Sample Paper 1 Flashcards
(15 cards)
- Describe how folate and magnesium levels might be influenced by a client taking the
oral contraceptive pill. What are TWO other nutrients that might be affected by this
medication? (2 marks)
Slide 46 Pharma. 2 x 0.5 per other nutrient. 2 x 0.5 per correct point on the mechanism – ie:
reduce absorption or increased excretion.
OCP Affect Folate, Magnesium, VitB6, B2, B1, A, B12, C, Zinc
Mechanism -
Reduced absorption,
increased excretion,
increased protein binding and induction of liver enzymes, Shift from plasma to tissues.
Reduced absorption or interference with conversion to active form.
Reduction in activity of thiamine dependent enzyme.
Reduced liver storage of VitA
Reduced B12 protein binding.
Increase requirement.
- What FOUR factors that cause disturbances in methylation? (2 marks)
Slide 24 Genomics. 4 x 0.5 for each of the following, total 2 marks
* Lack of essential co-factors (B2, B12, B6, zinc) / malabsorption.
* Specific nutrients depleting methyl groups (niacin).
* SNPs affecting enzyme activity (involved in methylation).
* Insufficient substrates (folate, methionine).
* Drugs (e.g. contraceptive pill, metformin = ↓ B vits).
* Toxin exposure ― aflatoxin (from fungi on crops), air pollution, BPA (e.g. food packaging),
phthalates (e.g. in beauty products), heavy metals.
- Describe TWO ways in which CoQ10 supports mitochondrial function (2 marks)Stress; slide 51. 1 mark each for any two of the following:
Transports high energy electrons in the ETC supporting mitochondrial function and energy
production. * Deficiency reduces ATP production and increases electron loss causing increased
oxidative damage and fatigue. * Production of ROS, which can damage cellular lipids, proteins and
DNA, is a direct consequence of the ET process. * CoQ10 is an efficient intra-mitochondrial
antioxidant, playing a vital role in neutralising ROS
- On reviewing your clients stool test, you notice they have elevated levels of
Calprotectin of > 80 µg / g. What does this marker mean, and what could it be linked
to? (2 marks)
Slide 20 A&D
The elevation is triggered by damage to the epithelial lining (1/2 mark) — in worst case scenarios
IBD, ulcers, cancer, but in most scenarios, relates to pathogens, NSAIDS etc (1/2 mark). It is a
marker of inflammation. (1 mark)
- What are short chain fatty acids (SCFA’s)? List TWO of the most common (2 marks)
Diagnostics; slide 26.
SCFAs are by-products of bacterial fermentation of fibre.
The most common being butyrate, propionate and acetate. (0.5 each, max 1 mark)
- Why would you prescribe vitamin D for someone with Type 1 diabetes? What dose
would be suitable for an adult? (2 marks)
Slide 94 Endocrine
* Improves survival of islet cells and insulin production OR Immunoregulatory (Th1 / Th2
balance). – 1 mark
* 2000 IU (adults), ↑ if deficient – 1 mark
- Contrast and compare the cause of PMS-A to PMS-C, and give an example
symptom related to each (2 marks)
Women;s; slide 37
PMS-A (anxiety): Possibly related to high oestrogen: progesterone (0.5 mark)
Symptoms: Irritability and anxiety (0.5 any related symptom)
PMS-C (craving): Blood glucose imbalance, hypoglycaemia and ↓ magnesium (0.5 mark)
Symptoms: Increased appetite, sugar cravings (0.5 any related symptom)
- How does chromium support weight loss? Describe the mechanisms (2 marks)
Obesity 32
* Lowers body weight yet increases lean body mass, likely via increased insulin sensitivity. 1 mark
* May reduce carbohydrate cravings. 1 mark
- List FOUR anti-microbials that can be used to help alleviate SIBO (2 marks)
Gastro; slide 45. (0.5 per herb)
* Berberine (or barberry bark and goldenseal, e.g., as a tincture) — inhibits protein synthesis of
bacteria; blocks TLR4 pathway.
* Oregano oil (affects bacterial cell membrane permeability).
* Allicin (extract of garlic) — mostly just for methane-producing bacteria.
* Neem.
* Also, uva ursi and cinnamon.
10.Describe TWO strategies you would suggest to a client looking to activate their
vagus nerve in support of GABA production (2 marks)
Nervous Slide 31
Strategies – 1 mark for any of the following
* Diaphragmatic breathing exercises (the Vagus nerve passes through the diaphragm).
* Being outdoor in green country space.
* Social enrichment (being around others and avoiding isolation).
* Singing, humming, playing music.
* Laughter (i.e. ‘belly laughter!’).
* Exercise (e.g. HIIT).
* Cold exposure (e.g. cold water swimming, cold showers etc.)
11.John has sprained his ankle and would like an infused oil to apply topically. Suggest
an infused oil and explain the mode of action of the herb (3 marks)
- Comfrey (1 mark)
- Decreases inflammation (1 mark); allantoin in comfrey increases cell proliferation to promote
healing (1 mark).
12.Describe TWO functional reasons for prescribing B5 to a client who is experiencing
high levels of stress. What dose would be suitable? (2 marks)
Stress; slide 29. 2 x 0.5 marks for TWO of the following. 1 mark for dose
* As a precursor to coenzyme A plays an essential role in adrenal cortex function.
* Increases production of glucocorticoids and other adrenal hormones.
* Thought to reduce secretion of cortisol in times of stress
* Dosage: 100-300 mg / day
- Your client Sally has a high BMI. Her recent GP blood tests indicate insulin
resistance, and she has been referred to you for weight management. Describe
some of the key general interventions that support weight loss. In your answer refer
to why green tea, chromium and 5-HTP might be suitable interventions, discussing
the key mechanisms and dosage involved (15 marks)
Obesity 27/30/31
Interventions that support weight loss – 1 mark per correctly identified mechanism – up to 6
marks.
* Smaller portions — eat from side plate vs. dinner plate
* Protein based breakfast — eating a protein-based breakfast helps normalise insulin
secretion and reduces tendency to snack.
* Protein with each meal — palm size.
* Keep meals simple — the variety of foods in a meal increases intake: The more foods differ
in their flavour, the greater the boost.
* Leave 4 hours + between meals. Fasting or a fasting window such as 16:8.
* Chew food well — 30 times.
* Turn off all ‘stimulators’ whilst eating.
* Mindful eating — enjoy the ritual of food vs. ‘food to survive’.
- Green Tea Dosage: 600–900mg / daily (~3–4 cups of brewed green tea)
- Green tea polyphenols, especially EGCG may stimulate thermogenesis and fat oxidation
Chromium – 3 marks
* Chromium Dosage: 200‒1000 mcg chromium picolinate
* Lowers body weight yet increases lean body mass, likely via increased insulin sensitivity.
* May reduce carbohydrate cravings.
5-HTP – 4 marks
* 5-HTP can aid weight loss by increasing feelings of satiety.
* Promotes sleep by enhancing melatonin production.
* Has free radical scavenging activities
* Dosage: 50‒100 mg twice daily. Start at lower dose; build up to minimise possible nausea.
- Isabel has recently been diagnosed with a Peptic Ulcer and would like advice.
Explain the aetiology and symptoms. Discuss the risk factors and potential
complications associated with this condition. Outline naturopathic suggestions for
Isabel, explaining your reasoning throughout (15 marks)
Answer GIT; slide 60 to 65
What is Peptic ulcer = ulcers of the stomach (gastric) or duodenum characterised by a
breakdown of the mucosal barrier and erosion of the regions wall by HCl (1mark)
Symptoms: Epigastric pain (may radiate to the back), gnawing / pain between meals, nausea,
vomiting, ↓ appetite, dyspepsia. * Complications: GIT bleed (persistent small loss of blood or large
haemorrhage), perforation (→ peritonitis). * Seek urgent medical attention if: Sudden sharp
worsening abdominal pain, haematemesis or melaena. (0.5 mark each, up to 2 marks)
Aetiology and risk factors: Stress (sympathetic dominance) — can lead to vasoconstriction and
inadequate blood supply which interferes with mucus production and reduces the secretion of
protective prostaglandins. * Low antioxidant status and low gastric output — may predispose H.
pylori colonisation. * NSAID use (↓ gastric prostaglandin synthesis, ↓ gastric mucosal blood flow
and mucus production; interferes with the repair of superficial injury). * Smoking, caffeine,
alcohol (damage the mucosa). Helicobacter pylori (H. pylori): * H. pylori infection in the
stomach is associated with peptic ulceration, chronic gastritis and gastric cancer. 80% of peptic
ulcer cases have H. pylori colonisation. * Its corkscrew shape enables it to burrow through the
protective mucus layer into the stomach lining, causing inflammation. * H. pylori secretes
cytotoxins and enzymes; e.g., protease, phospholipase and urease (releases ammonia) and
damages the mucosal barrier. * Numerous strains vary in their ability to trigger inflammation
(virulence factors CagA and VacA carry greatest risk (up to 6 marks)
Natural approach to peptic ulcers: * Avoid alcohol, smoking, fizzy drinks, spicy foods and
caffeine (potential GI mucosal irritants). Avoid NSAID use. * Increase fibre — especially for
duodenal ulcers as fibre slows gastric emptying. * Address stress. Consider calming nervine teas
(e.g., chamomile, passionflower). * Supporting the mucosal / mucin barrier: ‒ Demulcent herbal
powder — slippery elm, marshmallow, liquorice (see Nutrition 2, Herbal Medicine Lecture). ‒ ↑
dietary polyphenols and seaweeds / algaes (fucoidan content). Do not use herbs in GI Disorders
alcohol, i.e. tinctures * Saccharomyces boulardii (↑ SIgA and mucosal barrier; inhibits colonisation
and adhesion of H. pylori; inhibits IL-8 and TNF-α). * Mastic gum — dried sap from the mastic tree
with ulcer-healing properties. It is anti-bacterial; thought to relate to its triterpenic acid content. 2 x
500 mg capsules before bed (30 days), then 1 x 500 mg capsule before bed (60 days). * Liquorice
— contains flavonoids that inhibit H. pylori protein synthesis; it is anti-adhesive. * Cinnamon
(inhibits urease); berberine containing herbs e.g., barberry bark; curcumin from turmeric inhibit H.
pylori growth (up to 6 marks)
- Michael has a stressful job and asks for your support. What are herbal adaptogens
and tonics, and how do they differ? Compare and contrast the herbs Korean
Ginseng and Ashwagandha including parts used, energetics, constituents,
properties, actions/uses and intake (15 marks)
Herbs; slides 71/72/73
1 mark for adaptogens definition. 1 mark for tonics definition. 1 mark for how they differ = Total 3
marks
*Adaptogens increase resistance to physical, biological, emotional and environmental stressors.
Effects are exerted via a range of mechanisms, mediated largely by the HPA axis
*Tonics refer to herbs that improve tone, vigour and body function.
*Adaptogens conserve energy, while tonics restore energy.
(Ashwagandha - ½ mark for each point made to a max 6 marks)
Ashwagandha (Withania somnifera):
*Parts used: Root.
*Energetics: Warm.
*Key constituents: Steroidal compounds ― with anolides.
*Actions and uses: Adaptogen, tonic, nervine (GABA agonist), mild sedative, anti-inflammatory,
immune modulating, anti-anaemic (blood building); impotence, infertility (e.g. in males ― ↑ DHEA,
serum LH and testosterone; improves semen and sperm quality), convalescence, anaemia,
arthritis, insomnia (esp. those waking early with anxious thoughts), post-viral/CFS. (1/2 mark for
each of the above actions and uses)
*Intake: 3–6 g / day dried root (decoction); 1 tsp powder 1‒3 x per week in warm nut milk before
bed (especially before bed).
(Ginseng - ½ mark for each point made to a max 6 marks)
Korean ginseng (Panax ginseng):
*Parts used: Root.
*Energetics: Hot.
*Key constituents: Ginsenosides.
*Actions and uses: Adaptogenic (supports HPA axis), tonic, very stimulating (avoid at night!)
immune modulating, cardiotonic, male tonic, cognition enhancing; debility, stress, impotence, low
immunity (lung tonic), fatigue, male infertility, convalescence, to ↑ physical / mental performance,
Type 2 diabetes (↑ insulin sensitivity). (1/2 mark for each of the above actions and uses)
*Safety: Avoid long-term use due to stimulating effect, avoid during acute infection, anxiety, and
with caffeine, warfarin and MAOIs.
