YEAR 2 SEMESTER 2

Energy cannot be created or destroyed, but it can be  only transformed from one form into another

• Chemical work (synthesis of new macromolecules).
• Mechanical work (muscular contraction).
• Electrical work (maintenance of ionic gradients across membranes).

• When food is utilised in the body (for chemical,mechanical or electrical work),   this is always accompanied by the loss of some energy in the form of heat.
• This heat energy that is no longer available for work is called ‘entropy’.
• Up to 75% of the chemical energy in food is lost as heat!

• Elderly - decline in total energy expenditure
• Women - have lower energy expenditure than women
• Sedentary individuals / those not involved in physical work

• Lipostatic theory - body fat is the key substance which regulates eating behaviour
• Glucostatic theory - food consumption is triggered by decreased glucose availability to tissues.
• Hepatostatic theory - metabolic activity of liver regulates eating behaviours
• Aminostatic theory - fewer AA in blood stronger the hunger, serotonin signals satiety.
• Thermostatic theory - heat generated by eating inhibits further food intake

• Serotonin
• Leptin
• Cholesystokinin
• GLP-1
• Bombesin

• Neuropeptide Y - Potent stimulant of food intake
• Ghrelin - related to growth hormone, may trigger a meal.

• Most B vitamins and vitamin C should be taken with food. 
• B vitamins – contraindicated in the evening as they may exacerbate or trigger insomnia.– B6 is the exception.

• Ideally with Carbohydrate foods/drinks or on an empty stomach.
• Protein therapeutics are generally excluded from transport from blood to brain, owing to the negligible permeability of these drugs to the brain capillary endothelial wall, which makes up the blood-brain barrier (BBB).
• Protein shakes can be taken at any time of the day, depending on need.

Vitamins A, D, E, K and CoQ10 are best taken with food that contains at least 3g of fat

• Take with food.
• Preferably not with high amounts of their opposing fat (if omega 3, not in a meal of high omega 6 for example).

• Best taken with food as they require sufficient stomach acid for digestion
• Both calcium and magnesium are best taken in the evening for restful sleep.
• Zinc - on an empty stomach before bed. Some people will find this a bit difficult to stomach

No

• Iron (1 mark)
• Calcium (1 mark)

• inorganic = Magnesium sulphate
• organic form = Magnesium citrate

• They are called buffered forms
• They can reduce harshness on the stomach
• The body can also utilise the mineral

B6

Vegetarian

Contaminants tend to accumulate as we move up the food chain

• Lower total cholesterol – when oxidised LDL is dangerous to blood vessels
• Lower rates of hypertension – hypertension is implicated in stroke and heart attack
• Lower rates of obesity – obesity increases CVD risk
• Lower iron stores – excess iron can act as a pro-oxidant and damage vessels
• Higher levels of antioxidants – reduces oxidative damage and protect vessels
• Vegetarians have reduced levels of clotting factors eg. fibrinogen – blood clots cause heart attack and stroke.

• By improving the condition of the gut/digestive tract
• Supporting a symbiotic relationship with the gut flora
• To maximise absorption 
• To minimise unfavourable products of maldigestion / leaky gut

• Vitamin K
• To reduce the risk of haemorrhagic disease of the newborn
• Breast milk vitamin K content varies
• Infants lack the intestinal bacteria to synthesise vit K

• Excessive dairy intake.
• Prolonged breast feeding.
• Vegetarian or vegan diet.
• Fussy eating.
• High phytate content of diet.

• have some estrogen activity
• may alter the biological activity of endogenous oestrogens and testosterones
• can bind to oestrogen receptors, mimicking effects of oestrogen in some tissues and antagonizing (blocking) the effects of oestrogen in others.
• Anti-oestrogenic help reduce the risk of hormone  associated cancers (breast, uterine and prostate)
• inhibit enzymes crucial for stimulating cell proliferation(anti-tumour property).
• slow rising serum PSA concentrations associated with prostate tumour growth

• By coating/wrapping around the bacteria to prevent bacterial adhesion to bladder and bacterial colonization 
• E. coli responsible for most UTIs.

Inhibit

• Histamines
• Cytokines
• Prostaglandins

• Bed-wetting
• Nephrotic syndrome
• Chronic bladder infections.

• Central nervous system.
• Lowering IQ
• impaired memory

Clostridium difficile

• CoQ10
• Diseased gum tissues have significantly lower levels in comparison with healthy gum tissue
• Studies have shown substantial improvement in periodontal disease for coQ10 combined with normal care routines

• Identified by Schamroth's window!
• Pulmonary disease (lungs) 
• CVD (RF)
• Hyperthyroidism

• Slower growth can indicate thyroid or other metabolic disorders
• Can indicate a 6-month picture of history and lifestyle
• Time of events can be estimated from location of marks/ridges/white spots (Beau’s lines/Mee’s lines)

• Spoon nails
• Iron deficiency
• Diabetes mellitus
• Raynaud’s disease

• Beau's = furrowed horizontal line indicative of illness/trauma, severe infection, myocardial infarction, shock, low zinc, acute injury, chemo/immunosuppressive therapy
• Mee's = horizontal white lines, acute illness, heavy metal toxicity

• Malnutrition
• repetitive trauma
• Fire tree central line – arterial disease

• ENDOCRINE -
• Diabetes mellitus
• Thyroid
• Addison’s

• Polycythaemia (too many RBC)
• carbon monoxide poisoning
• malnutrition

• Absent from thumbs – anaemia / malnutrition
• Pyramindal lunula – trauma
• Pale blue – diabetes
• Red – cardiovascular or possible malignancy (RF)

• Cracks all over
• B2 deficiency, and B complex

Lower

Insufficient production of bile

• Alcohol- 7kcal
• Carbohydrate – 4kcal
• Fat – 9kcal
• Protein –4kcal

• Energy expenditure/metabolism can be altered by disease or injury.
• Physical activity in disease is impaired/reduced.
• Burns patients and cancer patients have a higher requirement.
• Underfeeding or overfeeding critically ill patients can result in metabolic complications.

Inhibits food intake

Increased fibre/bulk.

Harmless

This property confers a degree of mobility through the atmosphere that is sufficient to allow relatively great amounts to enter the atmosphere and be transported over long distances

ALA is both water and fat soluble

• Decreasing  inflammatory action.
• Increasing the synthesis of hyaluronic acid

Decrease

Chemically and physiologically, it resembles the water-soluble vitamins

Autism

Works in synergy with quercetin

Colonic bacteria play an important role in the metabolism of soy isoflavones

• Anti-tumour/anti-cancer
• Cholesterol-lowering
• Virus-inhibiting effects

• Vitamin C
• Potassium

Antioxidant properties

Red wine

Quercetin

5 or more

• Heavy metal detoxification,
• Anti parasitic,
• May lower blood glucose levels

• Milk from overweight mothers had considerably less diversity of species than normal weight mothers
• Elective caesarean mothers also showed less diversity in their breast milk microflora than in non-elective caesareans
• Suggesting a possible hormonal or stress induced influence

Lactoferrin

• Calcium
• Vitamin E
• Vitamin A
• Zinc

• Girls who consume more animal products and fewer fruit / vegetables between ages 1 and 8 were prone to early maturation and puberty
• Diet rich in animal protein before age of 5

No(1 mark) In the largest study ever done comparing the heart disease rates in similar, health-conscious non-vegetarians, death rates for vegetarians were also lower than for near-vegetarians who ate meat less than once per week!

• Too much iron can act as a pro-oxidant
• Increasing oxidation of LDL cholesterol and damaging body tissues

SCD allows lactose-free dairy products whereas GAPS does not

Purple

• Ideally with carbohydrate foods/drinks
• Or on an empty stomach

• Citrates 
• Malates

• Zinc
• Chromium

• Fibre
• Alcohol
• calcium
• Phosphorus.

• Energy cannot be created or destroyed, only transformed from one form into another.
• Plants depend on energy captured from the sun
• Animals get theirs from chemical energy stored in plants (and other  animals).

• RMR - energy required to maintain basic physiological functions to sustain life in the awake state largest use of energy (2/3 of total energy expenditure
• DIT - Diet-induced thermogenesis (happens up to 5h after the meal ingestion)- is usually 10% of the energy content of the meal.
• PHYSICAL ACTIVITY The increase in metabolic rate caused by using skeletal muscles for any type of physical activity - The most variable part of energy expenditure

• The energy cost of growth: significant only in
• the first months of life.
• Adaptive thermogenesis: heat production during exposure to reduced temperatures (mostly in infants).
• Drug-induced thermogenesis: – Nicotine: Heavy smokers may have 10% higher energy expenditure than nonsmokers of similar body size. – Caffeine (coffee, tea, chocolate) capsaicin (hot chillies)
• Psychological thermogenesis: anxiety, anticipation and stress stimulate adrenaline production leading to increased heat production.

• Weight
• Age
• Gender
• Activity
• Disease

• Conversion of carbohydrates into body fat 
• Although this is energetically not efficient 
• Hence, carbs are the first micronutrient used for energy, followed by fat and protein.
• But excess carbs will still lead to excess body weight as body stores of fat will not be used as fuel in the presence of excess carbs.

Fructose sugars in drinks are easily turned into fat tissue via DNL

RMR = 1kcal / min

Act on several immune receptors, triggering a group of immune cells including macrophages, neutrophils, monocytes, natural killer cells and dendritic cells

• Stimulate immune function
• Cytotoxic to cancer cells.
• Inhibit platelet aggregation and thrombus formation.

• Stimulate immune function
• Cytotoxic to cancer cells.
• Stimulate detoxification enzymes

• Slowing the spread of cancer cells
• Improving survival rates 
• Immune boosting properties for chemotherapy patients.
• Lessening some side effects of chemotherapy and radiotherapy

• Lentinan is found in Shiitake and is a licensed pharmaceutical in Japan
• (mainly used for stomach cancer)
• Is the 3rd most widely prescribed anti-cancer drug in the world today.

• May lower blood pressure.
• Improves the lipid profile in hyperlipidemia.
• Has a hypoglycemic effect

• Chemicals the plant makes in reaction to its environment.
• They are adaptive responses to
• maintain an evolutionary advantage.

• They may be medicines for the plant itself.
• Protection from animal predation.
• Organic plants often have higher phytochemical levels, due to the fact they must protect themselves in their environment as they don’t get ‘molly-coddled’ with pesticides, fertilisers and perfect conditions.
• The interaction the plant has with the environment around it

• They may function as antioxidants.
• They may regulate the cell cycle.
• They may increase detoxification of carcinogenic compounds.
• They may reduce DNA damage.
• They may mimic or interact with hormones.

• Water soluble molecules containing 15 carbon atoms.
• Are responsible for the colouring of fruits, vegetables and herbs
• Are found in most plant material.

• Flavanols
• flavanones
• flavonols
• flavones
• anthocyanins
• isoflavonoids.

• Fruits, tea and soybean.
• Green and black tea contains about 25% flavonoids. 
• Other important sources of flavonoids are apple (quercetin), citrus fruits (rutin and hesperidin).

• Antioxidant
• Anti-allergic
• Anti-cancer
• Anti-inflammatory
• Anti-viral

• Kaempferol (apples, citrus fruit, grapes)
• Catechins (cocoa, tea, grapes)
• Quercetin (apples, green tea, berries)
• Naringin (GRAPEFRUIT)
• Isoflavones (Genistein, Daidzein) (SOYBEANS)

• Anti-oxidant
• Chemopreventative
• Prevents atherosclerosis / arteriosclerosis
• Apples, citrus fruit, grapes

• Anti-oxidant
• Chemopreventative
• Decreases insulin resistance / mimics insulin
• Anti-inflammatory

Cocoa, tea, grapes

• most abundant of flavonoids
• building block for other flavonoids
• Antioxidant
• protective against CVD
• chemopreventative
• Apples, green tea, berries

• Antioxidant
• Anti-cancer
• Cholesterol lowering
• Reduces renal disease linked to diabetes
• reduces diabetic neuropathy.
• Can interfere with certain drug metabolism by increasing serum level of: sedatives, anti-depressants, cholesterol lowering drugs, warfarin, oestrogen, anti-psychotics
• Grapefruit

• Antioxidant
• Anti-cancer
• Phytoestrogens (Genstein & Daidzen)
• can mimic and block estrogen
• reduce hormone related cancers
• menopause
• osteoporosis.

• (ACE, Felix Can Manage)
• Vits - ACE
• Mins - Fe, Ca, Mg

• (AAC)
• Agropyrene
• Apigenin
• Chlorophyll

Ulcerative colitis (due to anti-inflammatory effects of apigenin).

Producers claim most Vits and Minerals although no reliable scientific info.

Chlorophyll (27mg in one 12g serving)

Binding carcinogens (especially alflatoxin) to prevent their absorption from the GI and reduce the amount that reaches susceptible tissues.

May interact with warfarin due to high vit K content.

Chlorella

• Heavy metal toxicity (chelates it), particularly mercury and lead elimination.
• Viruses which sap energy (Epstein-Barr, candida overgrowth, AIDS)

Do not recommend as a source of B12 for vegans as the analogues of B12 are nutritionally insignificant for humans.

• any pain which is persistent, particularly if severe or in the head, abdomen or central chest
• pain in the eye or temples, with local tenderness, in the elderly, rheumatic patient
• pain on passing urine in a man
• cystitis recurring more than three times in a woman
• absence of pain in ulcers, fissures etc.
• sciatic pain if associated with objective neurological deficit

• blood in sputum, vomit, urine or stools
• vomit containing “coffee grounds”
• black, tarry stools
• non-menstrual vaginal bleeding (inter menstrual, postmenopausal, or at any time in pregnancy)
• vaginal bleeding with pain in pregnancy or after missing one period

• deep depression with suicidal ideas
• hearing voices
• delusional beliefs
• incongruous behaviour

• vomiting and/or diarrhoea
• vomiting and/or diarrhoea in infant
• thirst
• increase in passing urine
• cough
• unexplained loss of weight (1lb per week or
• more)

• breathlessness
• swelling of face, lips, tongue or throat
• blueness of the lips
• loss of consciousness
• loss of vision
• convulsions
• unexplained behavioural change

• Breathing
• Swallowing

• in bowel habit
• a skin lesion (size, shape, colour, bleeding, itching, pain)

• pallor
• unexplained swelling or lumps
• neck stiffness in a patient with fever
• unexplained fever, particularly if persistent or recurrent
• brown patches (Addison’s disease

• An antecedent is the predisposing risk factors to illness such as:
• The pregnancy (of the clients mother)
• The clients birth
• Age
• Gender

• A trigger is an activator or critical event that may initiate disease, such as:
• Emotional trauma
• stressful life events
• physical trauma
• diet

• Mediators do not cause the disease but contribute to the manifestation of it, such as:
• Diet
• Medications
• Home life
• Hormones
• occupation
• lack of resources