NUTRITION EXAM JULY 2016

450kcal a day.

60-70kcal a day.

At around 6 months

1) That we are all biochemically individual, based on the concepts of our genetic and environmental uniqueness. 


2) That we use a patient-centred approach, not a disease-centred approach. 


3) We aim to find a balance between all aspects of health (body, mind, spirit)

4) That health should be viewed as the presence of positive VITALITY, not just the absence of disease.

Remove - trigger foods

Replace - vits, minerals, enzymes

Reinoculate - probiotics 

Repair - gut lining, L-glutamine

Rebalance - lifestyle, external stressors

Antecedents are the predisposing factors to illness. 


Triggers are discrete entities or events that may provoke the disease. 


Mediators do not cause disease, but contribute to the manifestation of the disease.

• Tiredness
• Shortness of Breath
• Hear palpitations
• Headaches

Other:

• Irritability
• Pica - craving substances that aren't food (clay, ice)
• Spoon shaped nails
• Pallor

• Consumption of fatty, processed foods
• Consumption of sweetened sugary drinks
• Increased energy intake
• Growth spurts (increased appetite)

Inadequate protein intake

Social / Psychosocial – peer pressure, body image and the media (can cause weight loss due to decreased appetite/ weight loss diets)

Drug or alcohol use (can cause weight loss from decreased appetite)

Iron deficiency anaemia – can cause weight loss due to decreased appetite

Drug or alcohol use (decreased appetite)

Social / Psychosocial – peer pressure, body image and the media (decreased appetite)

Economical – lack of prioritisation on food shopping (decreased appetite)

Iron deficiency anaemia – decreased appetite

Fat (major energy storage). 


Glycogen (short-term energy/carbohydrate reserve). 


Protein (rarely used by the body for energy except in severe cases of starvation and other wasting conditions).

1. Catechins (a flavonoid)

2. Beta Carotene

3. Lignans

4. Quercetin (a flavonoid)

5. Lycopene

6. Resveratrol 

7. Daidzein and Genistein (isoflavones)

Also known as Ubiquinone, Coenzyme Q10 is an antioxidant that is used for:

Ageing

Cardiovascular Disease

Gum Health (Periodontal Disease)

Parkinson's Disease

Coenzyme Q10 (Ubiquinone)

Alpha Lipoic Acid (ALA)

Glucosamine

Chondroitin Sulphate

Methyl Sulfonylmethane (MSM)

Betaine Anhydrous TMG (Trimethyl Glycine)

Dimethyl Glycine (DMG)

Phosphatidyl Serine

1. Coriolus Versicolor

2. PSK (Polysaccharide K)

3. Grifola Fondosa

4. Cordyceps

5. Reishi

6. Shitake

ALA is an antioxidant. It is used for:

- Type 2 Diabetes

- Peripheral Neuropathy

- Cognitive Function

Osteoarthritis

Inflammatory Bowel Disease (IBD)

An antioxidant. It is used for:

- Autism!!!!!

Antioxidant. Used for:

Alzheimer's Disease

Age-related cognitive impairment

Immune enhancer

Male / Female Fertility

Inhibits platelet aggregation

Anti tumour

Virus-stopping

Cholesterol-lowering

1. Fat (major energy storage/carbohydrate reserve)

2. Glycogen (short-term energy storage)

3. Protein (rarely used by the body for energy except in severe cases and other wasting conditions)

A theory stating that the short term regulation of food intake is governed by the rate glucose is metabolised at rather than blood levels of sugar.

Food consumption is triggered by decreased glucose availability to the tissues. 


Increased hunger = decreased glucose levels

• Decreased hunger =increased glucose levels. 

• *The rate of tissue glucose utilisation is more important than blood glucose levels.

Every organ in our body takes an active role at given times of the day; the opposite organ in the clock is at its lowest ebb at that time.

For instance if you frequently wake up during the night e.g. 1-3am – which is Liver time, this may be indicative that the liver is under stress.

Large and broad at the forehead, narrow at the chin. Large eyes with widely spaced arched eyebrows, narrow bridge of the nose and paler skin.

*Think "LARGE" "NARROW" and "PALE"

Round to square shaped face, the broader the jaw the more yang the face. Wide nose and mouth with medium to small sized eyes. There is often high colour in the yang face.

*Think "ROUND" "SQUARE" "WIDE" "COLOUR"

- Physical trauma or psychological trauma

- Stressful life events

- Microbes

- Drugs

- Lack of resources due to poverty

- Lack of health information / education

- Feelings and beliefs about illness

- Behavioural conditioning

All breastfed infants should be offered 4 further oral doses of vitamin K (1mg) at 2 weekly intervals because: 


– The vitamin K content of breast milk varies.


– The infants lack colonic flora synthesizing this vitamin.

- Initially given at birth to protect against haemorrhagic disease of the newborn

–  Dehydration 


–  Diarrhoea 


–  Fever

–  Elevated blood urea

- Vitamin B12

- Vitamin D

- Iron

- Calorie intake (energy deficiency)

Raw carrots

Cherries

Gum

Marshmallows

Nuts

Popcorn

Peanut Butter

Whole grapes

Because of risk of botulism.

*Botulism = food poisoning caused by a bacterium growing on improperly sterilized tinned meats and other preserved foods. Honey and corn syrup possess spores that are harmful to babies.

They can cause diarrhoea.

During the first two or three days after delivery, the breasts produce colostrum, a pre-milk substance containing mostly serum with antibodies and white blood cells.


Colostrum protects the infant from infections against which the mother has developed immunity.

The maternal antibodies inactivate pathogenic bacteria within the infant’s digestive tract.

This is partly the reason why breasted infants have fewer intestinal infections than formula-fed infants.

- Allergic reactions such as asthma, recurrent wheezing, and skin rash.

- Intestinal infections

Formulas contain no protective antibodies, unlike breast milk

Soy-based formulas are under particular scrutiny due to the high level of isoflavones and phytoestrogens (thousand times higher than breast/cows milk) 

Another particular concern is lead contaminated water. Can cause lead poisoning in infant.

Apart from the side-effects linked to excess protein intake, cow’s milk consumption can lead to:


– Iron deficiency anaemia.


– Deficiency of linoleic acid, vitamin E.


– Gastrointestinal blood loss.


– Type 1 diabetes (in genetically predisposed infants).

Ubiquinone

• Phosphatidyl Serine
• This is why it is therapeutically used for Alzheimer's Disease and Age-related Cognitive Impairment

Glucosamine

• *Also:
• - Chondroitin Sulphate (despite inconclusive data)
• - Methyl Sulfonylmethane (MSM)

• Ageing
• Cardiovascular Disease (CVD)
• Gum Health (Periodontal Disease)
• Parkinson's Disease

Dimethyl Glycine (DMG)

• Type 2 Diabetes
• Peripheral Neuropathy
• Cognitive Function

TRUE

TRUE

A large class of chemical compounds (phytonutrients) found in plants. They are characterised by the presence of more than one phenol unit or building block per molecule. They are the largest class of phytochemicals.

Can be broken down further into categories:

• Flavonoids
• Phenolic Acids
• Lignin's
• Tyrosol Esters

Flavonoids belong to the polyphenol family (a subclass of phytochemicals).

There are 6 major subgroups of flavonoids:

• Flavanols
• Flavones
• Flavonols
• Flavanones
• Anthocyanins
• Isoflavonoids.

• Fruits
• Tea
• Soybean
• Apple
• Citrus Fruits

Decreases blood levels of CoQ10

1. Catechins and Epicatechin

2. Quercetin

3. Kaempferol

4. Naringin and Naringenin *grapefruit*

5. Daidzein and Genistein

6. Lignans

7. Proanthocyanidins

8. Anthocyanins

9. Cyanidin

10. Punicalagins *puni pomegranates*

1. Catechins and Epicatechin

Quercetin

Flavonoids

Isoflavones (of the flavonoid and polyphenol family).

Isoflavones are also known as phytoestrogens, as they are capable of exerting oestrogen-like effects.

Abundantly found in legumes, particularly soy beans and soy protein (tofu)

Increases blood levels of:

• - Calcium channel blockers
• - Sedatives
• - Anti-depressants
• - Cholesterol Lowering Drugs
• - Warfarin
• - Anti-Psychotics
• - Sedatives
• - Antidepressants
• - Caffeine
• - Oestrogen

• Daidzein and Genistein
• (these are isoflavones/flavonoids/phytooestrogens)

1. Protects against infection

2. Protects against food allergies

3. Provides hormones that promote physiological development

4. Improves cognitive development

• - Delays the return of regular ovulation, thus lengthening birth intervals (not a
• dependable method of contraception!)

– Conserves iron stores (by prolonging amenorrhea).

– May protect against breast and ovarian cancer

710ml

Almost 500 extra calories a day above her regular need during the first 6 months of lactation.

• To meet this energy need, she can add extra 330kcal of food each day and let the fat
• reserved accumulated during pregnancy provide the rest.

• Intense physical activity can raise the lactic acid concentration of breast milk,
• which may influence milk’s taste.

• Therefore some infants prefer milk produced prior to exercise (with lower lactic acid
• content).

G astrointestinal Tract

N ervous System

E ndocrine System

R eproductive System

A llergies & Immunity

R espiratory 

U rinary System

C ardiovascular System


M usculoskeletal System

S kin

1. Interferes with lactation by inhibiting oxytocin production

2. Changes taste of breast milk

1. Reduces milk volume

2. Nicotine alters the smell and flavour of milk

3. Increases risk of Sudden Infant Death Syndrome

It can impair iron status as the caffeine can interfere with the bioavailability of iron in the milk.

Fat, followed by carbohydrate.

Human breast milk is relatively low in protein (6%)

Carbohydrate in breast milk: Lactose 
– Easily digested by infants and enhances calcium absorption. 


Protein: Mostly alpha-lactalbumin 


Fat:  - Linoleic Acid - Linolenic acid -Arachidonic (AA) acid - DHA

TRUE

Due to colostrum, a substance in the breast milk which contains antibodies and white blood cells.

• These antibodies inactivate pathogenic bacteria within the infant’s digestive
• tract.

Provides bifidus factors to aid friendly bacteria

Lactoferrin, an iron binding protein in milk keeps bacteria from getting the iron it needs to grow

The available energy per unit of weight.

For example, chocolate holds an energy density of 5 calories per gram

High red colour - inflammation

Blue/green discolouration - disorder of blood vessels

Yellowy tones/colour - Excessive bile secretion, Mucus and fat stagnation.

Deep purple hue - blood vessel disorder

Pale - Coldness, Deficiency, Iron deficiency, reduced Qi energy

Red - Form of Heat, inflammation

Red and Painful - Deficiency of B1, B12, or folate

Magenta - B2 deficiency

Purple - Blood stagnation, reduced Qi, poor circulation

Thin - Weakness or deficiency of fluids

Swollen, flabby - Problems with fluids, Dampness Present

Scalloped/Indentations (teeth marks on sides) - Weakness in digestion, pancreatic insufficiency, fatigue, nervousness

Deficiency of digestion requiring B vitamins, especially B12 and Folate (B9).

May also indicate iron deficiency and under secretion of HCL.

Deficiency of Qi

Thick, damp - Mucus production, dampness, spleen disharmony

Sticky and Moist - Extreme dampness of stomach/spleen

White - Cold, deficient

Dark brown - some form of stagnation

Slimy - Phlegm, mucus, damp

Yellow - Heat, excess, if thick dampness

Black - Indicates severe form of heat, if over digestive area - chronic constipation

No coat, shiny - possible deficiencies, weak digestion

Coat easy to remove - acute problem

Coat hard to remove - chronic deep problem

In TCM the ancients saw that energy or Qi circulates in a distinct pattern within the body. This vital energy moves from organ system to organ system. 

The body clock system is where every organ in the body takes an active role at given times of the day; the opposite organ in the clock is at its lowest ebb at that time. 

Body clock may indicate why certain times of the day are more difficult or more harmonious, and whether symptoms can be attributed to the organ at that particular time when it is at its strongest or weakest.

glycogen is a polysaccharide of glucose

it is the stored form of glucose (when energy needs are met)

it is stored in the liver and skeletal muscles

To fuel the Basal Metabolic Rate (BMR).

BMR/RMR total about 2/3 of total energy expenditure!

Basal Metabolic Rate

This is the rate at which the body uses energy while at rest in order to maintain vital functions such as breathing and keeping warm, heartbeat etc. It is the minimum level of energy expended by the body to sustain life in the awake state.

Also known as Lean Body Mass, is the body's weight excluding the body's fat.

Energy expenditure in the body caused by the metabolising of food consumed (above Resting Metabolic Rate).

So essentially this is how many calories are burned in order to actually break a food down (i.e. 10% of the energy content of the meal). So, if a banana is 100 calories in total, 10 calories (i.e. 10%) are expended in order to break it down and digest it!

Highest for Protein and Carbohydrates

Lowest for fats

TRUE

• Protein - 4 calories per gram
• Carbohydrate - 4 calories per gram
• Fat - 9 calories per gram
• Alcohol - 7 calories per gram

Remember PCF 449

Chondroitin Sulphate

Statins have been found to DECREASE blood levels of CoQ10

Alpha Lipoic Acid (ALA)

Immune Enhancer

Decreases Platelet Aggregation

Anti tumour

Hypotensive

Immune enhancer

Male / Female fertility

Inhibits Platelet Aggregation

Coriolis Versicolor

PSK (Polysaccharide K)

Reishi

Shitake

Daidzein and Genistein

Lignans

(i.e. the 2 polyphenols that are in the middle of my bathroom door sheet!)

Pomegranates 

*Think Puni pomegranates*

Grapefruit

H Pylori

Olive Oil - consuming 23 grams / day (2 tbsp) may reduce risk of heart disease

Cacao

Tomatoes

Grapefruit

Legumes

710ml

1) FAT = Linoleum, Linolenic, Arachidonic Acid, DHA

2) CARBOHYDRATE = Lactose

3) PROTEIN (6%) = Alpha-Lactalbumin

60-70kcal per day

TRUE

Koilonychia 


A sign of iron deficiency

Antioxidant

Prevents Atherosclerosis

Chemoprotective agent - inhibits formation of cancer cells  (Think KAEM - KAEMOPROTECTIVE)

Cardiovascular Disease

Menopause Symptoms

Antioxidant

Anti-diabetic /anti-obesity

Anti-inflammatory

Vasoprotective 

Anti-carcinogenic

Cardiovascular Disease

Menopause Symptoms

Osteoporosis

Red Wine contains resveratrol and an even higher number of flavonoids.

Moderate alcohol consumption increases HDL levels and promotes the dissolution of clots.

150mg per day for 6 weeks showed a drop in LDL cholesterol and hypertension

1) Immune imbalance/inflammation

2) Digestive/absorptive and microbiological imbalance

3) Hormonal imbalance

4) Mind-Body-Spirit integration

Glucosamine-6-Phosphate

Sneezing

Coughing

Itchy Eyes & Ears

Urticaria (HIVES)

Additives in foods - e.g. food colouring

Salicylates in foods

The balance between how much energy is spent and consumed

Energy Balance = Energy Intake + Energy Stores - Energy Expenditure

This is utilisation of the body's stores - glycogen, fat, protein

An increase in body energy stores, primarily as fat 

Food Safety and Zoonoses by the WHO (World Health Organisation)

Campylobacter

Persistent Organic Pollutants (POPs)

Organic compounds that are highly resistant to degradation by biological, photolytic or chemical means.

The most well known POPs are:

• - PCBs
• - DDT
• - Dioxins

Deficiency - deficiency symptoms are end stage symptoms associated with an extended lack of a particular vitamin

Insufficiency - can be identified by under functioning of certain biochemical pathways, nutritional evaluation and other symptoms. Most disease processes start and are retained due to an insufficiency of a vitamin or mineral

Medicines and Healthcare Products Regulatory Agency


This is the government agency set up to oversee the safety and efficacy of medicines and medical devices in the UK.

European Food Safety Authority

Nutrition and Health Claims Regulation (NHCR) - health and nutrition claims are regulated under the EU nutrition and health claims regulation. Supplement companies and food manufacturers must abide by their guidelines

A reference to particular nutritional benefits of a food such as "low salt" "low sugar" "high fibre"

Health claims refer to a relationship between a food and health - e.g. "calcium helps build strong bones"

Good Manufacturing Practise - part of quality assurance which ensures that medicinal products are consistently produced and controlled to the quality standards appropriate to their intended use and as required by the marketing authorisation or product specification. 

At the moment the MHRA only requires GMP for licensed medicines

An inactive substance that serves as the vehicle or medium for a drug or other active substance

Minerals are most often best taken with food because they require sufficient stomach acid for digestion

With food!

• Inorganic (tend to cause more side effects)
• - Sulphates
• - Carbonates
• - Oxides
• - Chlorides
• - Nitrates
• - Phosphates

• Organic (better absorption)
• -Citrates
• -Lactates
• -Picolinates
• -Glycinates
• -Fumarates