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clin nutriion
| Question | Answer |
|---|---|
| What is nutritionism | the idea that the nutritional value of a food is the sum of all its individual nutrients, vitamins, and other components |
| 3 pernicious myths regarding nutritional science | -nutrients matter more than food -need expert help -purpose of eating promotes narrow concept of health |
| What is orothorexia | An unhealthy obsession about healthy eating habits |
| Significance of the 1977 Dietary Goals for US | -told people to eat less beef and dairy -offended people, changed it to "choose meats poultry and fish that will reduce saturated fat intake (nutritionism) -were blaming nutrients, not foods |
| 3 reasons to avoid soda | -addictive-empty calorie reactive hypoglycemia -fructose damages the liver -acid forming |
| What is parking lot science | Assuming what we can see is more important to look at when actually we may need to look at something else |
| What is zero sum relationship | -eating more of one thing means eating less of another |
| What is epidemiological research | Collects stats and trends in nutrition and patters, causes, and effects of health and disease in defined populations |
| What are Randomized Control Trials | Specific type of experiment to test effectiveness of various types of intervention in a patient population, randomly allocated to receive one or another treatment of study |
| What problems arise when we wish to assess what people eat | -people lie, and cant accurately recall diet over 24 hours |
| What is the problem with the food frequency questionnaire | -very confusing, people only have 24 hour diet recall |
| 4 shifts in food relationships that have occurred in the Western Diet | -adding chemicals -more processed (fortified) foods -increased sugar -increased fat |
| What is food culture | passed on by parents, government, food industry |
| What is food science | What we should be eating based on studies - whole foods vs refined -complex vs simplicity -leaves vs seeds |
| Pollans suggestion to move beyond nutritionism | eat foods that rot and have bugs |
| What are fat soluble vitamins characteristics | -used for absorption and transport -similar to lipids -require bile salts -transport involves chylomicrons -stored in body lipids -fat malabsorption conditions |
| What are water soluble vitamins characteristics | -absorption into portal blood -limited storage in the body except B12 -only stored by binding to enzymes and transport proteins -excreted in urine when plasma levels exceed renal thresholds |
| 2 types of water soluble vitamins | Vitamin C Vitamin B-complex |
| B-complex vitamins function | -energy releasing -hematopoiesis -others |
| General sources of Fat-Soluble Vitamins | Fish, milk, kale, spinach, eggs, fortified cereal |
| What is vitamin insufficiency | you don't have enough of the vitamin but there are NO symptoms |
| What is vitamin Deficiency | You don't have enough of the vitamin and are showing manifestations |
| What is biomechanical individuality | Everyone is different and needs different things |
| What is RDA and what are problems with its measurement of nutritional status | -Recommended Daily Allowance -developed using deficiency diseases for large populations -consumers use it as a means to provide adequate nutrition -made for populations, NOT individuals. People may need more or less of certain things |
| Which vitamins are Fat Soluble | -Vitamin D -Vitamin A -Vitamin K DAKE -Vitamin E |
| Major Function of Vitamin A | -vision -regulation of gene expression(cell differentiation) -immunity -Growth and Development -RBC production |
| Vitamin A deficiency symptoms | -Vision problems: night blindness, bitots spots, xerothalmia(dry eyes), corneal scarring -Anorexia -Retarded growth -susceptibility to infections -enlargement of hair follicles, keratinization of skin |
| How to convert mcg to IU | 1 mcg= 3.33 IU so take whatever the mcg amount is and times it by 3.33 |
| What is vitamin A beta-carotene | -comes from green leafy veggies and is provitamin A -hard to convert to retinal -converted to retinol in the body |
| What is preformed Vitamin A | retinal and retinol (animal fat) |
| What is the tolerable upper intake level of Vit. A for a pregnant woman | 3000 mcg (10,000 IU) |
| Therapeutic applications of Vit. A | -cancer prevention( in animals and cell cultures, human inconclusive) -infectious diseases -skin(acne), scalp, and hair disorders -Gynecologic disorders |
| What is a teratogenic dose of Vit. A | >7500 mcg (25,000 IU) |
| What group of people may be susceptible to beta-carotene toxicity | Smokers |
| How do vitamin D and parathyroid glands function to regulate serum calcium | Parathyroid glands sense serum calcium is low and increase PTH secretion. This goes to the kidney which secretes calcitriol into the small intestine which absorbs more Vit. D |
| Vitamin D short-latency deficiency symptoms | -rickets(failure of bones to mineralize) -Osteomalacia(adults) -muscle weakness and pain |
| Vitamin D long-latency deficiency symptoms | -cancer -autoimmune disease -cardiovascular disease -depression |
| Risk factors for vitamin D deficiency | -breast fed infants, lack it =cell differentiation issues,immunity issues -dark skin -elderly because their reduced capacity to synthesize Vit. D in skin -covering or sunscreen when outside -fat malabsorption -inflammatory bowel disease -obesity |
| What is the tolerable upper intake level for vit D in adults | 100 mcg (about 4000 IU) |
| Therapeutic applications of vit D | -osteoporosis -maintain adequate calcium intake -help with autoimmune disease: MS, RA, IDDM -Cancer prevention: inhibits cell proliferation -hypertension |
| Best assessment for Vit. D | serum 25(OH)D |
| Value that signifies Vit D deficiency | <20 ng/ml (<50 nmol/L) |
| Value that signifies Vit D insufficiency | <30 ng/ml (<75 nmol/L) |
| Problems with having high optimal vit D levels | it could be toxic in some people who don't need that high of dosage |
| Symptoms of Vit D toxicity are the result of what | Hypercalcemia |
| Names of Vitamin E family members | -tocopherols -tocotrienols - alpha tocopherol is the only form in humans |
| Vit. E deficiency symptoms | -Neurological: impaired balance and coordination, muscle weakness, peripheral neuropathy, damage to retina -Hemolysis and anemia -atrophy of reproductive organs and infertility |
| Risk factors for vitamin E deficiency | -Vit. E is removed by processing -Consumption of polyunsaturated fatty acids -requirements increased in urban environments -Vit C and selenium deficiency: unable to recycle vit E -premature and newborn infants: difficult absorption |
| Tolerable upper intake level (UL) for vit. E in adults | 1000 mg |
| What is the difference between d-a-tocopherol and dl-a-tocopherol | - d-a-tocopherol is natural isomeric form found in foods - dl-a-tocopherol is the synthetic form in many supplements |
| Therapeutic applications of vit. E | -cardiovascular disease -cataracts -immune function -dementia -diabetes -cancer |
| Symptoms for vit. E toxicity | -nausea -diarrhea -flatulence -impaired blood coagulation |
| Contraindications and cautions for vit. E supplementation | -anticoagulant drugs -statins + antioxidants -diabetics |
| what are the 3 forms of vit K | -phylloquinone (K1) found in plants -menaquinone (K2) synthesized from bacteria - Menadione (K3) is synthetic form used in animal feed, can form MK-4 |
| Functions of Vit. K | -blood coagulation: essential cofactor in coagulation cascade, balances the 2 opposing sides- clot formation and breakdown -Vit K cycle: recycles vit K-liver -Cell growth and regulation: Gas6 is vit K dependent protein -bone mineralization |
| 3 vitamin K dependent proteins in bone | -Osteo calcin: sythesized by osteoblasts, regulated by vit D -Matrix GIa protein(MGP): found in bone, cartilage, blood vessels, prevents calcification of soft tissue, cartilage, and bv -Protein S: synthesized by osteoblasts, role is unclear |
| How does warfarin affect vit. K | Depletes active Vit. K recycling |
| Symptoms of Vit. K deficiency | -prolonged bleeding, easy bruising -impaired bone mineralization and/or remodeling |
| Why is Vit. K deficiency uncommon in adults | -ubiquitous in foods -active vit K cycle - activity of colonic bacteria |
| Who is susceptible to vit K deficiency bleeding and what is the treatment | new borns, inject K1 to all newborns |
| Tolerable upper intake level for vit K in adults | none recommended, 120 mcg male and 90 mcg females |
| Therapeutic applications of vit. K | -vascular calcification: aortic calcifications associated w/ lower vit K1 intake -hemorrhagic disease of newborns (HDN) |
| What is the effect of various forms of vit. K on osteoporosis | -epidemiological support for decreased risk of fracture -undercarboxylated osteocalcin |
| General symptoms of Vitamin B deficiency | -tired, weakness, tachycardia, easy bruising, photophobia, fissure tongue, sore throat |
| Vitamin B1 (Thyamin) functions | -energy metabolism: dehydrogenase enzymes -nerve AP -transketolase: enzyme thats a good marker for B1( pentose phosphate pathway) -DNA/RNA synthesis |
| Deficiency symptoms of Vitamin B1 (Thyamin) | -Beri-beri: dry-nerves, wet-heart, cerebral-brain |
| Susceptible to Vitamin B1 (Thyamin) deficiency | Pregant, breast feeding, alcoholics, athletes |
| Upper limit of Vit. B1 | NONE |
| Therapeutic applications of Vit. B1 | -cataract prevention -cancer -alzheimers |
| Functions of Vit. B2 (Riboflavin) | -redox reactions(antioxidant reactions) -ETC -drug metabolism |
| How does Riboflavin affect glutathione function | -the enzyme glutathione reductase needs FAD to recycle glutathione -FAD is a flavo-coenzyme that requires B2 -you need B2 to get FAD, and FAD to recycle glutathione |
| Tolerable upper intake of Vit. B2 (Riboflavin) | NONE |
| What is the symptom of excess riboflavin intake | Nuclear urine (bright urine) |
| Effect and dose of riboflavin for migraine headache | 400mg/day for 3 months -should reduce the frequency and number of headache days |
| Types of Vit. B3 (Niacin) | -nicotinic acid: main thing -niacinimidea: derivative of nicotinic acid; has an amide group - boh are co-enzyme forming |
| Functions of Niacin (B3) | -cellular metabolism for over 200+ enzymes -help form NAD and NADH -DNA repair, cellular signaling, and blood sugar regulation |
| Deficiency of Niacin (B3) | -Pellagra-late stage deficiency - symptoms: dermatitis, diarrhea, dementia, death |
| How is Niacin related to tryptophan | -NAD can be synthesized from tryptophan |
| Tolerable Upper intake of Vit. B3 (Niacin) | 35mg for flushing |
| Therapeutic applications of Vit. B3 (Niacin) | -cancer prevention -beta cell protection in type 1 diabetes -mental illness |
| Use of Niacin in CV disease and types of niacin and toxicity | -nicotinic acid only!! -3g/day for 6 years increased HDL levels, decreased lipoprotein A, increased bouyant LDL, and decreased mortality/morbidity |
| Active form of Pyridoxine (Vit. B6) | pyridoxal-5-phosphate |
| Functions of Pyridoxine (B6) | -transamination -nervous system functions -gluconeogenesis -steroid hormone inhibition |
| Tolerable Upper limit of Vit. B6 (Pyridoxine) | 100 mg -prevents sensory neuropathy |
| Therapeutic applications of Pyridoxine (B6) | -birth control side effects -PMS -morning sickness |
| Role of Pyridoxine in the Homocystine Metabolism | -it converts homocystine to cystine to decrease risk of heart disease |
| Potential Toxicity of Pyridoxine (B6) | -flushing -GI issues -increased uric acid levels -liver toxicity at 750mg/day |
| Compare and Contrast Folic Acid (B9) and Folate | -Folic acid: synthetic but stable and in all supplements -Folate: in leafy raw veggies, not as stable and not as effective |
| Functions of Folic Acid (B9) | -one carbon metabolism: methylation -cell growth -nucleic acid and amino acid synthesis** |
| Role of Folic Acid in Homocystine Metabolism | -synthesis of methionione from homocysteine |
| Who is susceptible to folic acid deficiency | Pregnant, active, alcoholics |
| Symptoms of Folic Acid (B9) deficiency | -increased homocysteine levels - atrophy and inflammation of mucous membranes -birth defects |
| Upper Tolerable Limit of Vitamin B9 (Folic Acid) | 1000 mcg |
| How do genetics affect folate requirements | depending on genetics, you might have a different type of enzyme |
| What is the role of folic acid in disease prevention | -neural tube -CV disease prevention -cancer |
| Toxicity of Folic Acid | Folic acid and B12 increased mortality in patients with heart disease |
| How is Cobalamin (B12) different from the other B vitamins | it is large, complex, and contains cobalt |
| Functions of Cobalamin (B12) | -cofactors for methionine synthase and coenzyme A mutase -HEMOGLOBIN SYNTHESIS -folate metabolism, production of succinyl-CoA, homocysteine recycling |
| Cobalamin (B12) susceptible deficiency people | -surgical resection -vegans -alcoholics |
| Discuss the absorption of cobalamin in the GI tract | intrinsic factor attaches onto B12 in the small intestine and gets absorbed by the ilium |
| Characteristic symptoms of deficiency of Cobalamin (B12) | -anemia -numbness -memory -dementia -disorientation |
| Upper Tolerable Limit of Vitamin B12 (Cobalamin) | NONE |
| What is the role of Cobalamin (B12) in disease prevention | -decreased risk of heart disease -breast cancer -neural tube defects |
| Therapeutic applications of Cobalamin (B12) | -alzheimers -depression -allergies -PNS disorders |
| Functions of Pantothenic Acid (B5) | -forming coA and acetyl-CoA -energy metabolism -FA and AA synthesis |
| Upper Tolerable limit of Pantothenic Acid (B5) | NONE |
| Therapy using B5 (Pantothenic Acid) | -helps with wound healing -helps with high cholesterol |
| Functions of Biotin (B7) | -required by all living organisms -attached at all active carboxylase sites -acetyl-CoA and pyruvate carboxylase |
| Symptoms of B7 (Biotin) deficiency | -hair loss -immunodeficiency -numbness, tingling -flaky skin with red patches around nose and mouth |
| Upper Tolerable limit of Biotin (B7) | NONE |
| Therapeutic applications of Biotin (B7) | -birth defects -diabetes -brittle nails -hair loss |
| Functions of Vit. C | -collagen synthesis -carnintine synthesis: getting fat into the mitochondria -NXT synthesis -antioxidant -blood clotting |
| Vit. C deficiency symptoms | -scurvy -sand paper skin -impaired wound healing |
| Upper Tolerable limit (TUI) of Vit. C | 2000mg |
| Disease prevention of Vit. C | -coronary heart disease: 400mg/day -stroke, cancer, cataracts, decreased uric acid for gout, and lead toxicity |
| Therapeutic applications of Vit. C | -CV disease: 500mg/day -cancer: 10g/day - helps with colds -osteoporosis |
| Toxicity concerns with Vit. C | -only occurs in really high doses -genetic mutations, birth defects, cancer, kidney stones, loose stools |
| Increases risk of calcium deficiency | -loss of gastric acid secretion -menopause -magnesium deficiency -magnesium excess |
| Upper limit of Calcium | 2000mg |
| Ca RDA of adullts 51-70 years old | -males 1000mg -females1200mg |
| Function of Calcium | -blood clotting -cell signaling -structural functions |
| Calcium Deficiency symptoms | -osteoporosis -muscle cramping and spasm -increased irritability of nerve cells |
| Therapeutic applications of Calcium | -oseoporosis -HTN -Colon Cancer |
| Toxicity of Calcium | -Only from supplements -Kidney stones -Hypercalcemia -milk alkaline |
| Dietary components that interfere with calcium | -protein intake -phosphorus -Oxalates (spinach, rhubarb) -Phytic acid -Sodium -Alcohol |
| Magnesium Function | -energy -synthesis of nucleic acids and glutathione -cell signaling -structural function -ion transport across cell membrane -wound healing |
| UL Magnesium | 350 mg loose stool |
| RDA Mg in Adults | male >31 420mg female > 31 320mg |
| Magnesium Deficiency symptoms | -hypomagnesia: neuro, personality, cramping, spasm -Chronic kidney failure: Mg cannot be excreted efficiently |
| Therapeutic applications of Magnesium | -Cramping -spasm -asthma -diabetes |
| Toxicity of Magnesium | -Hypermagnesemia: low bp, loose stool, arythmea -kidney disease- <1g/day |
| Function of Potassium | -energy -cell signaling -pyruvate kinase |
| Potassium amounts recommended | adults, male and female over 19 is 4700mg |
| Source of Potassium | unprocessed fruits and veggies |
| Potassium deficiency issues | hypokalemia: fatigue, spasm/cramp, arrhthmias |
| risk of becoming potassium deficient | alcoholics, diuretics, any BP pill |
| Therapeutic applications of Mg | -HTN -Osteoporosis by maintaining Ca |
| Toxicity of Potassium | -Tingling -Arrhythmias -Diuretics -BP pills -decrease aldosterone |
| Recommended intake of Potassium vs average intake | Recommended= 4700 mg/day - avg male 3100mg -avg female 2300 mg |
| Upper limit of sodium | 2300 mg |
| Upper limit of Salt | 5800mg |
| Adults recommended amount of salt and sodium | Sodium is 1300mg Salt is 3300 mg |
| Excessive sodium leads to what | increased ECF volume |
| Function of sodium | -membrane potential -maintain blood volume and pressure |
| Deficiency of sodium | -not due to decrease of intake -Hyponatremia: cerebral edema |
| Increases risk of sodium deficiency | -sodium loss(vomit, diarrhea) -excercise -sweating |
| Therapeutics of Sodium | -restriction -gastric cancer -HTN -Osteoporosis |
| Toxicity of Sodium | -Hypernatremia: excess water loss+decrease water intake, possible kidney failure |
| Average salt recommendation to average salt intake | recommend 7800mg for men, intake 11,800mg recommend 5800 mg for woemn, intake 7800mg |
| What is the DASH diet and what were the results of the trials | -diet high in fruits, veggies, whole grains, poultry, fish, nuts, and low fat dairy products substantially lower BP to SAD -higher in K and Ca-Na levels kept constant -effect of salt reduction was greater in control diet than DASH diet |
| Upper Limit of Iron | 45mg |
| Recommended Iron amounts for Infants7-12 months | 11mg |
| Recommended Iron amounts for Adults 19-50 years | Males- 8mg Females- 18mg Pregnancy- 27mg |
| Iron characteristics | -2/3 body iron is functional form -remainder stored in bone marrow and liver -powerful oxidant and potentially harmful -Copper increases iron absorption |
| Function of Iron | -O2 transport and storage -Enzyme function: antioxidant, pro-oxidant,DNA synthesis |
| Iron deficiency symptoms | -Microcytic hypocromic anemia -fatigue -Rapid HR -Fever -Spoon shaped nails -Impaired physical work capactiy -inability to maintain body temperature |
| Therapeutics of Iron | -fatigue -poor intellectual development -lead toxicity -restless legs |
| Toxicity of Iron | -largest case of poisoning in children under 6 -Hemochromatosis: iron overload leads to CVD, cancer, stained teeth, dark stools |
| Who is susceptible to iron deficiency | -Infants 6 months to 4 years -pregnancy -adolescents -vegetarians -intense exercise -chronic blood loss -gastric bypass |
| What is the most common deficiency in the US | Iron deficiency |
| What enhances iron absorption | Vitamin C, Organic acids, meat, fish, poultry |
| What inhibits iron absorption | phytic acid, polyphenols, soy protein |
| Upper limit of Zinc | 40mg |
| Recommended Zinc intake adults above 19 | Males 11mg Females 8mg |
| Function of Zinc | Catalytic role in 100+ enzymes -regulatory role -structural role |
| Deficiency of Zinc symptoms | -zinc/copper imbalance -acrodermatitis enteropathica -impaired taste -poor wound healing |
| Therapeutics of Zinc | -impaired growth and development -weak immune function -common cold -diabetes -macular degeneration |
| Toxicity of Zinc | -Copper deficiency at doses of 60mg/day -GI distress at 50-150mg/day |
| What is the most abundant intracellular trace element | Zinc |
| Relationship between Zinc and Copper | High Zinc interferes with copper bioavailability- 10 to 1 ratio |
| Upper limit of Copper | 10,000 ug |
| Recommended Copper amounts for Adults 19 and above | Males 900ug Females 900ug |
| Function of Copper | -Energy -MAO -Melanin -Epinephrine synthesis -Superoxide dismutase |
| Deficiency of Copper symptoms | -Anemia -Loss of pigmentation -Impaired growth -Osteoporosis |
| Therapeutics of Copper | -immune function -osteoporosis |
| Toxicity of Copper | -Tightly regulated in water supply -zinc deficiency -Wilson's disease -Liver damage with long term use |
| Chromium upper limit | None |
| Recommended Chromium in adults 19-50 years | Males 35 ug Females 25 ug |
| Deficiency of Chromium symptoms | -impaired glucose tolerance -endurance exercise can cause it -elevated cholesterol and TG -Peripheral neuropathy |
| Therapeutics of Chromium | -impaired glucose tolerance and diabetes -diabetes -CVD |
| Toxicity of Chromium | -hexavalent(VI) toxic vs trivalent(III) non toxic -impaired liver function |
| Difference between hexavalent chromium and trivalent chromium | -hexavalent is toxic: derived from trivalent by heating alkaline ph -readily reduced to chromium III in acidic stomach -Trivalent is non toxic |
| Iodine Upper Limit | 1100 ug |
| Iodine Recommended limit in adults 19 and above | males 150 ug females 150ug |
| Food sources of Iodine | -iodized salt -dried seaweed -potato with skin, baked if in iodine soil |
| Funcion of Iodine | thyroid hormone synthesis |
| Iodine Deficiency symptoms | -cretinism -hypothyroid -goiter -Fibrocystic breast condition |
| Risk that can lead to Iodine deficiency | -decreased selenium -goitrogens -soil deficiency |
| What happens in Iodine deficiency | Iodine-induced hyperthyroidism (IHH) -happens at 150-200ug/day |
| what happens in iodine sufficiency | -elevated TSH, hypothyroidism -happens at 1700-1800ug/day |
| Therapeutics of iodine | -hypothyroid -radiation-induced thyroid cancer -fibrocystic breast condition |
| Toxicity of Iodine | -hypothyroid -hyperthyroid -thyroid cancer |
| What is the most prevalent cause of preventable mental retardation in the world | Iodine- widespread efforts to iodize salts |
| What increases the risk of iodine deficiency | -soil deficiency in inland areas -pregnancy and lactation -Goitrogens block uptake or use of iodine (tobacco, soybeans) |
| Upper limit of Selenium | 400ug |
| Recommended amount of Selenium in adults 19 and up | Male 55ug Female 55ug |
| How does iodine interact with selenium | -selenium deficiency exacerbates iodine deficiency -selenium is required for T4 to T3 conversion |
| Function of Selenium | Selenoproteins: Glutathione peroxidases, Iodothyroninedeiodinases |
| Deficiency of Iodine can lead to | -increased risk of cancer -weak immune system -sign of deficiency is Kashin-beck disease and Keshan disease |
| Therapeutics of Selenium | -can help prevent cancer -CVD -Viral infection |
| Toxicity of Selenium | -Brittle nails -GI problems -garlic breath |
| Upper limit of Flouride | 10mg |
| Recommended amount of Fluoride for infants and adults | infants .01mg male adults 4mg female adults 3mg |
| Function of Fluoride | -Tooth structure -bone metabolism: stimulates osteoblast activity |
| Deficiency of Fluoride may lead to | increased susceptibility to dental caries |
| Therapeutics of Fluoride | -caries -possibly osteoporosis |
| Toxicity of Fluoride | -Dental fluorosis -Skeletal fluorosis -poising at 5mg/kg of bodyweight |
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