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clin nutriion

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
Created by: trevpeters
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