FINAL (test 3) Flashcards
1
Q
Describe current clinical guidelines for evaluating overweight patients and establishing whether weight loss should be recommended. What three pieces to of information do you need to perform this evaluati
A
a) Overweight = BMI >25 b) Obese = BMI >30 c) Extreme obesity = BMI > 40 d)Excessive abdominal fat, excessive weight gain (in adulthood, >10lbs after age 20), and BMI
2
Q
What percentage of the adult population is currently overweight?
A
64.50%
3
Q
How has the prevalence of overweight in teenagers changed in the last 30 years?
A
Increased from 4.6% to 15.5%
4
Q
Describe the importance of genetics in the current understanding of obesity
A
humans are physiologically predisposed to conserve calories to guard against future starvation. Individual genetic differences may influence weight gain (appetite patterns, metabolic rate, adipose cell development, hormonal effects, and psychological factors)
5
Q
Describe the importance of childhood development in the current understanding of obesity
A
environment also plays a role in weight gain, kids who develop eating an abundance of calories with a decrease in activity, tend to be overweight
6
Q
What life changes in adulthood increase the risk of weight gain?
A
Inactivity levels due to age b) Sedentary job and hobbies c) Having kids (gaining weight during pregnancy)
7
Q
List the health risks of overweight and obesity
A
a) Coronary heart disease b) Type 2 diabetes c) Hypothyroidism d) Hypertension e) Dyslipidemia f) Gallbladder disease g) Sleep apnea h) Osteoarthritis I) Cancer of colon, breast, prostate, and endometrium j) Menstrual dysfunction
8
Q
Describe the importance of learned eating behaviors in the current understanding of obesity
A
eating when not hungry (food as entertainment, social situation, mood states, and emotional needs) which encourages overeating
9
Q
Describe the importance of social environment in the current understanding of obesity
A
overconsumption of calories is facilitated by abundance of high fat, high sugar foods made readily available.
10
Q
Describe how the clinician can better understand the health risks of his obese patient through history
A
a) Evaluate personal and family history of obesity-related disease as well as current symptoms of undiagnosed disease b) Evaluate history for additional primary cardiovascular risk factors (age, smoker, family hx, or HTN) c) Evaluate patient history for contributors to weight gain and obstacles to weight loss
11
Q
Describe how the clinician can better understand the health risks of his obese patient through physical assessment process.
A
Measure BMI and waist circumference
12
Q
Describe how the clinician can better understand the health risks of his obese patient through lab assessment process.
A
R/O endocrine disorder, dyslipidemia, metabolic syndromes, and cardiovascular risk factors
13
Q
What kind of diet is most likely to decrease metabolic rate, resulting in poorer results and increased risk of weight regain?
A
Atkins
14
Q
List the possible complications associated with weight cycling
A
Diabetes, osteoporosis, gallstone disease, cardiovascular disease, some cancers, and reduced longevity
15
Q
List the possible complications associated with rapid weight loss
A
Bone loss, gallbladder attacks, electrolyte disturbances, and lowered metabolic rate
16
Q
What is “metabolic fitness”?
A
Ratio between mitochondrial capacity for substrate utilization and maximum oxygen uptake of the muscle. - Being fit is more important than being skinny
17
Q
how does the concept of “metabolic fitness” differ from traditional approaches for treating obesity?
A
Focus of getting body to a healthy state, instead of worrying about weight loss
18
Q
What is the correct method for measuring waist circumference?
A
Upright relaxed position at level of the iliac crest with normal minimal respiration
19
Q
What pre-existing risk factors are used to gauge the potential impact of overweight or high waist circumference?
A
a) genetics b)Weight history (including eating disorders) c) Diet history d) Exercise history e) Social history f) personal health history
20
Q
What falls under “personal health history” when gauging potential of obesity or high waist circumference?
A
a) Endocrine disorders b) Cardiovascular risk c) Metabolic syndrome d) Osteoarthritis
21
Q
indicate if the following patient should lose weight according to national guidelines: Male, 50 years old, BMI of 27, smoker, waist circumference 37 inches
A
high risk, loss weight
22
Q
indicate if the following patient should lose weight according to national guidelines: Male, BMI of 33, no risk factors, waist circumference 38 inches
A
high risk, loss weight
23
Q
indicate if the following patient should lose weight according to national guidelines: Female, BMI of 27, no risk factors, waist circumference 31 inches
A
low risk, should be conscious of her weight
24
Q
indicate if the following patient should lose weight according to national guidelines: Female, BMI of 26, fasting glucose 105mg/dL, sedentary lifestyle, waist circumference 34 inches
A
high risk d/t possible metabolic syndrome and sedentary lifestyle
25
indicate if the following patient should lose weight according to national guidelines: Male, BMI 28, hypertensive, waist circumference 41 inches
high risk d/t high waist circumference and HTN
26
What important information about obstacles to your patient's attempts to lose weight might be discovered in their family history?
other overweight/obese family members in household, number of social/family gatherings, and multiple special situation
27
What important information about obstacles to your patient's attempts to lose weight might be discovered in their personal health history?
history of unsuccessful dieting, eating disorders, endocrine problems, metabolic problems, psychological factors, and smoking/drinking
28
What therapeutic objectives are even more important than weight loss when considering how to manage an overweight patient?
Improvement in blood pressure, blood lipids, glucose tolerance, and other primary health goals are more important than weight loss
29
list some potential contraindications to recommending weight loss, even when supported by the national guidelines?
a) Repeated past failures b) Emotional/psychological issues c) Health conditions that can worsen with dieting
30
How might contraindications to weight loss be minimized?
a) stop trying to diet, and focus on eating healthy. Listen to when your body is hungry, and don’t eat out of boredom b) workout when stressed/sad instead of eating, don’t eat out of boredom, and see a therapist to talk about feelings c) lose weight slowly (ex. history of rapid weight loss can aggravate gallbladder)
31
What questions are useful to ask patient to determine whether they are truly ready to achieve long-term weight loss?
a) Why do they want to lose weight? b) Are they willing to exercise and change their diet?
32
What is a reasonable initial goal for weight loss?
a) Lose 5% of their weight to decrease change of diabetes b)Lose 10% of the current weight to improve health and reduce risk of failure (No more than 2lbs (1kg) per week)
33
What alternative goals can be set instead of weight loss goals?
a) Changes in eating habits b) Changes in exercise
34
How would you decided which type of weight loss diet is must suitable for a patient?
determine whether it is safe, healthy, achievable, and permanent for the patient
35
How important is exercise as a strategy for weight-reduction and weight-maintenance?
A )Very important b) Exercise increases caloric expenditure
36
What is meant by the following behavioral self-management terms?
a) Self-monitoring b) Portion control c) Stimulus control d) Cue suppression e) Contingency contracting
37
What does self-monitoring entail?
keeping a daily diary of food intake
38
What does Portion control mean?
using smaller plates at the table, ordering half portions when eating out
39
What does stimulus control mean?
removing temptations form home or work
40
What is cue suppression?
eating only at one designated place in the home, not pairing eating with enjoyed activities
41
What is contingency contracting?
set up recurring non-food rewards for maintaining diet
42
Why would joining a support group increase the changes of successful weight loss?
a) Sharing success/failure with others b) Help patient learn and practice behavioral self-management techniques may also be valuable as a cost-effective way to sustain use into long term
43
In what circumstances might referral to counseling professionals be advisable as part of a weight-loss program?
To teach specific skills, employ intensive behavior therapy, and to address emotional or psychological issues that may impact eating disorders
44
What supplements are supported by good scientific evidence that they can help a patient safely lose weight?
a) Multivitamin b) Dietary fiber c) Natural/synthetic ephedrine/caffeine combinations d) Bitter orange (citrus aurantium) e) 5-hydroxytryptophan f) Pyruvate g) chromium
45
How does a multivitamin help with weight loss?
ensures nutritional adequacy during weight loss
46
how does fiber help with weight loss and how much should you take?
helps add bulk to diet to provide feeling of fullness after a meal a) 5-7g/day helpful for enhancing weight loss b) 3-4g/day of glucomannan have shown effective weight loss
47
What are some drawback to fiber?
Can cause flatulence, and contraindicated for patients with esophageal/intestinal obstruction
48
How much of a Natural/synthetic ephedrine/caffeine combination should you take? And how does it help with weight loss?
90mg/day of ephedrine or 240mg/day of caffeine. Is a nervous system stimulant
49
What are the side effects of Natural/synthetic ephedrine/caffeine combinations?
Side effects may include increase heart rate, dry mouth, insomnia, and headache
50
How does bitter orange work on weight loss, and is it recommended?
contains similar beta-adrenergic compounds as ephedrine. Not recommended d/t poor clinical evidence and potential side effects (increased BP)
51
How much 5-hydroxytryptophan should you take for weight loss, and how does it work?
600-900mg/day, direct precursor to serotonin, shown to reduce appetite and promote weight loss
52
What are the side effects of 5-hydroxytryptophan?
GI symptoms, headache, sleepiness, muscle pain, and/or anxiety
53
How much pyruvate should you take for weight loss and how does it work?
6-10g/day, may increase metabolic rate and reduce insulin resistance
54
What are the side effects of pyruvate?
diarrhea, GI symptoms, and lowered HDL
55
How much chromium should you take for weight loss and how does it work?
200-600mg/day, affects carbohydrate and lipid metabolism, and promoting insulin sensitivity.
56
What are the side effects of chromium?
excess of 500mg/day maybe unsafe for long-term use
57
Which weight loss supplements are intended to stimulate sympathetic nervous system activity, and therefore may produce side effects of elevated blood pressure, heart rate, etc.?
a) Caffeine b) Ephedrine c) Bitter orange
58
What are the advantages of a high protein diet for achieving and maintaining weight loss?
a) Less hunger for some b) Small increases in metabolic rate
59
What are the disadvantages of a high protein diet for achieving and maintaining weight loss?
a) Deficiencies in some nutrients (fiber and vitamin K) b) Ketosis c) Unhealthy fat effects d) High protein effects
60
What the advantages of a low fat, high carbohydrate diet for achieving and maintaining weight loss
a) More calorically dilute b) Used by more successful dieters c) Usually effective for disease prevention
61
What the disadvantages of a low fat, high carbohydrate diet for achieving and maintaining weight loss
a) Some deficiencies possible b) May worsen metabolic syndrome risk factors
62
What are the arguments put forward by proponents of the Health at Every Size movement?
a) Fatness as bad paradigm is simplistic and not necessarily supported by scientific evidence b) Weight related health problems can be resolved independently c) Being fit is more important than being thin
63
What are the arguments put forward by Gleen Gaesser, Ph.D. in his article “Obesity, Health, and Metabolic Fitness”?
a) Fatness as bad paradigm is simplistic and not necessarily supported by scientific evidence b) Weight related health problems can be resolved independently c) Being fit is more important than being thin
64
What are the drawbacks of nonintervention studies on dietary cancer prevention?
Can’t control diet/lifestyle and supplemental intake
65
Describe the role of flax seed in the prevention of cancer.
reduced established tumor load and metastasis via enerodiol and enterolactone (high estrogenic activity). Researched with breast, melanoma, and prostate cancer
66
Describe the role of fruits and veggies in the prevention of cancer.
can reduce lung cancer, helpful in prevention of cancers of the stomach, esophagus, lung, oral, pharynx, endometrium, pancreas, and colon. Protective. Alium veggies (garlic, onion, leeks, & scallions) protective vs. stomach, prostate, and colorectal cancer
67
Describe the role of cruciferous veggies in the prevention of cancer.
contain sulforphone which has anti-cancer properties. Reduces/helps prevent prostate, bladder, and lung cancer
68
Describe the role of selenium in the prevention of cancer.
protective nutrient for some forms of cancer; present in thioredoxin reductase which induces cancerous cells to undergo apoptosis. Component of anti-oxidants, improves immune system response, triggers formation of natural killer cells, induces P450 enzyme in liver to help detoxify carcinogenic molecules, inhibits prostaglandins, and decreases rate of tumor growth
69
Describe the role of chlorophyll in the prevention of cancer.
green plants, bind to polycyclic aromatic hydrocarbons, heterocyclic amines, aflatoxin, and other hydrophobic molecules that are implicated with cancer development. Chlorophyll-carcinogen complex is much hard to absorb into body
70
Describe the role of B12 in the prevention of cancer.
no evidence that to be anti-cancer but could be beneficial. Methylcobalamin increased survival time and reduce tumor growth in lab mice
71
Describe the role of folic acid in the prevention of cancer.
dark green leafy veggies, essential in DNA methylation and DNA synthesis, reduction in colon, rectal, and breast with higher intakes of folic acid and B6 and B12. Alcohol is an antagonist to folate
72
low levels of selenium in men =
higher cancer risk
73
Describe the role of vitamin D in the prevention of cancer.
1000IU/day minimal amount needed to maintain adequate levels of vit D in absence of sun, up to 4000IU/day is safe for additional benefit. Active form of vit. D has potent anti-cancer properties. Prostate, colon, breast, ovarian, pancreatic, lung, and cervical tissue have ability to convert major circulating form of vit. D (25-D) into active hormonal form (1,25-D)
74
Describe the role of alpha and beta carotene in the prevention of cancer.
beta-carotene actually INCREASED risk of lung cancer in smokers. Does not have powerful protective effect in isolated pharmacological doses. Dietary carotenoids are caner preventative (alpha > beta carotene)
75
Describe the role of lycopene in the prevention of cancer.
very protective, PROSTATE cancer! Best source is cooked tomatoes
76
Describe the role of Vitamin C in the prevention of cancer.
at high levels, vit. C is toxic to cancer cells. Intravenous > oral doses. Amounts needed are far beyond dietary intake, but no side effects
77
What are the likely reasons that intervention research using beta-carotene supplements could not replicate the promising findings about the cancer prevention potential of a high beta-carotene diet?
Due to using synthetic beta-carotene, patients possibly having pre-existing micro-tumors in subjects (50 yr old male smokers), or possibly due to using megadoses of beta-carotene
78
Which vegetables belong to the Brassica family? Also known as the cruciferous vegetables.
Broccoli, cabbage, brussel sprouts, cauliflower, kale, and boc choy
79
Which antioxidants have some evidence for helping prevent specific cancers?
a) Vitamin C – 750-3000 mg/day and decrease in colon polyp recurrence (only 2/5 trails showed effectiveness) b) Selenium – 200mcg/day and prostate cancer (1/2 trials) c) Vitamin E – 50 IU/day and prostate cancer (1/5, one found harmful
80
Which is the only cancer site where an antioxidant combination was shown to reduce risk?
prostate
81
Why is meat intake sometimes, but not always, related to cancer risk? How dose meat preparations appear to influence cancer risk?
Processed meats (sausage, bacon, lunch meats, and ham) are associated with colorectal cancer due to the presence of heterocyclic amines and polynuclear aromatic hydrocarbons formed with cooking the meat. Also effect of nitrites used in processed meats
82
Which food is matched with lycopene that is thought to have cancer prevention activity? And how does it work?
a) tomatoes b) Protective vs. prostate cancer
83
Which food is matched with indole-3-carbonyl that is thought to have cancer prevention activity? And how does it work?
a) cruciferous vegetables (contains glucosinolates) b) Protective vs. cervical cancer
84
Which food is matched with isoflavones that is thought to have cancer prevention activity? And how does it work?
a) soy products (contains genistein) b) Protective vs. breast cancer
85
Which food is matched with ligans that is thought to have cancer prevention activity? And how does it work?
a) Flax seed (have anti-gonadal hormone effect b) Protective vs. breast and prostate cancer
86
Which dietary fats are associated with lower risk of cancer?
Healthy fats (omega-3) (Olive oil, fish oil, and flaxseed oil)
87
How does soy isoflavones and other phytoestrogens affect estrogen?
Soy isoflavones and other phytoestrogens can bind to estrogen receptors, mimicking the effects of estrogen in some tissues and antagonizing the effects of estrogen in others
88
How does the anti-estrogenic effect of soy and phytoestrogens affect cancer?
Because of the anti-estrogenic effects in reproductive tissue they could help reduce risk of hormone associated cancers (breast, uterine and prostate)
89
What effect on endogenous estrogens does soy isoflavones have?
soy isoflavones may alter biological activity of endogenous estrogens
90
Are isoflavones known to have antioxidant effects?
Isoflavones known to act as antioxidants in test tube, but extent to which they contribute to antioxidant status in humans is not yet clear
91
How might high intake of soy during adolescence effect risk of cancer later in life?
may lower risk of developing breast cancer later in life
92
How does soy effect risk of endometrial cancer?
Endometrial cancer d/t prolonged exposure to unopposed estrogen, high intakes of soy w/ its anti-estrogenic activity may protect against endometrial cancer
93
What did one study of the effect of soy on prostate cancer show?
One study found that drinking soy milk more than once daily had a risk of prostate cancer that was 70% lower that those who never drank soy milk (Associated with reduction in risk of prostate cancer but association was not statistically significant)
94
Which Malignant tumors have been found to contain vitamin D receptors?
Breast, lung, skin, colon, and bone
95
How does Vitamin D effect cancer?
Biologically active vitamin D (1,25-D) found to induce cell differentiation and/or inhibit proliferation. May protect against various cancers
96
Which form of Vitamin D is most effective in cancer preventions?
Biologically active vitamin D (1,25-D)
97
how much vitamin D should be taken to reduce risk of colon cancer (as shown in a dose-response analysis)
Recent dose-response analysis estimated that 1000IU of oral vitamin D would lower one’s risk of colorectal cancer by 50%
98
How much D3 should be taken to achieve a 50% risk reduction of breast cancer? (as shown in another study)
Another study found that 4000IU vit D3 would need to be consumed daily to experience a 50% lower risk of developing breast cancer
99
What kind of cancer was shown to have an increase with low concentrations of Vit-D-25?
prostate
100
What nutrients found in multivitamin-mineral may help reduce cancer risk?
Calcium (colorectal cancer), vitamin D, folic acid, and antioxidants
101
Which B-vitamin may prevent cancer in alcohol users?
Folic acid, especially when combined with B12 and B6
102
Which osteoporosis risk factors are considered major risk factors?
a) Age > 65 yo b) Vertebral compression fracture c) Fragility fracture after 40 yo d) Systemic glucocorticoid therapy > 3 months e) Malabsorption syndrome f) 1 hyperparathyroidism g) Propensity to fall h) Osteopenia appear on x-ray I) Hypogonadism j) Early menopause (before age 45)
103
Which osteoporosis risk factors are considered minor risk factors?
a) RA b) Past history of hyperthyroidism c) Chronic anticonvulsant therapy d) Low dietary calcium intake e) Smoker f) Excessive alcohol or caffeine intake g) Weight 10% at age 25 I) Chronic heparin therapy
104
What medical conditions and medications increase osteoporosis risk?
a) Corticosteroid, anticonvulsant, anticoagulant, aluminum-containing antacids and other acid-blockers, aromatase inhibitors, non-thiazide diuretic medication b) Gastric surgery or malabsorptive disease c) RA, diabetes, hyperthyroidism, Cushing’s disease, and other endocrine disorders, alcoholism, and kidney disease
105
How is osteoporosis risk managed in young patients?
a) Screen for amenorrhea and disordered eating/exercise b) Healthful diet and lifestyle choices c) Supplemental bone nutrients as needed (Calcium – 1000-1300mg/day, Vitamin D alone or in multi-vitamin)
106
What is the most reliable bone density method of estimating osteoporosis risk and determining the severity of bone loss?
DXA (duel energy x-ray absorptiometry)
107
Which patients should receive bone mineral density testing?
a) Women 65yo + and men 7 yo + b) Younger women and men with above average risk (unexplained fractures) c) Those considering or receiving osteoporosis therapy
108
Describe the elements of a healthful diet for reducing osteoporosis risk
a) Adequate calories and protein b) Moderate to low sodium and caffeine c) Replace soda with calcium-containing beverages d) Soy products e) Dairy products (Milk, yogurt, hard cheeses) f) Some veggies (greens, bok choy, kale, and Chinese cabbage) g) Tofu made with calcium
109
Describe the elements of a healthful lifestyle for reducing osteoporosis risk
a) Regular weight bearing and strengthening b) Avoid or stop smoking and chronic alcohol abuse c) Minimize repeated weight loss attempts
110
What are the three reasons that excessive soft drink consumption can increase osteoporosis risk?
contain phosphoric acid which can deplete/leach bone of calcium
111
What are some good dairy products?
Milk, yogurt, calcium-fortified beverages, hard cheese, tofu, sardines, Chinese leafy greens (bok choy)
112
What are some poorer dairy products?
Cottage cheese, frozen dairy desserts, broccoli, kale, white beans
113
What supplement might need to be taken along with multivitamin-mineral to ensure adequate bone nutrition?
Calcium and vitamin D
114
For which age group do calcium supplements have little effect on bone preservation?
Early menopause (little effect on bone loss)
115
Describe the differences if any, between the various forms of calcium supplement in terms of cost, concentration, safety, and effectiveness
Best will contain calcium, magnesium, vitamin D and K, and trace minerals
116
Describe all the mechanisms that help explain the beneficial effects of vitamin D on fracture risk
a) Facilitates calcium absorption into bone b) Helps improve muscle weakness and helped reduce falls by 20% c) 800IU per day is probably needed
117
What other nutrient appears to improve osteoprotective effects of vitamin D?
Vitamin K (1000mcg/day helped reduce urinary calcium losses in postmenopausal women)
118
Besides calcium, what minerals have been shown to help reduce bone loss?
Magnesium, copper, zinc, and manganese
119
What is IpriFlavone, and why is it controversial choice for treating osteoporosis?
a) Synthetic isoflavone related to soy phytoestrogens b) One negative study reported low WBC as side effect
120
Explain the role of vitamin K in bone formation.
Vitamin K2 plays an important role in bone formation. It is also involved in the prevention of bone loss. Vitamin K modifies the protein osteocalcin and gives osteocalcin the ability to bind to calcium. Calcium can then help to form the bone matrix. vitamin K also works with vitamin D to facilitate the function of osteoblasts, the bone building cells. On the other hand, it works to inhibit the production of osteoclasts (the cells which breakdown bone).
121
Distinguish between the way supplements of vitamin K1 and vitamin K2 have been used in osteoporosis research.
a) K1 Reduced calcium loss through urine b) K2 - Osteoprotective and fracture risk-reducing effects.
122
what are the common causes of Microcytic hypochromic anemia?
a) MAY be caused my nutritional deficiency (test w/ serum ferritin) b) Thalassemias c) Bone marrow failure d) Chronic disease (affects way nutrient is used or formation of Hgb) e) Iron-deficiency anemia
123
What are the lab findings for Micro hypochromic anemia?
low RBC, Hgb, and/or HCT with low MCV and MCHC
124
What are the common causes of Macrocytic normochromic anemia?
a) MAY be caused by nutritional deficiency b) B12 deficiency (Pernicious anemia, food cobalamin malabsorption syndrome, crohns/celiac sprue, or dietary deficiency) c) Folate deficiency (Dietary deficiency, alcoholism, or Crohn’s/celiac sprue)
125
What are the common causes of Normocytic normochromic anemia?
a) NOT caused by nutritional deficiency b) Acute hemorrhage c) Blood parasite d) Bone marrow failure (Multiple myeloma, sideroblastic anemia, “normal” aging) e) Systemic/chronic disease (Endocrine, kidney, liver, infections, inflammations, malignancies, and severe protein deficiency.) f) Hemolytic anemias (Sickle cell, vitamin E deficiency, autoimmune, spleen, lead poisinign, and drug-induced) g) Athletic pseudodilutional anemia
126
What are the lab findings for Normo normo?
low RBC, Hgb, and/or Hct
127
Which conditions lead to normocytic anemia?
blood parasite, hemorrhage, bone marrow failure, systemic/chronic disease, hemolytic anemia, and athletic pseudodilutional anemia
128
Which conditions lead to either microcytic anemia?
thalassemia, bone marrow failure, chronic disease, and iron-deficiency
129
DDX for iron deficiency?
a) In non-menstruating adults, occult GI blood loss is the most common cause of iron deficiency b) Use serum ferritin to diagnose and monitor (optimal 20-200ng/mL)
130
Treatment for iron deficiency?
a) Asses and treat any health conditions that affect iron status b) 100mg/day for several months to replenish stores c) Avoid drinking tea or coffee
131
DDX for Folic acid deficiency – macrocytic normochromic
a) Most common form b) High risk pt: alcholics, patients with diseases that impair folate absorption c) Use serum folate to dx and monitor
132
TX for Folic acid deficiency – macrocytic normochromic
a) Folic acid supplements b) Monitor B12 levels also, folate can mask B12 deficiency
133
DDX for Vitamin B12 deficiency- macrocytic normochromic anemia
a) 30% risk in elderly b) High risk pt: dieases that impair absorption c) Pernicious anemia s/sx (End stage of autoimmune inflammation of stomach, May take years to develop if stores are good) d) Vegans e) Patients with unexplained neurologic problems f) Use serum B12 to diagnose and monitor
134
TX for Vitamin B12 deficiency- macrocytic normochromic anemia
a) 10-25mcg/day, larger amounts may work faster b) Typically managed with injectable B12, can now be taken orally
135
List the substances that enhance iron absorption
animal flesh foods, fortified foods
136
List the substances that inhibit iron absorption
coffee, tea
137
Which form of iron supplement causes more gastrointestinal side effects?
Ferrous sulfate
138
What is the effectiveness of oral B12 supplements when malabsorption is the cause of B12 deficiency?
Individuals with food-bound vitamin B12 malabsorption do not have an increased requirement for vitamin B12, just need it in another form other than food (4000mcg/day for one month, 1000mcg/day thereafter for maintenance)
139
Why should B12 status be of concern when large doses of folic acid are used to treat anemia?
Large amounts of folic acid can mask symptoms of pernicious anemia
140
Which sports may encourage calorie restriction in an athlete?
Wrestling, boxing, any martial art, cheerleading, crew, and gymnastics
141
What are the three components of the female athlete triad?
Low energy availability, irregular menstrual function, and bone loss
142
Why is testing for anemia an unreliable method for screening athletes for iron deficiency?
a) Dilutional pseudoanemia @ the beginning of training which will not respond to iron supplementation b) Is d/t increased water (dilutes blood)
143
When are high glycemic carbohydrates helpful for improving athletic performance?
During high endurance events (triathlons, marathons, etc)
144
when are important times to guarantee adequate carbohydrate intake for optimal endurance sports performance?
a) Pre-event loading b) Carbohydrate supplementation during exercise c) Post-exercise glycogen recovery
145
Of the many strategies for maximizing and sparing glycogen stores, which strategy does not seem to benefit all athletes?
Carbohydrate loading
146
Why does carb loading not benefit all athletes?
Only helpful for exercises that last over 90 minutes
147
What are two options for carb loading?
1) 10grams/day per kg body weight for 3-5 days prior to event while gradually reducing training time, ending with a day of no training; 2) perform exhaustive exercise followed by 1-2 days’ rest and a high carbohydrate diet prior to event
148
Under what conditions are athletes most likely to be at risk for electrolyte deficiency?
Several hours of exercise in warm and/or humid conditions may result in significant depletion of sodium/other electrolytes
149
Described the issues regarding how dietary protein may benefit the strength training athlete?
more protein is needed when calories are restricted, help provide the building blocks necessary for new muscle - Need at least 10-20g of whole protein
150
Described the issues regarding how amino acid supplements may benefit the strength training athlete?
helps in muscle recovery - Need at least 6g essential aminos
151
For which type of exercise is creating loading likely to benefit performance?
Those lasting 30 seconds or less (sprinting, weight lifting,
152
For which types of exercise is creatine loading unlikely to benefit performance?
Endurance sports - Creatine increases muscle weight d/t water retention, may impair endurance
153
How much creatine should be taken while “loading”? How much for general maintenance?
15-25 g/day for 5-6 days - Maintenance: 2-5g/day
154
What enhanced creatine absorption?
carbohydrates
155
When should you take creatine?
Ingestion following exercise may produce best results (Can cause upset GI or muscle cramping)
156
Describe the possible benefits of glutamine and how much shoudl you take?
Strenuous exercise has been associated with immune suppression and increased risk of post-exercise infection, glutamine helps stave off infection - Take 5g immediately after exercise and again two hours later
157
Describe the possible benefits of vitamin C and how much?
Strenuous exercise has been associated with immune suppression and increased risk of post-exercise infection, glutamine helps stave off infection - Take 5g immediately after exercise and again two hours laterVitamin C can help combat free radicals produced during strenuous activity and reduce muscle soreness and increase strength recovery after activity (400-3000mg/day for several days prior to and following intense exercise)
158
Describe the possible benefits of alkalizing agents and how much?
a) When taken just prior to exercise, may improve performance in events lasting 1-1Strenuous exercise has been associated with immune suppression and increased risk of post-exercise infection, glutamine helps stave off infection - Take 5g immediately after exercise and again two hours laterVitamin C can help combat free radicals produced during strenuous activity and reduce muscle soreness and increase strength recovery after activity (400-3000mg/day for several days prior to and following intense exercise) 0mins or 30-60 minutes d/t reduction of lactic acid in muscle cells b) Sodium bicarbonate (115-180mg per lbs.) dissolved in at least 2 cups fluid taken at least 1 hr prior to exercise
159
Describe the possible benefits of pyruvate and how much?
a) May improve results of an exercise program in an untrained person. Specifically, increased weight loss and decreased body fat have been demonstrated. Results in trained athlete is disappointing b) 6-10g/day in combo with exercise
160
Describe the possible benefits of HMB and how much?
a) Metabolite of leucine that plays a role in protein synthesis. Research has found that HMB only has benefit in untrainted individuals when combined with exercise b) 17mg/da) May improve results of an exercise program in an untrained person. Specifically, increased weight loss and decreased body fat have been demonstrated. Results in trained athlete is disappointing b) 6-10g/day in combo with exerciseay per lbs (average of 3g/day)
161
Describe the possible benefits of caffeine and how much?
a) Stimulates mobilization of fatty acids which may help delay depletion of glycogen stores during exhaustive exercise. b) Intense exercise lasting @ least 30 minutes appears to benefit from caffeine c) Tablets containing 3-5mg/kg body weight taken one hour before exercise (1-3c brewed coffee)
162
Name the most useful supplements for upper respiratory infection (URI)
Vitamin C, Zinc lozenges, Echinacea, Andographis paniculata, black elderberry, Eleutherococcus senticosus
163
Name the most useful supplements for Lower respiratory infections (LRI)
N-acetylcysteine (NAC), Souther African geranium (Pelargonium sidoides) tincture.
164
Name the most useful supplements for bronchial asthma (BA)
Antioxidants (carotenoids, vit C, selenium), B6, Eicosanoid modifiers, Probiotics, English Ivy
165
How does vitamin C help URIs?
a) People under severe physical stress experience a 50% less risk when taken regularly b) Shortens duration of severity of cold w/ 2-3g/day
166
How does zinc lozenges help URIs?
a) 13-25mg every two waking hours @ starting at first sign of cold b) Must allow for complete ionization of the mineral so it can interact with viruses in oropharynx c) Desirable when it contains: zinc acetate, zinc gluconate, or zinc gluconate-glycine d) Zinc nasal sprays and gels also effective, but may damage sense of smell
167
How should you use echinacea to help URIs?
a) E. purpurea as source species b) Liquid extracts that may have local effects in oral cavity c) Beginning treatment at very first sign of symptoms d) Frequent doses (1-5ml extract or 1 cup tea every two waking hours) in first 24 hours, but back to 3-4xday after
168
How does NAC help treat LRIs?
a) Antioxidant b) Used to treat acetaminophen poisoning c) Mucolytic activity and 400-600mg/day is effective Tx for chronic bronchitis (Improves symptoms and prevents acute exacerbations)
169
How do carotenoids help with BA and how much should be taken?
a) Low carotenoid diets associated with increased risk of severity of asthma b) 30/mg lycopene or 64/mg natural beta-carotene helped prevent episodes of exercise induced asthma
170
How does Vitamin C help BA? And how much?
a) Anti-histamine effects on bronchial reactivity b) Less symptoms in diets with high amounts of vitamin C c) 500-1500mg/day help prevent exercise induced asthma
171
What is seleniums relation to BA? And how much to take?
a) Low selenium associated with asthma risk b) 100mcg/day improved Sx
172
How does B6 affect BA? How much to take?
a) May affect bronchial tone b) 100-200mg/day reduced frequency and/or severity c) Beneficial when people taking B6 depleting drugs (theophylline and aminophylline)
173
How do eicosanoid modifiers help with BA? How much to take?
a) Omega-3 FA may help those physically active patients who experience exercise induced asthma in large amounts b) 1mg per lbs. body weight of Pycnogenol (extract of pine bark) has been soon to improve lung function and asthma symptoms
174
What should we look for in an effective zinc lozenge formula?
a) Desirable when it contains: zinc acetate, zinc gluconate, or zinc gluconate-glycine b) NOT: citric acid, tartaric acid, vitamin C, sorbitol, and mannitol
175
For which respiratory condition has Andrographis paniculate been effective?
URI
176
For which respiratory condition has Sambucus nigra been effective?
URI (black elderberry)
177
For which respiratory condition has each Pelargonium sidoides been effective?
LRI (south african geranium)
178
For which respiratory condition has Hedera helix been effective?
BA (english ivy)
179
What is the active constituent in Andrographis paniculate?
andrographolides
180
What is the active constituent in Sambuca nigra?
quercetin and anthocyanins (black elderberry)
181
What is the active constituent in Pelargonium sidoides?
7-hydroxycouramin and catechin phenolic compounds (african geranium)
182
What is the active constituent in Hedera Helix?
saponins (alpha hedarin) (english ivy)
183
What two herbs compose the Chinese herbal combination known as Kan Lang?
Combines andrographis and eleuthero
