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Nutrition 2 (Semester I) > 3. Assessment and Diagnostics > Flashcards

3. Assessment and Diagnostics Flashcards

(122 cards)

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1
Q

What is functional testing?

A

Focuses on how body systems are functioning

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2
Q

What is diagnostic testing?

A

Looks for marker to diagnose an illness

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3
Q

What figure is considered in conventional medicine as ok for vit D levels?

A

50 nmol/L

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4
Q

What is the optimal range of vit D in functional medicine?

A

75-125 nmol/L

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5
Q

What are the benefits of functional testing?

A

Helps uncover a deeper understanding of imbalances
Can make a plan more targeted and effective
Allows to quantitatively measure a client’s progress and the client can see that progress from the reports

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6
Q

What are the disadvantages of functional testing?

A

Expensive
Challenging to interpret
Not diagnostic so difficult to communicate results to GPs

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7
Q

What questions do you need to ask yourself when interpreting functional tests?

A

Do the results correlate with the symptoms at time of testing?
Has the client’s diet impacted the results?
Do any activity at the test time affect the results?

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8
Q

Where in the body can microbiome niches be found?

A

GI
Vaginal
Oral
Skin
Urinary

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9
Q

What sort of things can a stool test test for?

A

Increased intestinal permeability
Inflammation
Gas producing bacteria
Pathogenic microbes

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10
Q

What are gram negative bacteria?

A

Bacteria with an outer cell wall rich in LPS

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11
Q

What abilities do LPSs have?

A

Induce inflammation
Induce immune responses

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12
Q

What is a CDSA?

A

Comprehensive digestive stool analysis

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13
Q

What can a CDSA show?

A

Digestive function
GI microbiome

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14
Q

What is metabolic endotoxaemia?

A

Immune response
Sub clinical
Persistent
Low grade inflammation due to increased LPSs

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15
Q

When is metabolic endotoxaemia more prevalent?

A

With poor GI barrier integrity

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16
Q

What can metabolic endotoxaemia be a risk factor for?

A

Insulin resistance
Diabetes
CFS
AI

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17
Q

What are the microbial markers that comprehensive stool tests can evaluate?

A

Commensal bacteria
Pathogenic bacteria
Pathobiont microbes
Mycology
Worms

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18
Q

What are the host markers that comprehensive stool tests can evaluate?

A

Immune
Digestive
Inflammation
Intestinal permeability
Occult blood

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19
Q

Why is it important to know a client’s diet when interpreting a stool test?

A

Different dietary models impact the microbiota in different ways

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20
Q

Which inflammatory host markers are tested for in a stool test?

A

Calprotectin
Eosinophil protein X

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21
Q

What is calprotectin?

A

A protein made by leukocytes when they have migrated to and are active in the GI wall

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22
Q

What is a high level of calprotectin?

A

Over 50 ug/g

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23
Q

In what situations can calprotectin be raised?

A

IBD
Ulcers
Cancer
Pathogens
NSAIDs
Age

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24
Q

In what situations could eosinophil protein X be raised?

A

Intestinal inflammation
Food allergies
Colitis
Parasites

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25
What is beta-glucuronidase?
A metabolic enzyme made by some intestinal bacteria
26
In which situations could beta-glucuronidase be raised?
Dysbiosis Western diet
27
Beta-glucuronidation can interfere with the elimination of which hormone?
Oestrogen
28
Which digestive host markers are tested for in a stool test?
Pancreatic elastase Faecal fats
29
What is the normal range for pancreatic elastase?
200-500 ug/g
30
Why can measuring faecal fats be inaccurate?
The amount of fat in the stool can change with diet and testing type
31
What do high levels of faecal fat indicate?
Fat maldigestion associated with pancreatic insufficiency, SIBO, hypochlorhydria
32
What do low levels of faecal fat indicate?
Low fat diet
33
What immune markers are tested for in a stool test?
Secretory IgA Beta-defensin 2
34
What does low IgA indicate?
Chronicity Increased susceptibility to GI infections
35
What does high IgA indicate?
Upregulated immune response when testing
36
What is beta-defensin 2?
Anti-microbial peptide produced by the GI wall when breached
37
What does high beta-defensin 2 indicate?
Immune system could be responding to a breach by microbes GI inflammation - e.g. ulcerative colitis
38
What intestinal permeability marker can be tested for in a stool test?
Zonulin
39
What is zonulin?
A peptide produced by the epithelial cells when the GI tight junctions are open
40
Why might zonulin be raised in a client?
Poor nutrition Heavy metals Drugs Alcohol Dysbiosis Coeliac disease
41
What should be checked for when looking at commensal bacteria on a stool test?
Diversity Good levels of SCFAs Good levels of Bifidobacteria and Lactobacilli
42
What can impact the diversity of commensal bacteria in the GI?
Diets lacking diversity - junk food, FODMAP Overeating Antibiotic use Chronic conditions
43
What are SCFAs?
By products of the bacterial fermentation of fibre
44
What can impact levels of SCFAs in the GI?
Low fibre diets Diarrhoea Antibiotic use
45
What can create low mucosal integrity?
Ulcers IBD Gastritis High levels of mucin-degrading bacteria Low diversity of commensal bacteria High gram negative bacteria
46
Examples of mucin-degrading bacteria
Akkermansia Ruminococcus gravus Ruminococcus torques
47
Why should levels of Akkermansia be balanced?
Mucin-degrading...BUT ALSO Protective role in the mucosal barrier
48
What are low/absent levels of Akkermansia a risk factor for?
Metabolic endotoxaemia patterns of disease: Obesity Insulin resistance AI
49
Examples of gas-producing bacteria (and possibly SIBO)
Methanobrevibacter smithii Desulfovibrio spp Bilophila wadsworthia
50
Examples of methane producing bacteria
Methanobrevibacter smithii
51
Examples of sulphur producing bacteria
Desulfovibrio spp Bilophila wadsworthia
52
Which condition is smelly flatulence a sign of?
SIBO
53
Examples of pathobiont bacteria
Prevotella copri Klebsiella spp Staphylococcus aureus
54
Examples of pure pathogenic bacteria
Giardia spp Clostridium difficile Shigella
55
Examples of anti-microbials to eradicate pathogenic bacteria
Oregano oil Garlic Neem Clove
56
Which phytonutrients can be used to increase Akkermansia?
Polyphenols (grape extract, quercetin, dark choc, tea, red wine)
57
If calprotectin tests high, what can be used to lower levels?
Reduce gluten/sugar Increase D3 EPA/DHA Curcumin Quercetin Chamomile
58
If commensal Bacteroides spp. are low, what can be eaten to increase levels?
Brown rice
59
What are the 3 gram negative bacteria typically present in a stool test?
Bilophila Hafnia Veillonella
60
Which gram negative bacteria may explain bloating and possibly SIBO?
Bilophila
61
Which gram negative bacteria is linked with liver disorders?
Veillonella
62
What bacterial count in the SI is considered as SIBO?
Over 105 CFU/ml (colony forming units)
63
What is SIBO a result of?
Fermentation of carbs in the SI
64
Which gases are raised in SIBO?
Methane Hydrogen
65
How is SIBO tested?
Breath test
66
What type of substrates can be used for a SIBO breath test?
Lactulose Glucose Fructose
67
How do you decide which substrate to use for a SIBO breath test?
Which ever your client reacts to the most in their food
68
What can be the underlying cause of SIBO?
Poor MMC Low stomach acid/pancreatic juice Poor ileocaecal valve functioning Low IgA
69
What foods are allowed 24 hours before a SIBO breath test?
Meat/poultry/fish - not cured Steam white rice Eggs Fats/oils Salt/pepper
70
In hydrogen positive SIBO, what is the result ppm?
A rise of 20 ppm before 90 mins
71
In methane positive SIBO, what is the result ppm?
A rise of 12 ppm before 90 mins
72
In combined hydrogen/methane positive SIBO, what is the result ppm?
A rise of 15 ppm before 90 mins
73
In which conditions is it best to test the vaginal microbiome?
Bacterial vaginosis Recurrent thrush Infertility Miscarriages Endometriosis
74
What the key markers in vaginal testing?
pH IL-1
75
What is the pH of a healthy vaginal microbiome?
3.8-4.5 (acidic)
76
Why is the vagina acidic?
To prevent pathogenic microbes from growing
77
Which bacteria is important in maintaining the acidic pH of the vagina?
Lactobacilli
78
What is a high vaginal pH indicative of?
Bacterial vaginosis-associated bacteria Vaginal dysbiosis
79
What is IL-1?
An inflammatory marker made when epithelial cells break apart (i.e. in an infection)
80
What is considered a healthy IL-1 level?
<220 pg/ml
81
Should the vaginal microbiome population be diverse?
No
82
How can the vaginal microbiome be supported?
Avoid soap, antibiotics, copper coil Avoid excess carbs, alcohol, smoking Include probiotics and prebiotics to support Lactobacilli growth
83
What can oral dysbiosis be associated with?
Tooth decay Periodontitis Oral cancer CV disease AI conditions AZD
84
What pathogen is mostly associated with the oral microbiome?
P. gingivalis
85
How can the oral microbiome be supported?
Optimise intake of pre/probiotic foods and polyphenols Minimise intake of processed carbs, trans fats Avoid mercury fillings Brush teeth with electric toothbrush Scrape tongue Use probiotic mouthwash
86
What is OAT?
Organic Acid Testing
87
What are organic acids?
Natural by-products (metabolites) created from the functioning of enzymatic pathways
88
How are organic acids measured?
Urinalysis
89
Which clients would benefit from OAT?
Chronic fatigue Suspected nutritional deficiencies Mitochondrial dysfunction Autism Mood disorders
90
Benefits of OAT?
Overview of metabolic functioning Where there's need for certain nutrients Focuses nutritional plan
91
Downsides of OAT
Food eaten before test can influence results (get food diary completed before test done) Doesn't measure vitamin levels directly - just the function
92
What metabolites can be measured with OAT?
Nutritional function Glycolysis Krebs Cycle Ketone/fatty acids Amino acids Detoxification Bacterial Neurotransmitters Oxalates
93
Why could using OAT be beneficial when testing vitamins and minerals?
Blood serum tests only tell you how much of a vitamin or mineral is in the blood stream They don't tell you how that vitamin or mineral is being utilised by tissue
94
Which B12 test is better than testing serum B12?
Methylmalonic acid
95
What is a functional biomarker for low B9 and B12?
Homocysteine
96
Which Fe test is better than testing serum Fe?
Serum ferritin
97
What is the best way to test Mg?
At cellular level
98
What is the best way to test Ca?
OAT RBC nutrients
99
What is the normal range for CRP?
<5 mg/L
100
What is a better measurement when looking for low grade inflammation?
High sensitivity CRP (hsCRP)
101
What is the normal range for hsCRP?
0.2-3 mg/L
102
What does a red blood cell nutrient test look at?
The amount of minerals that have been taken up inside the RBC More indicative of tissue levels
103
What nutrients are RBC tests good for?
Minerals Toxic minerals EFAs
104
What are mixed methodology nutrition tests?
Where different markers i.e. serum, organic acids from urine or RBC levels give a more complete profile
105
What are the benefits of hair mineral tests?
Non-invasive Easy to do Inexpensive
106
What do hair mineral tests measure?
Minerals Toxic metals
107
What does standard thyroid testing measure?
TSH T4
108
What does extended panel thyroid testing measure?
TSH Free T3 Free T4 Reverse T3 Thyroid antibodies
109
What is subclinical hypothyroidism?
Normal reading but close to cut off Symptoms of poor thyroid function
110
What does high TSH and normal T4 indicate?
Subclinical hypothyroidism
111
What does low TSH and high FT4 indicate?
Hyperthyroidism
112
What does raised anti-thyroid peroxidase antibodies indicate?
Grave's disease
113
Which type of tests are better for viewing adrenal function?
Salivary Urine
114
What is four point testing?
Taking four samples during the day to test adrenal function
115
Which metabolites are tested in adrenal testing?
Cortisol DHEA
116
What do high levels of cortisol indicate?
Someone is in an intense period of stress
117
What do low levels of cortisol indicate?
Someone is in the exhaustion phase of a stress response
118
What does DHEA do?
Down-regulates the cellular effects of cortisol
119
How is the DUTCH test conducted?
Urine
120
What does the DUTCH test measure?
Hormones (and may adrenal/nutritional markers)
121
When should a DUTCH test be used?
Low libido PMS Irregular/painful periods Hormonal imbalances
122
What must you know to read a DUTCH test?
Patient's menstrual history and stage If they are on hormone-altering medication

Nutrition 2 (Semester I) (15 decks)

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