Midterm 1 Flashcards
(146 cards)
1
Q
Example of adaptogen
A
Ginseng
2
Q
Example of astringent
A
Witch hazel
Horse chestnut
3
Q
Example of bitter tonic
A
Gentian root
4
Q
Example of carminative
A
Peppermint
Chamomile
5
Q
Example of cholagogue
A
Dandelion
6
Q
Example of demulcent
A
Slippery elm
7
Q
Describe powder
A
Dried and ground plant part used in tablets and capsules
8
Q
Describe infusion
A
Brewed briefly as a tea
9
Q
Describe decoction
A
Boiled for a longer time
10
Q
Describe tincture
A
Extract with solvent e.g. alcohol
1: 5
herb: alcohol
11
Q
Describe fluid extract
A
Solvent partially distilled off
12
Q
Describe solid extract
A
All solvent removed
5:1 concentration
Herb:alcohol
13
Q
Describe standardized extract
A
Produced to deliver consistent amount of one or more active or marker compounds
14
Q
What are the 4 therapeutic programs?
A
Longevity
Functional restoration
Allergy elimination
Prostaglandin modification
15
Q
What is the basics of a longevity therapeutic program? 3
A
Diet/exercise
Mental health (stress & depression)
Environmental health: minimize environmental exposure
16
Q
What is predicted to become the #2 cause of death?
A
Depression
17
Q
What are the effects of stress and depression?
A
- Contributes to multiple diseases e.g. heart disease, chronic pain
- Reduces QOL and work productivity
- predicted to become #2 cause of death
18
Q
What is the main idea/goal of functional restoration program?
A
Correct underlying disturbances of body system that is thought to be the root of disease
19
Q
What are the 2 parts of functional restoration program?
A
GI rehab
Detoxification support
20
Q
What are the 4 Rs to restore GI integrity and function?
A
Remove
Replace
Re-inoculate
Repair
21
Q
What is the only detox program with published research?
A
Hubbard program
22
Q
What is the goal of allergy elimination program?
A
Remove sx-producing sources in the diet or environment
23
Q
What are elimination options?
A
Water fast Hypoallergenic formula Hypoallergenic diet Combined formula and diet Remove sus foods only
24
Q
What program was set up for ground zero workers after 9/11?
A
Hubbard program
25
What are the 3 main parts of Hubbard program?
Lipolytic exercise
Low-heat saunas
Nutritional support
26
What is a timeline to eliminate allergens?
Take food out
Observe for Sx reduction 1-3 weeks
If Sx clear, challenge with 1 eliminated food per 24-48 hours
- If sx provoked, remove and rechallenge 3 months later
- if sx not provoked, eat in mod but never daily
27
What is the basis of prostaglandin modification?
Eicosanoids mediate many pathological states
Influenced by: diet, lifestyle, supplements, environ factors
28
What are the key players for prostaglandin modification
AA (Arachidonic acid)
GLA (gamma-linolenic acid)
Fish oil; omega-3 FA
29
What does AA do?
Arachidonic acid (AA) are metabolites implicated in many disease including asthma, HTN, atherosclerosis, menstrual cramps, chronic inflammatory disease
30
What is GLA?
Precursor to beneficial eicosanoids, may not be produced in adequate amts under certain conditions
31
How much GLA/day?
500-2800 mg/day
32
Examples of GLA from least concentrated to most concentrated
Evening primrose oil
Black currant seed oil
Borage oil *1200mg/day for anti-inflammation effects
33
What does fish oil/omega-3 FA do?
Inhibit arachidonic acid production
34
Plant sources with omega-3 FA?
Flaxseed
Walnuts
Canola oil
35
How much EPA+DHA/day?
1-10 grams per day of EPA+DHA
36
What does a prostaglandin modification program look like?
Removed unfriendly AA
Remove known inhibitors of normal prostaglandin metabolism
Provide cofactors for prostaglandin metab
Provide FA that are precursors of friendly prostaglandin and/or inhibit production of unfriendly prostaglandin
37
What are dietary sources of undfriendy AA?
Animal meat
Dairy fat
Shellfish
38
What are inhibitors of normal prostaglandin metab?
Trans fat
| Alcohol
39
What are cofactors for optimal prostaglandin metab
Vit B6
Magnesium
Zinc
40
What is a low arachidonic acid “anti inflammatory diet”
Dietary fat from plant sources
Low-nonfat dairy only
Minimal-no animal flesh
No egg yolks
41
What is a botanical for depression?
St. John’s wort
42
Scientific name for St. John’s wort?
Hypericum perforatum
43
What parts of Hypericum perforatum / St. John’s wort do you use?
Above ground parts
| Harvest when flowering
44
What are Hypericum perforatum/ St. John’s wort active consituents? Which one is 1st important standard and 2nd important?
Hypericin *1st
Hyperforin **2nd
Flavonoids
45
What are the 2 physiologic effects of Hypericum perforatum/ St. John’s wort?
1. Neurotransmitter fxn modifications: serotonin, norepi, dopamine
Inhibits synaptic reuptake, similar to common antidepressant drugs
2. Affects neuroendocrine system (HPA axis)
46
What is Hypericum perforatum /St. John’s wort used for?
- Mild-moderate major depression
- Helps mood, sleep, body symptoms
- Possibly effective for “somatoform disorders” e.g. chronic pain patients, physical sx w/o physical pathology
47
How much Hypericum perforatum /St. John’s wort/day and what kind of preparation is done?
300 mg TID dried alcoholic extract of flowering aerial parts containing
0.3% hypericin OR
1-3% hyperforin
48
In Hypericum perforatum /St. John’s wort, how much of each constituent is necessary?
0.3% hypericin OR
1-3% hyperforin
In 300 mg TID dried alcoholic extract of flowering aerial parts
49
Contraindications for Hypericum perforatum/ St. John’s wort?
Bipolar disorder
| Antidepressant drugs
50
Side effects for Hypericum perforatum/ St. John’s wort?
```
Upset stomach
Fatigue
Itching
HA
Sleep disturbance
Skin rash
Skin photosensitivity at high doses
```
51
At high doses, what side effect might show up with Hypericum perforatum /St. John’s wort
Skin photosensitivity
52
What is ASCVD
Atherosclerotic Cardiovascular Disease
53
What disease does ASCVD encompass
Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease
54
What are risk components of atherosclerotic vascular disease? (8)
```
Dyslipidemia
HTN
Insulin resistance
Platelet dysfxn
LDL oxidation
Hyperhomocysteinemia
Arterial dysfxn
Inflammation
```
55
What is dyslipidemia characterized by?
Elevated LDL
Low HDL
Elevated Tg
56
What factors help evaluate risks for vascular disease?
```
Age
Genetics
Lifestyle
Adiposity
Lipids
BP
Other
```
57
What is the prevention principle of ASCVD?
Give diet, exercise, lifestyle advice to all
Measure ASCVD risk routinely in older adults and younger with suspected risk
Tx risk factors when indicated: HTN, obesity, metabolic syndrome
58
What is the 10 year ASCVD risk calculator used for?
Predict risk in currently healthy people
Calculated from age, gender, race, HDL, total cholesterol, systolic BP, smoking status, presence of diabetes
59
What is a low risk number in US and Canada for an ASCVD risk?
<7.5 US
| <10 Canada
60
What is high risk LDL US vs canada?
>70 mg/dL US
>135 mg/dL Canada
PLUS >70 mg/dl with additional risk factors
PLUS >70 with 10 year risk fo 20% or more
61
ASCVD high risk indicators: (5) AKA you don’t need to evaluate if they have these diagnoses/history/disease processes/lab results
```
Current ASCVD dx
LDL cholesterol >190 mg/dl
Diabetes
CKD in >50yo
Hx of AAA
```
62
What is the lifestyle recommendation for prevention of ASCVD? (6)
- Mediterranean or DASH diet
- Regular mod/vigorous physical activity
= Healthy weight
- Tobacco smoke avoidance
- Moderate alcohol usually ok
- Stress management
63
What supplements can people with ASCVD take?
Phytosterols
Viscous fibers
Standardized fresh garlic powder
64
How much Phytosterols/day?
2 grams/day with meals
65
How much viscous fibers/day? (Range)
3-15 grams/day
Beta-glucagon 3
Glucomannan 4
Psyllium husk 10
Guar gum 15
66
How much garlic /day?
4000 mcg allicin per daily dose
67
What are high intensity interventions? (5)
- R/o 2˚ causes hyperlipidemia (thyroid issues)
- Refer for intensive lifestyle coaching
- Chinese red yeast rice 1200-1400/day
- Statin therapy
- Niacin therapy 1500 mg/day
68
How much niacin/day?
1500 mg/day
69
How much Chinese red yeast rice?
1200-1400 mg/day
70
Therapy if High TG and/or low HDL
- Healthy weight
- Moderate-intense exercise
- Avoid unhealthy carbs
- Niacin therapy
71
Therapy if High TG only
- Rule out secondary causes
- Reduce alcohol
- Fish and fish oils: At least 2000 mg/day EPA+DHA
72
Low HDL only
- Smoking cessation
| - Alcohol ok
73
what is a good HTN Tx?
- Control weight
- Control salt: Reduction to <2400 mg/day
- Aerobic exercise
- Control alcohol
- Fiber and mineral-dense semi-vegetarian diet → DASH Diet
74
What is the benefits of fiber and mineral-dense semi-vegetarian diet e.g. DASH Diet
Heart healthy
High in minerals associated with BP control
Works w/ or w/o salt restriction
75
What are minerals and quantities/day are associated with BP control?
Potassium: 2000+ mg/day
Magnesium: 350 mg/day
Calcium: 1000-1200 mg/day
76
How much coenzyme Q needed /day for vascular disease?
100-200 mg/day
77
What are supplements/special foods for vascular disease/ASCVD?
```
Coenzyme Q10 (non essential)
K+, Ca, Mg
Garlic powder
Fish and fish oils
Dark chocolate
```
78
How much garlic /day?
4-5 mg/day allicin potential
79
What is garlic’s scientific name?
Allium sativum
80
What part of allium sativum is used?
Bulb containing individual cloves
81
What are active constituents of FRESH allium sativum chemistry?
Alliin and enzyme allinase
Alliin + allinase → allicin which may further transformt to other active compounds in vivo
82
What are active constituents of AGED allium sativum / garlic chemistry?
Complex sulfur compounds (S-ally cysteine aka SAC)
83
What are the cardiovascular physiologic effects of allium sativum / garlic
- Antioxidant
- Hypolipidemic
- Antihypertensive
- Antithrombotic/antiplatelet
- Possible other anti-plaque mechanisms
84
How much FRESH allium sativum/garlic should you take per day?
1.3 alliin precursor, 0.6% allicin yield
600-900 mg/day (3.6-5.4 mg/day allicin)
85
How much AGED allium sativum/garlic should you take per day?
2.4-7.2 grams Powder or 4-5ml liquid
If standardized, 1.2-3.6 mg/day S-alkyl cysteine SAC
86
Is allium sativum/garlic oil effective?
No
87
Contraindications for allium sativum/garlic
Bleeding risks
| Drug interactions
88
What drug interactions might occur with allium sativum/garlic?
Anticoagulants
BP meds
Diabetes
89
What are side effects of allium sativum/garlic
GI Sx in some
Breath/body odor
Can be secreted to baby in breast milk and alter flavor and affect nursing behavior
90
What are the Healing phases of MSK trauma?
Inflammatory phase: days
| Proliferation phase: weeks-months
91
Challenge for trauma research?
Almost all patients improve with time
Patient healing varies based on severity, tissues, areas involved
92
What do proteolytic enzymes do?
1. Augment natural tissue proteases:
- Degrade inflammatory protein to reduce pain and edema
- Degrade fibrin and cellular debris (from phase 1 inflamm phase of healing) to improve lymphatic drainage and restoration of normal circulation
2. Possible prostaglandin modification effect as anti-inflammatory and anti-thrombotic mediators
3. GI absorption up to 40%
93
What are 2 pharmaceutical products that are proteolytic enzymes?
Bovine pancreatin extract = trypsin and chymotrypsin
Note: In athletic player soft tissue trauma, 70% of trypsin/chymotrypsin group was fit to play in 6 days compared to 30% of placebo group
Pineapple stem extract = bromelain
Note: In bruised boxers, bruising disappeared by day 4 compared to natural progression of placebo group. Also In hospital patients with inflammation and edema from trauma, surgery, or skin infection, 75% recovered faster than similar cases not treated with bromelain
94
Bovine pancreatin extract
Trypsin and chymotrypsin
95
Pineapple stem extract
Bromelain
96
When choosing multiple enzyme ingredient formulas, they should only contain proteolytic enzymes such as (5)
List dosage too
Pancreatin (from porcine), 100mg
Bromelain, 50mg
Papain, 50mg
Trypsin and chymotrypsin, 100mg
SOD 10mcg
Catalase 10mcg
97
Most research suggests ____ enzymes on an empty stomach for better absorption
Enteric coated
98
Potency of an enzyme produce depends on
Total enzyme activity
99
How do you measure total enzyme activity?
Depends on mg of enzyme per dose (typically 100-500mg)
Depends on activity of enzyme per gram (diff units of enzyme activity make comparison tricky)
100
What is a common way to measure enzyme?
Milk-clotting units (mcu)
Less common:
- gelatin-digesting units (gdu)
- USP
- FIP
101
What are 2 important numbers for choosing enzyme produce?
A) Enzyme activity per gram of enzyme concentrate
B) Total weight of concentrate per dose
A * B = total enzyme activity per dose
102
Recommendation for daily dose of enzyme produce?
3000 mcu 3X/day on empty stomach
3-4 enteric coated pills, 3-4X/day
103
Caution for enzymes
Generally save and free of side effects
R/o allergies
It has blood thinning effect
Avoid during peptic ulcer or other serious infections
104
What are flavonoids?
Plant substances with molecular similarities that
- reduce vascular permeability to limit trauma-related swelling
- inhibit production o inflammation eicosanoids to reduce p and local congestion
105
When can you start patient on flavonoids?
Immediately after trauma or before high-risk activities
106
What are some clinically-investigated flavonoids? (4)
Citrus bioflavonoids: reduction of recovery time
Curcumin: reduction of edema and wound tenderness
Bilberry anthocyanosides: reduction of postoperative complications
Grape seed OPCs: shortened postoperative edema
107
Name example of proteolytic enzyme and flavonoid combo?
Wobenzyme or Phlogenzyme
108
What are Wobenzyme and Phlogenzyme and what is it used for?
Enteric coated proteolytic enzymes of pancreatic and plant origin plus flavonoid Rubin
Used for traumatic inflamm
109
How much Wobenzyme and Phlogenzyme do you dare per day?
9 tablets for athlete or postoperative surgical trauma
110
How do you best manage muscle involvement in trauma?
Manipulation and physical modalities
111
What about minerals and botanicals for muscle involvement in trauma?
No research has been done
Theoretically reduces neuromuscular irritability during acute phase of healing and may provide anti anxiety effects and/or aid sleep. Which is good.
112
What are typical natural muscle relaxants? (4) And quantities
Magnesium 100mg
Calcium 50mg
Passion flower 180mg
Valerian root 90mg
113
What does valarian show in CNS and smooth muscle?
CNS depressant activity
Antispasmodic properties in smooth muscle
But herbal tranquilizers have other clinical uses: insomnia (valerian) and anxiety (kava)
114
What supplement can be taken before and after unaccustomed exercise to reduce DOMS severity?
Vit C
NO BENEFIT: bromelain, fish oils, homeopathic arnica
115
What contains flavonoids that have anti inflammatory activity and may benefit DOMS? And how much do you take
Tart cherry juice
12oz 2X/day starting 5 days before exercise
116
What are 3 reasons why non-traumatic muscle cramps happen and what can you do about it?
1. During activity: mm shortening d/t dehydration or electrolyte disturbance
2. Poor circulation may respond to vit E 600-1600 IU/day or ginkgo extract 120 mg/day
3. Magnesium insufficiencies 300mg/day or during pregnancy 365 mg/day
117
If taking vitamin E for poor circulation, how much/day?
600-1600 IU/day
118
If taking ginkgo extract for poor circulation, how much per day?
120 mg/day
119
If taking magnesium for leg cramps, how much per day (2)
Night leg cramps 300mg/day
During pregnancy 365 mg/day
120
What are important micronutrients for fracture healing? (4)
Ca
Vit D
Mg
Zn
121
What is microcrystalline hydroxyapatite and what is it used for?
It’s a specially processed bone meal
Contains minerals, proteins, GAGs
Good Ca absorption according to some research
122
How much microcrystalline hydroxyapatite/day?
6-9 grams/day resolved delayed union in one study of fracture healing
123
What is the scientific name of valerian
Valeriana officinalis
124
What part of Valeriana officinalis/valerian is used?
Root
125
What are the active constituents of Valeriana officinalis/valerian?
Valerenic acid**
Valepotriates
Flavonoid (linarin)
126
What are the physiologic effects of Valeriana officinalis/valerian seen in non human studies?
GABA related activities similar to sedative drugs
- sedative/hypnotic
- anxiolytic
- anticonvulsant/antispasmodic
127
What are the physiologic effects of Valeriana officinalis/valerian seen in human studies?
EEG wave pattern suggests mental relaxation
Counteracts caffeine effects
128
How is Valeriana officinalis/valerian used in clinical research?
Insomnia/anxiety/sleep
129
Valerian vs melatonin for insomnia?
Melatonin is more consistently effective
130
What is the evidence about valerian and kava in regards to anxiety and stress?
Suggests valerian or combined with kava is stronger
131
How much Valeriana officinalis/valerian of standardized extract per day VS dried root powder/day?
2-5 mg valerenic acid per day dose of 500 mg
(Can include extract of hops, lemon balm, Passion flower)
Dried root powder: larger amounts needed
132
Contraindications for Valeriana officinalis/valerian
Sedatives, narcotics, general anesthesia
| Alcohol
133
Side effects of Valeriana officinalis/valerian
Altered mental function
134
Scientific name of kava?
Piper methysticum
135
Parts of Piper methysticum/kava used?
Rhizome
136
What are the active constituents of Piper methysticum/kava
Kava lactones (aka pyrones)
137
What is the physiologic effect of Piper methysticum/kava in non-human studies? Human studies?
Non-human studies: GABA related activities similar to valerian
Human studies: EEG changes similar to anti-anxiety drugs w/o excessive sedation
138
How is Piper methysticum/kava used in clinical research?
Anxiety and stress
But low quality evidence for stress relief
139
Dosage of Piper methysticum/kava ?
35-70 mg lactones TID to Tx anxiety or chronic stress
140
Contraindications for Piper methysticum/kava
CNS depressants, surgical anesthesia
Use caution with alcohol and anti anxiety drugs
Caution w/ drugs with potential hepatotoxicity (this led to kava ban in several countries)
141
Side effects Piper methysticum/kava
Acute mental impairment similar to alcohol at high intakes
142
Is Piper methysticum/kava associated with cognitive impairment?
No
143
Chronic excessive use of Piper methysticum/kava leads to ?
Dermopathy
144
Piper methysticum/kava recommended during pregnancy and lactation?
No
145
St. John’s wort / hypericum perforatum recommended during pregnancy and lactation?
Safety not established
146
Valerian / valeriana officinalis recommended during pregnancy?
Too little research to ensure safety
