nephritic syndrome/pyelonephritis
or does she mean nephrotic syndrome as she says in notes? there is a difference
for the neph syndrome: fish oil, garlic, prot, Zn, B6, vit D
for pyelo: cranberry, D-mannose, proteolytic enzymes, acidophilus
vit C, uva ursi, goldenseal, onion/garlic, flax

Know #1 risk factor for nephrolithiasis
low urine volume

Identify food that raise oxalates
spinach, rhubarb, beet greens, almonds/peanuts, chocolate, tea, strawberries, bran, soy

Key nutrient used to prevent stone formation
potassium, citric acid/lemon

Safe calcium form to use with stone formers – not hyperabsorbers
citrate

Dosing (mg) limit of Vit C in stone formers
1gram/day

Identify foods that are alkaline vs. acidic
acidic forming: meats, dairy, coffee, PB, cranberries, prunes, plums
alkaline forming: veggies, all fruits besides the 3 listed above

Know ways to remove intestinal toxins
fiber, bentonite clay, SCFAs

Know Phase I Antioxidants used and role they are believed to play in CYP 450
antioxidants: bioflavonoids: quercetin, green tea, milk thistle, ginkgo, anthocyanins
NAC requires selenium to make GSH
CoQ10 and vit C needed for ETC, C to stabilize, CoQ10 as a component
vit E and anthocyanins to stop lipid peroxidation

Know role of cruciferous veggies & grapefruit juice in Phase I pathways
crucifers and DIM ramp up phase 1, hydroxylate xenoestrogens
grapefruit inhibits phase 1, so does aging

Know role of curcumin in CYP 450 detox pathway
inhibits phase 1, stimulates phase 2
prevents cancer
inhibits p450 1A1/1A2 and 2B1/2B2

Know role of Phase II conjugate agents (eg NAC)
NAC-->GSH (glutathione): needs B6, is protective vs xenobiotics
sulfation: remove RX, metab CATS and bile acids, need molybdenum
(cysteine, methionine, molybdenum)
glucuronidation: calcium-d-glucarate, cancer fighter
methylation: need methionine, SAM3, adds methyl to est, converts homo-->methionine
amino acids: need glycine, glutamine (ammonia detox) and taurine (bile acid conjugation)

Know which mineral/vitamin deficiencies decrease CYP 450 activity
vits: B's, C, E
minerals: Cu, Zn, Ca, Mg

Be able to identify key hepatitis nutrient/herbs used
silymarin, schisandra, astragalus, thymus, glycyrrhiza, catechin (for acute), betaine
multi (no Fe), selenium, B's, C, glutamine

Know role of SAMe/BCAA/Pcholine in trt of cirrhosis patients
SAMe: reduces glutathione and resolves cholestasis
BCAA increases protein processing?
Phosphatidylcholine: use in Hep B to improve fx and reduce fibrosis

Know which key digestive enzymeneeds to be replaced in chronic pancreatitis pt
lipase

Week 10


What key B vits are used in infertility for men/women?
men: B12
women: B6

Role of Vit C infertility of males who smoking
smoking-->decr sperm count
vit C helps counter that reduction

Use of L-arginine in infertility
4g/day for mild oligospermia

Know IOM nutrient guideline for pregnant women
all preg women should take folate and iron

Amt of protein (gm) and folic acid (mcg) needed daily for pregnant women
71g prot, 600mcg folic

Vit A (IU) limits and iron (mg) dosing in pregnant women
??? notes not clear
vit A:
80-85mg or 2800 IU?
not over 10,000 IU
iron: 30mg/day if not def (UL 45)
if deficient: 60-120mg/day ferrous, divided doses, interferes with Zn absorption

Reasons to supplement magnesium in pregnant women
prevents pre-eclampsia and IUGR
360-400mg/day
IUGR = intrauterine growth retardation

What amino acids are highest in breast milk; also digestive enzyme present
taurine, cysteine (not necc highest, but in high concentrations)
bile activated lipase

Know Anti-infective properties of breast milk
milk oligosaccharides support bifido and lactobacillus establishment
sIgA an dlactoferrine in milk
peroxides and vit C attack bacterial membranes
lysozymes finish 'em off

Strategies for introducing solid foods to infants
add 1 food at a time to assess allergies
introduce veggies first
avoid troublesome foods with skins, PB sticks to roof of mouth
cup liquids at 9mo
1TBS of each food/year of age
start small let them ask for more
let child eat w/o help until tired then help
1 year old eats 1/3-1/2 adult portion ???
3 yr: 1/2 adult
6 year: 2/3 adult

Know Adolescent Energy requirements
kCal needs not in notes or in book, says it varies widely p250 in Krause
under energy heading find these needs:
protein for boys: 52g, girls: 46g
Ca 1300mg for all, folic 400 for all
Fe: boys 11mg, girl: 15mg

Nutrients to consider and role in elderly (see slides)
Zinc: sense of smell, oral sx, GI, CV, renal
antioxidants
vit A: too much-->hip fractures
D, MTHF, Ca+, K
limit Na to 2000mg max
C for smokers
E for heart and CA prevention
Bs esp 6, 12, folate need higher dt gastritis, liver dyxfx, malabsorption

Know symptoms of dehydration in elderly
thirst, dry mouth, tongue, speech truoble, headache, urine change
change in drug effects, LOC, constipation, wt loss, low BP, sunken eyes

Nutritional screening initiative for elderly – be able to identify issues
tooth loss/mouth pain-->hard to eat
economic hardship-->cant afford food
decr social life-->eats alone
incr meds-->more interactions
involuntary weight gain or loss-->malabsorption, inactivity, organ disease
disabilities, memory problems-->can't shop, cook, feed self, needs help with self care
decr vision, hearing, incr rxn time-->can't get out in world very well to get food
constipation

Test will be case based multiple choice.
The test will be for 30% of your grade.
Everyone, including those who need special accommodation, must take test at same time - the test will start at 8am Tuesday March 23rd.

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