week six Flashcards
(142 cards)
1
Q
What are risk factors for cognitive decline?
A
Low sex hormones
DM, HTN, metabolic syndrome
Obesity
Poor sleep
Stress
Smoking, alcohol
Sedentary lifestyle
Poor diet, nutrient deficiencies
2
Q
Lifestyle support for CVD prevention in older pts
A
Smoking cessation
Reduce alcohol intake
Reduce rec drug se
Movement (aerobic, interval training)
Stress management
3
Q
Nutrition support for CVD prevention in older pts
A
Reduce sugar, refined carbs, processed foods
Promote circulation (garlic, ginger, onions) ESP if on hormone therapy to reduce clot risk
Bioflavonoids (citrus, berries, apples, onions, broccoli, tea, beans)
Fish and fish oil
Soluble fiber
4
Q
Strategies to enhance digestion in menopausal/andropausal pts
A
Food hygiene
Warming, aromatic, and pungent herbs (cinnamon, turmeric, ginger)
Easy to digest, nutrient rich foods
Fiber rich foods
Probiotics
5
Q
What GI change occurs with aging?
A
GI motility dec with age;
Constipation
Bloating
Nutritional deficiencies
RF for low bone density
6
Q
What happens to the levels of cortisol and DHEA (and thus estrogen and testosterone) during high stress levels?
A
Cortisol levels inc
DHEA (+E + T) dec
7
Q
Is it true that pregnenolone in the adrenals is “stolen” by cortisol for regulation?
A
No
8
Q
Things you can do to support adrenals for andropause pts
A
Stress management/mindfulness
Break the twitch**?
Sleep hygiene
Veggies, esp leafy greens
Healthy dietary cholesterol
Blood sugar regulation
Adaptogenic herbs
9
Q
What is the importance of supporting the adrenal glands for male sex hormone production?
A
They are the ONLY source of DHEA, estrogen, progesterone
And after andropause, they are a major source of testosterone
10
Q
Goals of nutritional therapy for andropause
A
Sx relief
Support adrenals
Weight optimization
Prevent complications of hormone deficiency (CVD, osteoporosis, cognitive decline)
11
Q
Risks of testosterone abuse/overmedication
A
Stroke
Heart attack
HTN
Inc LDL
Liver damage, tumors
Can cause growth to stop in teens
12
Q
Signs of testosterone abuse/overmedication
A
Aggression, depression
Acne
Voice change
Elevated BP
Weight gain
Bloating
Inc LDL
13
Q
Main symptom of excess aromatization of testosterone > estrogen? What is this caused by?
A
Caused by TRT; main sx gynecomastia
14
Q
What is the cautin with DHEA and why it is important to take supervised by a doctor?
A
Can increase testosterone levels, leading to side effects
15
Q
Pharmaceutical treatments for andropause
A
Testosterone replacement therapy (TRT)
Aromatase inhibitors for men on TRT who get excess aromatization of testosterone > estrogen
DHEA
16
Q
Other names for andropause
A
Late onset male hypogonadism
Androgen deficiency syndrome
Androgen deficiency in the aging male
Testosterone deficiency syndrome
Male menopause
17
Q
Sx of andropause
A
Loss of libido
Erectile dysfunction
Low serum testosterone
18
Q
How is andropause defined?
A
Sx testosterone deficiency
19
Q
Around what age does testosterone begin declining? At what rate?
A
30-35
1% each year
20
Q
Side effects saw palmetto
A
Mild, infrequent, reversible
GI upset, headache, rhinitis, dec libido
21
Q
MOA b-sitosterol for BPH
A
Anti-inflammatory
22
Q
MOA saw palmetto for BPH
A
Blocks a1 receptors, dec cell proliferation, inc apoptosis, anti-inflammatory and antioxidant
23
Q
MOA rye grass pollen for BPH
A
Dec 5-a-reductase
Blocks a1 receptors
Anti-inflammatory
24
Q
MOA pygeum for BPH
A
Dec 5-a-reductase
Anti-inflammatory
25
MOA nettle for BPH
Dec action sex hormones
Dec proteolytic enzyme
26
What are two combination treatments for BPH that are shown more effective than each component individually? What markers did they show improvement on?
Saw palmetto + lycopene > reducing prostate inflammation GF expression, oxidative stress, and histologic features in bladder obstruction model
Saw palmetto + pumpkin seed oil > dec serum PSA, improved QOL
27
Selenium MOA on prostate cancer prevention
Inhibits cell proliferation and stimulates apoptosis, antiinflammatory and antioxidant
28
Selenium effects on BPH
Slows prostate growth and prevents prostate cancer
29
Proposed MOA lycopene on reducing risk of prostate cancer
Antioxidant and anti-inflammatory
Dec 5-a-reductase + IL-6 signaling
Dec cell proliferation in normal prostatic epithelial cells
Promotes apoptosis in hyperplastic prostate tissue
30
Lycopene effects on prostate conditions
Slows progression BPH
Reduces risk prostate cancer
31
Zinc effect on BPH
Dec prostate size; unknown mechanism
32
Pumpkin seeds effect on BPH
Reduced LUTS
33
MOA pumpkin seeds for BPH
Dec elevated DHT, tonic effect on bladder
34
Why might soy be beneficial in BPH?
Contains isoflavones genistein and daidzein; ed 5-a-reductase, inc antioxidant enzymes, dec NF-KB upregulation of apoptosis
35
Phytotherapy options for BPH
Saw palmetto
African plum
South african star grass
Stinging nettle root
Rye pollen extract
Pumpkin seeds
Soy
Grape juice
Cactus flower
Zinc
Selenium
36
Components of “watchful waiting” with BPH
Dec PM fluids
Dec caffeine/EtOH/bladder irritants
Timed voids/double vodis
Treat constipation
37
BPH tx options
Watchful waiting
Phytotherapeutics
Medical management (alpha blockers, 5 ARIs, PDE5i, combination therapy)
Minimally invasive techniques
Surgical techniques
38
Etiology/RF BPH
Higher incidence with higher income and education
Metabolic syndrome increase likelihood
Familial component
20% males 41-50
50% males 51-60
Inc by 10% per 10 years
39
Clinical sx BPH
LUTS: storage vs voiding vs both (nonspecific)
Incomplete emptying
Frequency
Urgency
Intermittency
Weak stream
Straining
Nocturia
40
BPH macroscopic changes
“Enlarged prostate”; DRE, TRUS, CT, MRI
Static (epithelial/having a large blockage)
Dynamic (increased “tone” of muscle fibers)
41
BPH microscopic changes
Proliferation of stromal (fibromuscular) and epithelial (prostate secretory glands) in the transitional zones
42
Viagra effect on ED; what needs to be present in adequate levels for viagra to result in an erection?
Viagra-like drugs artificially shore up cyclic GMP levels by inhibiting its breakdown and will produce an adequate erection provided there is sufficient nitric oxide to stimulate enough cyclic GMP.
Although we now realize that they do stimulate NO, they do not fully correct deficiencies of NO due to poor lifestyle choices. Think of a simple analogy of a fire hose that will become distended if the nozzle is partially closed off, but not if the fire hydrant is partly shut or there is not enough water in the system. It is crucial to have enough NO production for erection to occur, with or without the use of drugs.
43
Affects of obesity on male fertility
Alters sperm function
Increases sperm DNA damage
Dec sperm mitochondrial activity
Induces seminal oxidative stress
Impairs blastocyst development
**evidence varies**
44
Substances associated with decreased aromatase activity
Zinc
Flaxseed
Nettle
EGCG
45
What causes decreased 5-a-reductase activity
Saw palmetto
Nettle
EGCG
Zinc
46
What causes increased 5-a-reductase activity
High insulin and obesity
47
Inc Dihydrotestosterone (DHT) is associated with what conditions
Prostate enlargement (cancer, BPH)
Male pattern balding
Female hirsutism
Acne
Skin aging
Breast tumors
48
What enzyme converts testosterone to dihydrotestosterone?
5-alpha-reductase
49
Aromatase activity is upregulated in what scenarios
Obesity (high activity in adipose tissue)/excess adipose
Hyperinsulinemia
Alcohol use
Inflammation
50
Testosterone is converted to estrogen via what enzyme
Aromatase
51
Ways to prevent negative estrogen burden
Increase:
CYP-1A1
COMT
Quinone reductase
Glutathione conjugation
Decrease:
CYP-1B1
Peroxidase
B-glucuronidase activity
52
Ways to improve estrogen elimination
Support phase 1
Support phase 2
Lower beta glucuronidase
53
Nutritional strategies for lowering beta-glucuronidase
Plant based diet low in animal protein
Raw vegan diet
Prebiotic foods - chicory, asparagus, banana, onions, leeks, nuts and seeds, cruciferous, garlic, shallots, beets, fennel, peas
Prebiotic supplements
Probiotic supplements
54
During what process does the conjugation and elimination of estrogens in bile take place?
Glucuronidation
55
Supplements to maintain reduced glutathione
Reduced glutathione
N-acetyl-cysteine
Lipoic acid
Whey protein
Mg
Vit C
Vit E
Silymarin
Pantothenic acid
SAMe
56
Dietary sources of glutathione S transferase
Cruciferous veggies
Allium veggies
Resveratrol
Citrus
Garlic
Fish oil
Black soybean
Purple sweet potato
Curcumin
Green tea
Rooibos tea
Honeybush tea
Ellagic acid
Rosemary
57
Steps to improve methylation
Increase substrate for COMT (SAMe)
Add methyl donors
58
What enzyme helps control the levels of certain hormones?
Catechol O methyltransferase (COMT)
59
What are sulfotransferases/SULTS and in what foods are they found?
Enzymes that catalyze the transfer of a sulfo group from a donor molecular to an acceptor alcohol or amine
Caffeine (coffee, cocoa, black tea, green tea)
Retinoic acid (liver, fish, egg, dairy, apple, apricot, artichoke, arugula, asparagus)
60
Issues with phase 2 detox
Genetic difficulties with phase 2 > chronic disease, unexplained wt gain, fatigue, mood problems
Phase 2 limited vs phase 1 > toxic intermediates can accumulate
61
Types of pathways for phase 2 liver detox
Methylation
Glutathione conjugation
Amino acid conjugation
Sulfation
Acetylation
Glucoronidation
62
What nutrition may support phase one liver detox?
Cruciferous veggies
Antioxidant foods
Flavonoids
63
Liver detox pathway
Fat soluble toxin > phase 1 reactions > activated intermediate > phase 2 reactions > water soluble compound
64
Phase 2 liver detoxification
Transforms fat soluble substances into forms that can be excreted
Conjugation reactions
Conguates toxic intermediate from phase 1 making it non-toxic and able to be removes
6 pathways for phase 2
65
Phase 1 liver detoxification
Inactivates chemicals (caffeine, alcohol, meds)
Hydroxylation reactions
CYP450 enzymes
Creates intermediates that are no longer active but may be more toxic to the body. Creates ROS.
66
How does the liver remove toxins?
Removes fat soluble toxins into vile for intestines
Transforms fat soluble toxins to water soluble for kidney to remove them
67
How long does it take to regenerate about ½ of liver function?
6 weeks
68
How can you support metabolite detox?
Promote balanced phase 1 and phase 2 estrogen biotransformation and clearance
Promote a healthy gut microbiome, gut ectology
69
How can you modulate estrogen receptors?
Defend cellular sensitivity (estrogen receptors) from other hormones
70
How can you modulate the transport of estrogen?
SHBG
Distribution
Interaction with other hormones
71
How can you reduce the estrogen burden?
Reduce peripheral production via aromatase inhibition
Reduce exposure to environmental estrogen imitators
72
What are the four components of strategy to improve estrogen biotransformation and clearance
Reduce estrogen burden
Modulate transport
Modulate receptors
Support metabolite detox
73
Which metabolite of estrogen is the protective/weak? Which are carcinogen and active?
2-OH - protective
16a-OH and 4-OH** - carcinogen
74
Estrogen metabolism biochem
Phase 1 detox - estrone and estradiol hydroxylated by CYP450 enzymes > 2-hydroxy/4-hydroxy metabolites
Phase 2 detox - in liver; sulfotransferases, glucuronidation, COMT, glutathione
Human estrobolome: aggregate of enteric bacterial genes; products are capable of metabolizing estrogens
75
3 P’s of hormone disruptors and their sources
Plastics: food storage, plastic bottles, produce bags
Parabens: cleaning products, makeup, hair products
Pesticides
76
Sources of xenoestrogens
Commercial meat and dairy
Microwaved plastic
Baby bottles (BPA)
Conventional produce
Children's toys
Plastic
Sunscreen
Synthetic hormones
77
What are some effects of estrogen on the body?
Breast development
Stimulate bone growth
Epiphyseal closure
Small amount of increase protein deposition
Increased subcutaneous fat deposition (hips, thigh, butt)
Increased skin vascularity, warmth, and softness
78
What enzyme is present in ovaries and what can it do?
What enzyme is present in ovaries and what can it do?
79
What does cholesterol get converted into before estrogen? By what?
Pregnenolone; by ovarian cells
80
What can cause decreased progesterone?
Stress
Insulin
Opioids
Luteal phase defect
High prolactin
Underweight
Hypothyroid
Birth control pills
81
What can cause increased progesterone?
Vitex
Pregnancy
82
What actions can be taken to normalize estrogen production? Give examples of nutritional tx for each of these.
Decrease inflammation: anti-inflammatory diet, omega 3 FA
Normalize insulin and glucose dynamics: low glycemic diet, alpha lipoic acid, chromium, cinnamon
Increase SHBG: lowering insulin levels, EFAs, flax
83
Adiposity biochemical effects
Induces IR
Increases IGF-1 and suppresses hepatic binding proteins, increasing free unbound bioavailable circulating estrogens
Insulin = growth factor for tumor cells
84
Adiposity is linked to higher circulating ____ and increased risk of _____.
Estrogens
Breast, ovarian, endometrial cancers
85
What happens to hormone levels in underweight females or those who exercise excessively?
Non-essential hormone processes cease; sex hormone productino declines and infertility increase. Loss of interest in sex and dec sexual responsiveness.
Dec release of gonadotropin releasing hormone and LH/FSH
86
“Obesity” may have what effect on puberty?
Early onset of puberty in girls
87
“Obesity” is associated with alterations of what hormones and metabolites?
In males:
Dec SHBG
Dec total testosterone
Higher urinary estrone metabolites
Women:
Disturbed LH pulsatility
Dec SHBG levels by insulin
Insulin stimulates inc production of androgen from ovaries (PCOS)
88
What is the substance in red yeast rice that makes it similar to a statin in terms of lowering cholesterol and sex hormone production?
Monacolin K
89
Why would people on statins have altered serum sex hormone concentrations?
Statins inhibit the enzyme 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase, reducing cholesterol production. Cholesterol is the starting product for sex hormone production.
90
What is the effect of Mentha spicata on androgens?
Anti-androgenic effect in PCOS
91
What is the effect of Camellia sinensis on SHBG?
Inc SHBG
92
What is the difference between angelica sinensis that is prepared from fresh root versus that which is decocted?
If volatile oils present - circulatory stimulant, analgesic, antispasmodic
If decocted - uterine stimulant
93
Rheum rhaponticum is particularly useful in perimenopausal states with associated with _____
Depression and anxiety
94
Paeonia lactiflora is described in Chinese medicine as nourishing the yin. How does this relate to its effects on sex hormone regulation?
Nourishes blood and regulates menses
Invigorates blood and dispels blood stasis
95
Explain the theory of how Vitex agnus-castus works to treat mastalgia
Vitex suppresses the stress-induced latent hyperprolactinemia (a release of increased levels of prolactin in some patients in response to stressful stimuli).
Vitex could be effective in the treatment of cyclical mastalgia by inhibiting the release of excess prolactin by blocking Dopamine-2 receptor type on the pituitary.
96
List 5 effects of phytoestrogenic constituents aside from effects on reproductive function
Positive effects on
Bone density
Skin aging
CVD risk
Metabolic syndrome
Nervous system and immune function
Cancer risk and recurrence
97
Name the 8 major types of phytoestrogens and give examples of herbs in which they are found
Chalcones - glycyrrhiza
Flavonols - glycyrrhiza
Isoflavones - medicago sativa (alfalfa), trifolium pratense (red clover),
Prenylated isoflavonoids
Coumestans - medicago sativa (alfalfa)
Lignans - flaxseed
Stilbenoids - rheum rhaponticum (false rhubarb)
Resocyclic acids of lactones
98
Hot sitz bath indications
Painful spasms (vaginismus, tenesmus)
Colic
Neuralgia (ovarian,testicular, intestinal)
Sciatica
Lumbago
Insomnia
Suppressed menses
Congestive headache (derivative)
Painful hemorrhoids
99
Hot sitz baths CI
Hemorrhage
Menorrhagia
Prolapse
Pelvic congestion
Acute UTI
100
Alternating hot and cold sitz actions
Dec stagnation of blood and lymph
Inc tissue tone
Activates spinal cord reflexes to underlying pelvic and abdominal organs
101
Alternating hot and cold sitz indications
Vaginal infections (esp with pelvic congestion)
Chronic UTI
IC
PID
Hemorrhoids
Anal fissure
Prostatitis/BPH
Atonic constipation
Chronic sciatica, lumbago
Laxity of pelvic fibers (postpartum and perimenopausal)
102
Alternating hot and cold sitz CI
Hemorrhage
Acute cystitis
103
Neutral sitz action
Calming and soothing to inflamed/irritated tissues
104
Hot sitz actions
Relieves/relaxes muscle spasm
105
Neutral sitz indications
Acute PID
Acute cystitis
Endometriosis
Mental restlessness with any condition
Vaginitis with pruritis
Pruruitic ani
106
perineal bath actions
Dec swelling, inflammation, pain
107
Perineal bath indications
After childbirth
After rectal or perineal surgery
108
Hot foot bath indications
Congestive headache
Epistaxis
Lung congestion
Pelvic congestion/prostatic conditions
Suppressed menses/dysmenorrhea
Chill
Fatigue
Renal and gallstone colic
May prevent or shorten cold/flu
Prep for wet sock treatment
109
Hot foot bath CI
Peripheral vascular disease
DM
Loss of sensation to extremities
110
Douches actions
Soothe irritated and inflamed tissues
Heal injured tissues
Restore balance to imbalanced vaginal microbiome
111
Douche CI
Pregnancy
Don’t use on a regular basis
112
Castor oil pack actions
Emollient
Softens scars and adhesions
Shrinks cysts/non malignant growths
Shrinks warts
Detoxifying/drawing
Stimulates smooth muscle
Laxative
Anti-inflammatory
Oxytotic (inc uterine contractions)
113
Castor oil pack indications
Liver/GB detox
Migraines/headaches
Abdominal adhesions post surgery
Ovarian cysts
Fibrocystic breast disease
Uterine fibroids/lipomas
Hormonal imbalances:
PMS
Endometriosis
Dysmenorrhea
FBD
Menopause
Inflammation
114
Castor oil pack CI
Uterine growths
Bleeding
Pregnancy
Ulcers
While menstruating
115
High frequency VITA RAY actions
Dec inflammation
Inc circulation of blood and lymph
Speed up wound healing
Antiseptic
116
High frequency VITA RAY indications
Acne
Increased facial tone (wrinkles, etc)
Male pattern baldness prevention
Instead of sine for:
Dysmenorrhea
Heavy menses
Ovarian cysts
Prostatitis/high PSA
Uterine fibroids
Abdominal scar tissue
Breast cysts
Mastitis
117
High frequency VITA RAY CI
All electrical CI
Over metal implants
Over moisture on the skin
118
Heating trunk pack actions
Promotes gastric secretions, liver activity
Normalizes motility of GI tract
119
Hydro treatments for constipation
2 glasses of water when waking, waiting an hour until eating
Contrast showers,, long hot short cold (esp to abdomen and anal)
Cold abdominal compress (long term constipation)
Reflex water therapy (hot shoulder, cold hip, cold back shower)
120
MOA using cold hydro to improve digestion and elimination
Contraction of muscles and organs
Dilation of arteries to liver
Inc gastric secretion
Inc free and total hydrochloric acid
121
Dysmenorrhea hydro tx
Hot herbal teas such as peppermint, chamomile, linden
2 cups rock/coarse salt roasted 15 mines and wrapped in a towel applied to abdomen/ovaries
Cold shallow bath with hot foot bath
Hot moist compresses to spine/abdomen
Hot water bottle
Keep extremities warm
Before/during start of menses lower half body hot pack, cold friction rub, finish neutral bath
122
Profuse menses hydro tx
Cold foot bath
Ice between thighs
Cold water irrigation of vagina
Cold sitz baths, hot foot bath
Cold hip baths/cold mitten friction
123
Delayed/suppressed menses hydro tx
Alternate hot and cold sitz or compresses
Irrigate vagina with alternating hot and cold douches
Prolonged hot moist compresses
Hot herbal teas
124
Childbirth hydro tx
Red raspberry leaf tea
Cold compresses or showers to breasts
Short cold foot baths
Hot moist compress on pubic area
Warm deep sit bath at early labor
125
Postpartum hydro tx
2 days after - hot dry pack to breasts, ACV douches
5 days - cold sheet pack over abdomen and breasts
Cracked breasts - Vit E oil, hot moist compresses then cool sponging
126
Insomnia hydro tx
Neutral and warm tub baths
Hot moist compresses on head
Alternating hot and cold leg baths
Hot milk and honey
Neutral or warm bath
Wet sheet pack starting neutral
Prolonged mild hot baths
Heating compresses
Heating pad
127
Different actions of neutral/warm baths and alternating hot and cold leg baths on insomnia
Neutral and warm baths calm and sedate body
Alternating hot and cold leg baths reduce congestion and help with sleep
128
Nausea hydro tx
Ice pack to base of skull and neck and one at solar plexus
Peppermint tea
Heating trunk pack with hot water bottle on upper abdomen
129
Spasms in bladder/rectum/uterus hydro tx
Prolonged hot moist compresses to pelvic
Shoulder showers
130
Pelvic period cramps and pelvic inflammation hydro tx
Cold shallow bath + hot foot bath
131
Pelvic congestion hydro tx
Hot foot bath
Alternating hot and cold sitz bath
132
Non inflammatory pelvic problems hydro tx
Hot shallow bath
Hot foot bath
133
Uterine hemorrhage hydro tx
Cold compress on inner thighs, perineum, lower back
134
Uterine inflammation hydro tx
Cold low pressure shower from naval to pubic bone
135
Vaginismus hydro tx
Hot water/rosemary tea douche
Hot shallow sitz baths
Hot foot baths
Ice pack from shoulder to neck
136
Yeast vaginitis hydro tx
Douche with acidophilus and water, ACV
137
Mastitis hydro tx
Castor oil packs
138
Acute Prostatitis hydro tx
Hot OR cold, not both
Hot shallow bath
Cold ice pack to area
139
Chronic Prostatitis hydro tx
Alternate hot and cold perineal spray
Graduated cold shallow bath
Hot sitz
Lower half body pack
Small hot retention enema
140
Liver imbalance hydro tx
Cold abdominal compress
Alternating compresses
Hot lemonade
141
Congestion of liver hydro tx
Alternate long hot and short cold percussion of shower sprays to area
Alternate hot and cold compresses
142
Phytoestrogen herbs
Glycyrrhiza (licorice)
Medicago saliva (alfalfa)
Trifolium pratense (red clover)
Humulus lupulus (hops)
Vitex agnus cactus (chaste berry)
Actea racemosa (black cohosh)
Lepidium (maca)
Trigonella foenum graecum (fenugreek)
Paeonia lactiflora (peony)
Rheum rhaponticum (false rhubarb)
