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334 Cards in this Set
- Front
- Back
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Define conventional medicine
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The practice of medicine taught at Western Medical School
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Define alternative medicine
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Diagnostic methods, treatments and therapies that appear not to conform to standard medical practice and are generally not taught at accredited medical schools
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Define Kampo
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The practice of Chinese medicine in Japan relying primarily on prescription of herb formula
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Define Ayurdevic
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A system of traditional medicine native to the Indian subcontinent
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Define Botanical
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A drug made from part of a plant
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Define Herb
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"Crude drugs" of plant origin utilized for the treatment of disease to attain a condition of improved health
Material may be from flowers, bark, roots, leaves Taken in the form of teas, ground, tablets |
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Define herbalism
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The use of crude plant-based products to treat or prevent disease
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Define Herbal medicinal
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A product derived from plants or parts of plants that elicit pharamacological effects
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Define phytopharmaceutical
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Plant-based medicines that have been standardized based on the pharmacologically active constituents
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What is phytotherapy?
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A form of medical treatment which relies on the use of plants, either whole or in the form of prepared extracts and essences.
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What is an elixir?
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A clear, sweet-flavored liquid containing alcohol used in compound medicines intended to cure one's illness
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What is an extract?
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A substance made by soaking an herb in a liquid that removes specific types of chemicals
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What is a guaranteed potency herb?
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The manufacturer of the herbal preparation warrants that it contains the claimed amount or concentration of a particular substance.
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What is "standardized?"
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A process in which one plant chemical is used as a marker and extracts are produced to have the same, standardized concentration of the marker substance. This process is necessary because the chemical composition of plants varies widely.
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What is tincture?
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A preparation created by steeping dried or fresh plant material with a mixture of water and alcohol to extract the plant material at room temperature
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Are tincture as concentrated as liquid extract?
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No but they frequently contain alcohol
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What is tea?
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A preparation created by pouring boiling water over chopped plan material and straining after steeping
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What is infusion?
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See definition for tea
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What is tonic?
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An herb used to help restore and tone systems in the body or to promote general health or well being
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What are the NIH classifications of complementary and alternative medicine?
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1. Mind-body practices (prayer, yoga)
2. Alternative systems (acupuncture, naturopathy) 3. Biologically-based therapies (nutritional supplements, herbal medicines, therapeutic diets) 4. Manipulative and body-based methods (osteopathic manipulation, PT, massaging, chiropractic) 5. Energy therapies (qi gong, therapeutic touch) |
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Why are individuals using herbal and alternative medicine?
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Herbal medicine produces fewer unintended effects
To take action For a sense of control Cultural/religious beliefs Less satisfied with conventional medicine Professional care is time consuming and costly or inconvenient |
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Describe the basic concepts, issues, and hazards associated with the use of herbal medicines.
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Quality control
*What is on the label may not be what is in the bottle *Potency affected by growing conditions, storage, handling, preparation *Labeling, incorrect, mislabeling, misID, additives not listed *Contamination by heavy metals, bacteria, other herbs/drugs Efficacy and safety issues *Few randomized, double blinded placebo controlled trials bc manufacturers are not required to conduct such trials and cannot patent the products to recoup costs Toxicities *Dosage, interaction with other drugs Pharma basis Storage and shelf life Standardization |
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What is the use and contraindication of echinacea?
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Use: Protects against common colds and upper respiratory tract infections, boosts immunity
Contraindicated in: Autoimmune diseases such as lupus, MS, AIDS, etc |
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What is the use of aloe and its contraindications?
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Use: Would healing when applied to skin and stimulates digestion when taken internally
Contraindicated: When taken by women and children internally. When used externally on surgical wounds |
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What is the use of black cohosh and its contraindications?
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Use: Alleviates PMS and reduces menopausal symptoms
Contraindicated: When taken during pregnancy bc it can cause UTI's, can cause N&V |
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What is the use of cat's claw and its contraindications?
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Use: Reduces inflammation associated with rheumatoid arthritis or osteoarthritis
Contraindicated: When taken with anti-HTN, anti-coagulatory or immunosuppressive drugs |
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What is the use of cranberry juice and its contraindications?
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Use: Prevent and treat UTI
Contraindicated: When taken in large doses such as 1L per day can cause GI distress, diarrhea, and increased risk of kidney stones |
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What is the use of dong quai and its contraindications?
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Use: Decreases menopausal and symptoms
Contraindicated: In those taking blood thinners |
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What is the use of evening primrose and its contraindications?
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Use: Decreased PMS symptoms, decrease inflammation in rheumatoid arthritis, and decrease atopic dermatitis
Contraindicated: In those taking immunosuppressive meds |
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What is the use of feverfew and its contraindications?
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Use: Relieves migraines, menstrual pain, asthma, dermatitis, and arthritis
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What is the use of garlic and its contraindications?
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Use: Anti-HTN, lowers cholesterol, and anti-thrombotic
Contraindicated: Potential for serious interactions with anti-platelet drugs |
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What is the use of ginger and its contraindications?
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Use: Anti-throwing up and anti-nausea
Contraindicated: Moderate doses probably safe |
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What is the use of ginkgo biloba and its contraindications?
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Use: Memory booster, blood thinner, reduces platelet aggregration
Contraindicated: When taken by pregnant/lactating women, children less than 2 years of age, may interact with vitamin E, blood thinners (warfarin and aspirin), MAOI and other anti-platelet therapies |
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What is the use of ginseng and its contraindications?
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Use: Stimulant and aphrodisiac (stimulant of sexual desire)
Contraindications: In diabetics, may interact with warfarin, steroids, caffeine, and phenelzine (used to treat depression) |
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What is the use of gotu kola and its contraindications?
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Use: Memory booster, stress reliever (internally)
Ulcers, eczema, wounds, and scars (externally) Contraindicated: With contact dermatitis and pregnancy |
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What is the use of Hawthorne and its contraindications?
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Use: Treats blood pressure, tachycardia, arryhythmias
Contraindicated: With cardiac drugs and BP meds, causes nausea, dizziness, and increased heart rate |
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What is the use of Kava kava and its contraindications?
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Use: Sedative
Contraindications: May potentiate sedative effects of alcohol, barbituates, valium, and may cause over-sedation |
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What is the use of Saw palmetto and its contraindications?
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Use: Prostatic enlargement and genitourinary problems
Contraindications: In pregnant and lactating women, children less than 2 |
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What is the use of Stinging nettle leaf and what are its contraindications?
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Use: Acute allergy, rheumatism
Contraindicated: In patients retaining fluid as a result of reduce cardic/renal activity |
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What is the use of St. John's wort and what are its contraindications?
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Use: Depression and anti-viral
Contraindicated: Interacts with protease inhibitors, oral contraceptives, anticoagulants, MAOIs, and antidpressants. Should not be used by pregnant women |
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What is the use of Licorice and what are its contraindications?
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Use: Anti-ulcer, cough suppressant, diuretic
Contraindicated: With raising BP, lowering K and interacting wtih Anti-HTN drugs |
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What is the use of Ma Huang and what are its contraindications?
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Use: Weight control, appetite control, energy booster
Contraindicated: Irregular heart beat, palpitations, increase BP, neuropathy, stroke and death. Do not take with caffeine, PPA, and pseudoephedrine |
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What is the use of Pau d'Arco and what are its contraindications?
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Use: Blood purifier
Contraindicated: May cause nausea, vomiting, anemia, increased tendency to bleed |
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What is the use of Yohimbe and its contraindications?
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Use: Vasodilator, reduced BP, enhanced male performance. MAO inhibitor
Contraindicated: With kidney failure, shock, seizures. Not to be taken with MAO inhibitors |
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Does the term "natural" guarantee safety?
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No, for example mushrooms are natural but poisonous
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What is a Food Faddism?
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An unusual pattern of food behavior enthusiastically adopted by people who believe that foods can cure disease of the elimination of foods from the diet with help
Emphasis: Natural food |
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What is a Quackery?
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The promotion for profit for a medical remedy that is unproven or known to be false
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What is a Health Fraud?
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Similar to quackery with deliberate deception involved
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What are Quack methods?
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Unscientific methods
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Who are the target victims of quackery?
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The unsuspecting, those who believe in magic, desperate people, and overconfident people
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What are some examples of fad diagnoses?
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Hypoglycemia, Environmental illness, yeast infections, Bogus cancer therapies
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What are some examples of bogus claims?
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Claims for food such as pesticides and additives
Promotion of supplements *Pitches---nutrition insurance, needed to deal with stress, needed for antioxidant *Strategies---Testimonials, quick results |
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What are dubious credentials?
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Degrees from unaccredited correspondence schools
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What is the Dietary Supplement and Health Education Act (DSHEA)?
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Dietary supplements as any product added to the total diet that contains at least one of the following ingredients: a vitamin, mineral, herb, botanical, amino acid, metabolite, constituent, or extract
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What is a nutrient content claim?
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Level of nutrient in product
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What are structure-function claims?
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Improves memory, promotes digestion, helps maintain intestinal flora, builds strong bones, supports the immune system
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What are functional foods?
What are some examples? |
Any food that may provide a health benefit beyond the traditional nutrients it contains
High fiber cereal, orange juice with calcium, and soy drink with genistein |
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What is Synergism?
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Influence that occurs when constituents of a botanical act together in a system to elicit an effect that is biologically greater
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What is a Class 1 herb?
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Herbs that can be safely consumed when used appropriately
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What is a Class 2 herb?
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Herbs that have restrictions for external use, not to be used during pregnancy or nursing
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What is a Class 3 herb?
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Herbs to be used only under supervision of an expert qualified in the appropriate use of that herb
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What is a Class 4 herb?
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Herbs for which insufficient data are available for classification
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What does Cardiovascular disease include?
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CHD, aka coronary artery disease or ischemic heart disease, Cerebrovascular disease, and peripheral artery disease
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What is the underlying cause of Coronary Heart Disease?
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Atherosclerosis
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What is Atherosclerosis?
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A chronic, immuno-inflammatory and proliferative disease of medium and large arteries promoted by atherogenic blood lipids such as LDL-C, and TAG-rich lipoproteins
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What does Atherosclerosis involve?
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Endothelial cells, leukocytes, and smooth muscle cells
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Describe the pathogenesis of Atherosclerosis?
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1) Endothelial damage which stimulates accumulation and oxidation of LDL-C in vessel wall
2) Monocytes migrate from the blood into the subendothelial intima and transform into macrophages 3) Macrophages accumulate lipids to form the lipid core of the atherosclerotic plaque. 4) Production of inflammatory mediators, adhesion molecules (VCAM-1) and cytokines stimulate migration and proliferation of smooth muscle cells and deposition of elastin and collagen, which leads to plaque expansion and the formation of the fibrous cap. 5)Eventually the fibrous cap may weaken and rupture, due to macrophages expressing collagen degrading enzymes 6) When plaque ruptures, thrombus forms and is responsible for most complication of athero |
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What is the role of the Chylomicron?
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To transport dietary TAG
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Where can the Chylomicron be found?
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In the intestine
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Where can VLDL be found?
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In the liver and intestine
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Where can ILD be found?
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In circulation from catabolism of other lipoproteins
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Where can LDL be found?
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In the liver
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Where can HDL be found?
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In the liver and intestine
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What is the physiologic role of VLDL?
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To transport endogenous TAG
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What is the physiologic role of IDL?
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LDL precursor
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What is the physiologic role of LDL?
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Major cholesterol transport lipoprotein
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What is the physiologic role of HDL?
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Reverse cholesterol transport
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What is relative atherogenicity?
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Negatively correlated with atherosclerosis
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What is the major apolipoprotein of the Chylomicron?
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A, B-48, and C
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What is the major apolipoprotein of VLDL?
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B-100, C, and E
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What is the major apolipoprotein of IDL?
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B-100 and E
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What is the major apolipoprotein of VLDL?
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B-100
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What is the major apolipoprotein of HDL?
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A
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What is the significance of C-reactive protein?
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It is involved in immune and inflammatory response
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What are the 9 emerging risk factors for CHD?
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1) CRP
2) Calcium content of coronary arteries 3) Lipoprotein (a) level 4) Homocysteine level 5) Leukocyte count 6) Fasting glucose concentration 7) Periodontal disease 8) Ankle-brachial index 9) Carotid intima-media thickness (IMT) |
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What are the mechanisms by which diet potentially influences risk of CHD?
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Diet>>>Lipid levels, BP, Thrombotic tendency, cardiac rhythm, endothelial function, systemic inflammation, IS, Oxidative stress, and Homocysteine levels>>>Risk of CHD
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What are the contributions of Keys, Hegsted metabolic research studies?
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Studied subjects with high likelihood of dietary complicance and saw that the higher the medium serum cholesterol was, the higher risk of death one was.
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What is the significance of the Framingham Study?
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High LDL is correlated with higher risk of mortality due to CHD (RR=1).
High HDL is correlated with lowest risk of mortality |
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What is the metabolic pathway of n-6 FA?
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N-6>>>Desaturase>>>Gamma linolenic acid>>>Arachidonic acid>>>N-6 eicosanoids (proinflam, proaggre)
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What is the metabolic pathway of n-3 FA?
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N-3>>>Desaturase>>>EPA>>>DHA>>>N-3 eicosanoids (anti-inflam, anti-aggre)
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What effect does saturated SFA have on blood lipids?
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Increases LDL-C
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What are some examples of SFA?
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Lauric, myristic, palmitic, stearic
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What effect do PUFAs have on blood lipids?
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n-6 FA decrease LDL and HDL
n-3 FA decrease TAG, viscosity, and aggregation |
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What effect do MUFAs have on blood lipids?
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Decrease LDL relative to SFA
Do not lower HDL-C or TAG |
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What effect do Trans-fatty acids have on blood lipids?
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Increase LDL-C
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What are some protective nutritional factors for CHD?
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Anti-atherogenic (Cholesterol lowering)
*n-6 PUFAs, soluble fiber, plant sterols/stanols, soy protein Antithrombogenic/anti-inflammatory *n-3 PUFAs, folate, B12, B6 to reduce homocysteine, polyphenols/flavonoids Antioxidant *Vitamin E, A, C, Polyphenols/flavonoids |
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Who has a higher risk of obesity and mortality?
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Men
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What is the goal of the National Cholesterol Education Program (NCEP)?
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To detect, evaluate, and treat high cholesterol in adults
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What is the primary target therapy of the ATP III Guidelines?
How often should a fasting lipoprotein profile be obtained? |
LDL cholesterol
Every 5 years in adults 20 y/o or older |
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What is the first step in risk mgmt of the ATP III Guidelines?
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Risk Assessment
Measure risks that modify LDL goals such as cigarette smoking, HTN (>140/90), low HDL (<40), Family history, age (men >45 y/o, women >55 y/o) |
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Is having an HDL level greater than 60mg/dl a positive risk factor?
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NO
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According to the ATP III cholesterol categories, what is optimal, near optimal, borderline high, high, and very high LDL cholesterol?
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Optimal <100
Near optimal 100-129 Borderline high 130-159 High 160-189 Very High >190 |
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According to the ATP III cholesterol categories, what is desirable, borderline high, and high Total cholesterol?
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Desirable <200
Borderline high 200-239 High >240 |
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What is low and high for HDL cholesterol according to ATP III guidelines?
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Low <40
High >60 |
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What are CHD and CHD risk equivalents?
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Diabetes and multiple risk factors for 10 year risk of CHD >20%
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What are multiple (2+) risk factors with a LDL goal of <130 mg/dl?
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10 year risk of CHD is <20% and Framingham risk scores
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What is the zero to one risk factor with an LDL goal <160 mg/dl?
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10 year risk <10%
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What are the CHD risk equivalents?
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Diabetes and Noncoronary atherosclerosis (peripheral artery disease, carotid artery disease, and abdominal aortic aneurysms
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How do you perform a risk assessment according to the ATP III Guidelines?
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Count major risk factors
Estimate 10-year CHD risk (framingham) |
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When considering other risk factors, what are some life-habit risk factors and emerging risk factors and metabolic syndrome issues?
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Life-habit risk factors
*Obesity, Physical Inactivity, Atherogenic diet Emerging risk factors *Lipoprotein(a), homocysteine, prothrombic factors, proinflammatory factors, impaired fasting glucose, athersclerotic disease Metabolic syndrome *Abdominal obesity, elevated BP, IR, prothrombic and proinflam, and athero dyslipidemia |
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What are the nutrient composition of the TLC Diet?
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SAT FAT --- <7% kcals
PUFA --- Up to 10% kcals MUFA --- Up to 20% kcals TOTAL Fat --- 20-35% CHO --- 50-60% kcal Fiber --- 20-30 g/day PRO --- ~15% kcals Cholesterol --- <200mg/day Energy --- Maintain desirable wt or prevent wt gain |
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What is a TLC diet?
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A therapeutic lifestyle changes that emphasize decreasing SAT FAT and cholesterol with plant sterols/stanols and soluble fiber, weight reduction, and increasing physical activity
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Can PUFAs reduce HDL?
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YEs, but only a small reduction
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What is high intake of CHO accompanied with?
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Reduced HDL and increased TAG
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What is %kcals of total fat for those with metabolic syndrome following a TLC diet?
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30-35%
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What is the requirement of increasing soluble fiber for the TLC diet? Plant sterols/stanols? Soy protein?
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Soluble Fiber --- 5-10 g per day with 5% reduction in LDL
Plant sterols/stanols --- 2-3 g per day reducing LDL by 6-15% Soy protein --- 25 g lowering LDL by 5% |
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What are some food sources of trans fat?
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Cakes, cookies, crackers, pies, animal foods, margarine, fries, potato chips, popcorn, shortening, and salad dressing
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What type of meat has the lowest saturated fat content?
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Ground turkey breast
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What type of meat has the highest saturated fat content?
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Beef, whole rib, broiled
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Does natural cheddar cheese have more sat fat than beef, top round and roasted chicken?
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Yes, 6g compared to 3 for beef and 1 for roasted chicken
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How can one decrease their saturated fat intake?
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Choosing vegetable oils, trans-free margarine soft than hard or butter
Choosing lean meats and trimming fat Removing skin of chicken Limiting bacon, sausage and other processed meats Using egg yolks instead of whole eggs Choosing fat-free milk, cheese and yogurt |
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Which fish has the highest EPA and DHA content? Lowest?
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Highest-Salmon, farmed Atlantic
Lowest-Cod, Atlantic |
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What are the dietary CAGE questions?
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C-Cheese and other dairy fats
A-Animal fats G-Got is away from home (high fat meals purchased or eaten at restaurant) E-Eat (extra) high fat commercial products, candy, pastries, pies, donuts |
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What are some advantages of very low fat?
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Decreases cholesterol w/o drugs
High fruits, veggies, and grains Decreases food intake, achieve wt loss |
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What are some disadvantages of very low fat?
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Long-term maintenance difficulty
Decreases HDL and increases TAG |
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What was the rational for very low fat, high CHO (Atkins diet)?
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Cholesterol reduction
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What is the high fat, high MUFA Mediterranean diet?
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~35% fat, 15% or more MUFA
Olive oil, canola, nuts/seeds, avocado |
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What are advantages of the Mediterranean diet? Disadvantages?
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Adv: Low Sat fat, MUFA less likely to be oxidized, decreases TAG and maintains HDL
Dis: Higher fat may make wt control more challenging |
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What is familial hypercholesterolemia due to?
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Defect in LDL receptor (autosomal dominant)
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What is familial defective apo-B-100 due to?
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Apo B defect (autosomal dominant)
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Canola oil has less of this fat and more of this fat?
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Less saturated fat and the most MUFA
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Which oil has the most saturated fat and least amount of MUFA?
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Coconut oil
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What is MEDFICTS?
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An assessment tool that assess weekly consumption of foods eaten to determine risk for CVD
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What are the mechanisms of HMG-CoA Reductase (statins)?
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It is a statin that decreases LDL, increases HDL, and decreases TAG
Side effects include increased liver enzymes and myopathy Contraindications: Liver disease |
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What are the mechanisms of Bile acid sequestrants?
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Decreases LDL, Increases HDL, and No change in TAG
Sides effects include GI distress, constipation, and decreased absorption of other drugs Contraindications: TG increases |
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What are the mechanisms of Nicotinic acid?
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Decreases LDL, Increases HDL, and Decreases TAG
Side effects include flushing, hyperglycemia, gout, upper GI distress Contraindications: Chronic liver disease, severe gout, diabetes, |
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What are the mechanisms of Fibric acids?
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Decreases LDL, Increases HDL, and Decreases TAG
Side effects include dyspepsia, gallstones, and myopathy Contraindications: Several renal disease and hepatic disease |
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Women should have an HDL level of...
Men.... |
<50
<40 |
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What is HTN?
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Systolic BP of >140 and diastolic of >90
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What percentage of US adults 18 y/o or older have HTN?
60 y/o or older? |
18---1/3
60---2/3 |
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What is primary or essential HTN due to?
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An unknown origin, probs genetics of environment
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What is the difference between primary essential HTN and Isolated Systolic HTN?
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Primary---both sys and dia are elevated
Isolated---only sys is elevated and found in 2/3 of elderly population |
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What is endothelial dysfunction and vascular remodeling due to?
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RAS (renin-angiotensin system) which precedes the development of athero
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When BMI increases, your risk for HTN...
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increases
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What are the BP Classifications for adults 18 y/o?
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Normal <120
Pre-HTN --- 120-139 Stage 1 HTN ---140-159 Stage 2 HTN --- >160 |
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When should drug therapy be given with HTN?
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At stage 1 and 2
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Blood pressure can be regulated by arterial pressure and peripheral vascular resistance. How are they determined?
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Arterial pressure - determine by cardiac output (the amount of blood pumped by heart) = stroke volume X heart rate
Vascular resistance --- determined by viscosity of blood and width of vessels constricted or dilated |
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What is stroke volume influenced by?
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Cardiac contractility and vascular volume
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What controls the width of vessels?
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Muscle tone in vessel wall
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Blood pressure is also regulated via the SNS system. Explain.
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Vasoconstriction or Vasodilated
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Long term regulation of BP is mediated by...
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Changes in fluid volume and the renin-angiotensin system
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What is the renin-angiotensin system?
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Retains Na and H20 to increase blood volume
Constricts blood vessels Increases aldosterone |
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What is the central role of the kidneys?
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Regulate fluid volume
Respond to renin-angio system Secrete aldosterone and ADH |
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Explain the renin-angiotensin system
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1) Activated when there is a loss of blood volume or drop in BP
2) Jux cells secrete the enzyme renin when lol 3) Renin cleaves to an inactive peptide called angiotensiongen and converts it to angio I 4) Angio I is converted to II by Angiotensin converting enzyme (ACE) found in lung capillaries 5) Angio II vasoconstricts arteries, releases aldoesterone, which stimulates absorption of Na and H2O, and released Anti-diuretic hormone (ADH) which stimulates reabsorption of water in kidneys |
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What are some examples of oral antihypertensive drugs?
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Thiazide diuretics
-inhibit reasbsorption of Na and Cl from distal convoluted tube Loop diuretics -acts on loop of henle to inhibit Na reabsorption Potassium sparing diuretics Beta blockers -work on CNS -propranolol is most commonly used -diminishes effect of stress hormones |
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What are some examples of oral hypertensive agents?
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ACE Inhibitors
-Blocks conversion of A1 to A2 -Persistent dry cough side effect Angiotensin receptor blocker -Inhibits AII -Increases blood potassium Calcium channel blockers -Disrupts calcium ion and lower Ca -Decreases contraction of the heart |
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Target organ damage consists of...
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Heart
Brain CKD Peripheral artery disease Retinopathy |
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The % of Na in NaCl is...
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40%
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How many mg of Na are in 1 tsp of NaCl?
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2400 mg
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1500 mg of Na is...
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2/3 tsp of NaCl
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What did the INTERSALT study show?
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A positive correlation between Na excretion and sys and dia pressure, and that increase in BP increases with age
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Who is more susceptible for salt sensitivity?
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Elderly
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What were the original DASH approaches?
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Fruits and veggies and low fat dairy
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Phase I of the Trials of HTN Prevention showed that...
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Weight loss is the most important for HTN
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Phase II of the Trials of HTN Prevention showed that..
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Weight loss, reduced sodium or combination is the most important for HTN
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During the DASH-sodium trial, what evidence did they find?
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Systolic BP decreases with lower intakes of Sodium
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What kind of lifestyle modifications effectively lower BP?
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Losing weight to <25 BMI to decrease BP
Limiting alcohol intake to no more than 1oz per day for men and 0.5 for women and lighter weight people Increase aerobic PA Lower salt intake |
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What can excessive alcohol intake do?
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Risk factor for high BP, can cause resistance to antihypertensive therapy and risk for stroke
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Can blood pressure be lowered with moderately intense PA?
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Yes
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What is the DASH Eating Plan?
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Grains--- 7-8 daily svgs
Veggies--- 4-5 daily svgs Fruits--- 4-5 daily svgs Low-fat or fat-free dairy--- 2-3 daily svgs Meats---2 or less Nuts---4-5 Fats and oils---2-3 Sweets---5 per week |
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What are some dietary sources of Sodium?
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Salt, BP, (Meat, fish, eggs, dairy)---naturally found, processed foods, water, meds
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What is sodium-free?
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<5mg per serving
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What is low sodium
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140mg or less per serving
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What is very low sodium?
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35 mg or less
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What is reduced sodium?
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At least 25% less sodium than in reference food
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Light sodium is...
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50% less per serving
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Unsalted is...
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No salt added during process NOT salt free
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What is the most important mgmt for HTN?
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Lifestyle modification
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What are the JNC-7 lifestyle recommendations for HTN? Which one is most effective?
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Weight reduction, Adopt DASH eating plan, Dietary sodium reduction, PA, Moderation of alcohol consumption
Weight reduction is the most effective because it is directly associated with BP. It is reinforced with the high prevalence of overwt and obese people. All those overwt and obese have high BP |
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Explain the role of Na, K, Ca, omega-3, body weight, alcohol in HTN
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Na-Increase in Na increase BP, BP responds to changes in Na
K-High K is associated with reduced BP Alcohol-Dose-dependent relationship Vegetarian diet-Low BP Fish oil-dose dependent therefore lowers bp Fiber-may reduce BP Ca and Mg-insufficient data CHO-inconclusive Vitamin C-unclear |
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Do all CHO have the same effect on glucose?
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Yes
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What is the 7th leading cause of death in the US?
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Diabetes
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How many people have diabetes in the US?
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21 million
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What is the #1 cause of non-traumatic blindness, ESRD, and below knee amputations?
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Diabetes
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How many % of people with diabetes die from cardiovascular complications?
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75%
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What are the two types of diabetic complications?
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Microvascular
-retinopathy -nephropathy -neuropathy Macrovascular -athero, angina, heart attacks, stroke |
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Are most complications of diabetes preventable?
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Yes
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What is type-I diabetes characterized by?
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Failure of beta cells to produce insulin
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What is type-II diabetes characterized by?
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Insulin resistance and linked to obesity
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What are some examples of acute diabetic complications?
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Hyperglycemia, ketoacidosis, and hyperlipidemia
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What are some examples of short-term diabetic complications?
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Protein glycosylation and glycogen accumulation in non-insulin dependent tissue
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What are some examples of long-term diabetic complications?
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Retinopathy, nephropathy, neuropathy, and athero
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What did the DCCT show?
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9 year trial in US and Canada that showed the risks for the development and progression of complication in type 1 diabetes was directly related to blood glucose control by HgA1C
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EDIC followed up with....
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DCCT participants
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UKPDS study did...
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20 year trial with more than 5000 individuals with type 2
Showed intensive blood glucose control reduced risk of complications |
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The more glycosylated hemoglobin decreased....
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The more the risk of diabetes decreased
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What are the 3 diagnostic tests for diabetes?
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Fasting plasma glucose FPG
Oral glucose tolerance test OGTT Glycosylated HbA1C |
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What is pre-diabetes?
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Impaired fasting glucose or Impaired glucose tolerance or both
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What is Impaired fasting glucose?
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An FPG of 100-125
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What is the mg/dl of diabetes in IFG?
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>126
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What is IGT?
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2 hour postload glucose of 140-199mg/dl
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What is the mg/dl of diabetes in IGT?
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>200
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What is insulin resistance?
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The inability of insulin to stimulate glucose uptake by glucose requiring tissues
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Which tissues are insulin requiring?
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Muscle and adipose
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In insulin resistance, the body compensated by producing more insulin which results in...
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Increased insulin and increase glucose
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What can insulin resistance lead to?
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Pancreatic insufficiency and diabetes
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How is glucose transported?
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By insulin-dependent glucose transporter, or GLUT-4
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What is the relationship between IR and CVD?
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With insulin resistance, there is an inadequate insulin response, leading to type 2 diabetes and eventually CVD
Also with insulin resistance, there is hyperinsulinemia, leading to metabolic syndrome or syndrome X, and eventually CVD |
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What happens with free fatty acids in metabolic syndrome with insulin resistance?
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FFA production increases leading to an accumulation of fat and the released of FFA increases
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What happens to proteins in insulin resistance?
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Breakdown increases and muscle glycogen decreases
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What are the metabolic consequences of IR and Metabolic syndrome?
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Glycogen synthesis decreases, glucose production increases, and high concentrations of small dense beta lipids increase after you eat
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What is metabolic syndrome characterized by?
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Elevated waist circumference (>102cm men and >88cm women)
Elevated TAG (150) Low HDL Elevated BP (130/85) and fasting glucose |
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What is the role of FFA and fat cells in Metabolic syndrome and IR?
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Fat cells secrete proinflammatory cytokines suchas TNF alpha and IL-6
FFA and cytokines interfere with the action of insulin receptor and inhibit insulin action |
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What are the benefits of weight control in diabetes?
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Decreases the incidence by 58% of type II
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Is insulin resistance greater in obese/overweight people?
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Yes
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Weight loss in diabetes also improves...
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insulin sensitivity
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What are some benefits of weight loss in diabetes?
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Improved glucose control
Decreases glycosylated HgB Decreases oral agents Improves insulin sensitivity Improve lipid profile and decreased BP |
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What are secretagogues?
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They stimulated pancreas to secrete insulin, reduce hepatic glucose production and improve glucose uptake by muscles
Ex. Sulfonylureas (Glimepiride) Nonsulfonylurea (Glinide)--causes wt gain and hyperglycemia |
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What are sensitizers?
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They enhance insulin action
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What are some examples of sensitizers?
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Biguanides (Metformin)---can' use with RF or HF pts
Thiazolidinediones (Rosiglitazone)---causes wt gain and edema Alpha-glucosidase inhibitors (acarbose)---inhibits glucose |
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What is incretin?
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GLP-1 secreted in gut in responses to meals and stimulates insulin secretion
Increases in GI hormones after food |
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What enzymes breaks down GLP so action of GLP stays around longer?
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Protein beta enzyme
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What are the nutrition organizing recommendations according to the America Diabetes Association?
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1) Prevent diabetes
2) Manage diabetes to prevent complications 3) Manage complications to prevent morbidity and mortality |
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For those with high risk for developing type 2 diabetes, what should be emphasized and consumed?
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Emphasize lifestyle changes including moderate wt loss (7% body wt) and regular PA (150min/week)
Consume fiber (14g/1000kcal) and whole grains |
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Do low glycemic load diets reduce the risk for diabetes?
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Not enough info to conclude
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What is the RDA recommended amount for CHO?
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130g/day
45-65% AMDR |
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How can you manage dietary CHO for improved glycemic control in diabetes?
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Day to day consistency in CHO intake
Exchange list Adjusting bolus insulin to match dietary CHO CHO counting |
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How does food influence the postprandial blood glucose?
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The Glycemic Index determines this
It is the area under the bloood glucose curve for 2 hours after the test food is eaten divided by the area after the food is eaten multiplied by 100 |
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Rank the sugars according their effect on raising blood glucose
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Fructose<<<Sucrose<<<Glucose
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What is the glycemic load?
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The amount of CHO
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Name some foods with a high GI?
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Instant rice, baked potato, corn flakes, carrots, white bread
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Name some foods with a low GI
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Soya beans, peanuts, milk, yogurt, apples, sweet potatoes, oranges
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What has the highest GI and lowest GI?
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Highest---glucose
Lowest---peanuts |
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What factors influence the rate of glycemic CHO availability in the GI tract?
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Macronutrient composition
Fiber content Viscosity Volume and structure of the food |
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What is the GI concept used to classify?
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CHO-rich foods and is only meaningful within a comparable group
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When is national diabetes education month?
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November
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What is the comprehensive care?
|
The ABC's of Diabetes
A-A1C (<7%) B-BP (130/80) C-Cholesterol (LDL<100) |
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Name the two prevention diabetes trials?
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Type 2-DPP
Type 1-Diabetes Prevention Trial-Type 1 (DPT-1) -European Canadian Nicotinamide Diabetes Intervention Trial (ENDIT) |
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What are the 4 goals of MNT that apply to individuals with diabetes?
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1) Achieve and maintain
*Blood glucose levels in normal range or as close to normal *A lipid and lipoprotein profile that reduces risk for vascular disease 2) Prevent or slow down development of chronic complications of diabetes to modifying nutrient intake and lifestyle 3)Address individual nutrient needs 4) Maintain pleasure of eating |
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What is recommended for all individuals who have or are at risk for diabetes?
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Wt loss
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What does evidence demonstrate in regards to diabetes?
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That structured, intensive lifestyle programs involving participant education, individualized counseling, reduced dietary energy and fat intake, regualr PA promote wt loss
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What has the modest wt loss effect?
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Exercise and PA, however they improve insulin sensitivity independent of wt loss
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What does substantial evidence say about sweeteners in diabetes?
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Dietary sucrose does not increase glycemia more than isocaloric amounts of starch
Sucrose does not need to be restricted because of concern about aggravation hyperglycemia |
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Which sweeteners produce a lower postprandial glucose response than sucrose or glucose?
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Sugar alcohols
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What are the approved five nonnutritive sweeteners?
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Acesulfame K, aspartame, neotame, saccharin, and sucralose
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What is the primary goal wrt dietary fat in individuals with diabetes?
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Limit SFA, trans FA, and cholesterol intake to reduce risk for CVD
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For individuals with diabetes and normal renal fx, is there evidence to suggest that usual protein intake should be modified?
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NO
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What was the number one cause of cancer in 2004 for males?
Females? |
Prostate
Breast |
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What is the association between breast cancer incidence and total dietary fat intake?
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The higher the fat intake the higher the death rate
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What have migration studies shown?
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Japanese have a higher rate of stomach cancer and lower rate of colon and breast cancer
Hawaiians have a higher rate of breast cancer and lower rate of stomach and colon |
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What is the direct effect of food on cancer?
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Carcinogen and toxicant exposure which are present naturally in food and are products of cooking or preserving
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What is the indirect effect of food on cancer?
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The effects of diet on energy balance, obesity, metabolism, inflammatory mediators
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What are some characteristics of tumor cells?
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Have their own growth signals
Do not respond to growth inhibitors Replicate indefinitely Undergo metastasis |
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What are genetic changes of cancer?
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Oncogenes (on switch) increase rate of transformation, such as ERBB2 (breast), Ras (lung), MYC (lymphoma)
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What do tumor suppressor genes do?
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Prevent excessive growth
Ex. p53 (killer) |
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What is cellular differentiation?
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When cells become specialized to do different functions
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What are some endogenous causes of cancer?
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Inherited germ line mutations
Oxidative stress Inflammation and hormones |
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What are some exogenous causes of cancer?
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Tobacco use, infectious microorganisms such H.pylori, HPV, Hepatitis B and C, Radiation, Chemicals, Drugs, Meds, Carcinogenic agents in food
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How many stages does cancer occur in?
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4
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What is the 1st step of carcinogenesis?
|
Initiation-generation of carcinogenic cells due to mutation
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What is the 2nd step of carcinogensis?
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Promotion-multiplication of initial cancer cell and growth into tumor
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What is the 3rd step of carcinogenesis?
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Progression-spreading throughout the tissue of origin
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What is the last step of carcinogenesis?
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Metastasis-Spreading of cancer to other organs
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What are precancerous lesions?
|
Polyps, adenomas, dysplasias
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What causes DNA damage?
|
Electrophilic substances that cause conformational changes in the DNA
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Where does the damage of cancer occur?
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In genes that are predisposed to cancer that influence oncogenes, tumor suppressor genes, cell cycle, signal transduction, DNA repair, apoptosis
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How do most cancer0causing compounds become potent mutagens?
|
Only after they are activated by phase 1 enzymes located in the liver
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Where do phase I rxns of carcinogen metabolism take place?
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In the liver making molecules soluble which is more dangerous becaue it can cause changes in DNA
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What are the phase II rxns of the carcinogenic metabolic process?
|
Insertion of polar groups that reduce biological activity
Ex. GST, NAT, UDP UGT |
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What are potential cancer causing agents?
|
Electrophilic substances that form adducts with DNA
Substances that undergo metabolic activation |
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What do most substances undergo detoxification by?
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P450 and become harmless
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What are potential cancer causing agents?
|
Electrophilic substances that form adducts with DNA
Substances that undergo metabolic activation |
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What do most substances undergo detoxification by?
|
P450 and become harmless
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What do most substances undergo detoxification by?
|
P450 and become harmless
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What is the role of hormone-like substances?
|
Vitamin A and D promote differentiation of undifferentiated tumor cells
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What is tumor angiogenesis?
|
The proliferation of blood vessels that penetrates into cancerous growth
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What are the chemical carcinogens found in plant foods?
|
Pyrrolizidine alkaloids
Alkenylbenzene derivatives such as safrole in oil of sassafras |
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What are the chemical carcinogens that are metabolites of molds (myocotxins)?
|
Aflatoxin B-1
Sterigmatocystin Fumonisin B1 |
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What are the chemical carcinogens formed during processing and cooking foods?
|
Nitrosamines (cheese, beer, nitrite preserved meat)
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What are nitrosamines composed of?
|
Protein/amino acids + nitrite (NaNO2)
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What is the nitrosamine rxn enhanced by?
|
Acidity of stomach and inbited by Vitamin C
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What is acrylaminde?
|
When you make fries it develops
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What are polycyclic aromatic hydrocarbons (PAH)?
|
In cigarettes, in smoked and broiled meats and fish
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What are heterocyclic amines (HCA's)?
|
Carbolines and quinolines from cooking of meat
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What is the significance of restriction caloric intake?
|
It retards the onset of aging, prolongs life
|
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What does the calorie effect inhibit?
|
Neoplasia
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What is the calorie effect?
|
The interaction between calories (energy) and dietary fat
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Which is more effective, the calorie effect or fat restriction?
|
Calorie effect
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What are risk factors for liver cancer?
|
Hep B, alcohol, food contaminated with aflatoxins, and high Fe
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What are protective factors of liver cancer?
|
Veggies possibly
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What are probiotic foods?
|
Good bacteria we humans eat such as yogurt, kefir, tempeh, miso
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What are prebiotic foods?
|
Foods for bacteria such as whole grains, legumes, veggies and fruits, nuts and seeds, foods containing inulin
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What are some risk factors for lung cancer?
|
Cigarettes, Asbestos, radiation, and alcohol
|
|
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What are protective factors of lung cancer?
|
Fruits, veggies, carotenoids, vitamin C and E
|
|
|
What are the odds of surviving prostate cancer?
|
98%
|
|
|
Prostate cancer is associated with....
|
The western diet
|
|
|
What are some risk factors and protective factors assoc. with prostate cancer?
|
Risk-total fat, animal fat, meat, milk and dairy
Protect-Vegetables and tomatoes |
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Which hormones control the growth of prostate?
|
androgens and IGF-1
|
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What type of protein increases IGF-1
|
Animal protein
|
|
|
What are the phase 2 enzymes for excretion that add acetyl groups?
|
NAT2 and NAT1
|
|
|
When cooking meat, what are the genetic and dietary factors that contribute to cancer?
|
Genetic-Phase 2 enzymes, NAT, increases risk of colon cancer
Dietary-Meat, protein, fat, coffee, cruc veggies |
|
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With DNA methylation, what are the genetic and dietary factors contributing to cancer?
|
Genetic-MTHFR
Dietary-Folate, B12, B6, alcohol |
|
|
With Insulin, what are the genetic and dietary factors associated with cancer?
|
Genetic-IGF
Dietary-Sugar, fat, energy |
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|
With vegetables, what are the genetic and dietary factors associated with cancer?
|
Genetic-Phase 2 enzymes (GST)
Dietary-Calcium and vitamin D |
|
|
For cell growth regulation, what are the genetic and dietary factors that contribute to cancer?
|
Genetic-VDR, apo E
Dietary-fat and sugar |
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|
What did the CAPS II Study for cancer prevention find?
|
A statistically significant linear relationship between BMI and death from all cancer among non-smokers
Overwt and obesity accounts for 20% of cancer deaths in women and 14% in men 900000 US adults followed for 16 years |
|
|
What are some other dietary factors related to cancer?
|
CLA---found in dairy and meat (rumenic acid is the most common)
Vitamin D and Calcium Methylation and 1C metabolism Fe overload Omega 3 fatty acids Biologically active factors in plant foods |
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What are increases and decreases in DNA methylation associated with?
|
The aging process and cancer
|
|
|
DNA methylation decreases with...
|
AGE
|
|
|
In the intestinal crypts, increased hypermethylation is associated with...
|
Increasing risk of colon cancer with age
|
|
|
What does Nuclear factor kappa Beta do? (NF-kB)
|
Induces expression of COX-2 and genes related to cancer promotion
|
|
|
What other markers are related to cancer?
|
IL-6, COX-2, Beta-catenin
|
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|
What is the active compound of the plant tumeric?
|
Curcumin
|
|
|
What does tumeric target?
|
decreases NF-kB
|
|
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What is the active compound in grapes, peanuts, and berries and what do they target?
|
Resveratrol is the active cmpd and decreases COX2
|
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|
What is the active compound in soy and what does it decrease?
|
Genistein, daidzein and decreases NF-kB and COX-2
|
|
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What is the active cmpd in tea, berries, and cocoa?
|
Flavonoids, EGCG
|
|
|
What is the 2nd most common cancer in the world and most common cancer in women?
|
Breast cancer
|
|
|
What are risk factors for breast cancer?
|
Alcohol, rapid growth and greater adult height, high body mass postmenopausal, adult wt gain, total fat
|
|
|
Adipose does what in overwt post menopausal women?
|
Keeps forming estrogen
|
|
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What did the Women's Health Initiative Primary prevention find?
|
Low fat and more grains prevented breast cancer
|
|
|
What did the women's intervention nutrition study find based on 2ndary prevention?
|
Reduced dietary fat prevented cancer
|
|
|
What did the women's health eating and living study of 2ndary prevention find?
|
5 veggie servings, 16 oz veggie juice, 30g fiber and 15-20% energy from fat decreased breast cancer
|
|
|
What are examples of plant estrogens?
|
Isoflavones (soy): genistein, daidzin,
Lignans (grains, fruits, seeds): enterolactone, enterodiol, coumestrol |
|
|
What is the mechanism of plant estrogens (phytoestrogens)?
|
Compete for estrogen receptor, stimulate sex hormones binding globulin production in liver, and inhibit aromatase enzyme
|
|
|
How can you prevent breast cancer?
|
Chemo, avoid alcohol, PA, wt control, low fat diet, fruits and veggies
|
|
|
What are the risk factors for stomach cancer?
|
H.pylori, salt, cured meats, nitrosamines, grilled meats
|
|
|
How can you protect yourself from stomach cancer?
|
Fruits, veggies, refrigeration
|
|
|
What is the 3rd most common cancer in the world?
|
Colon, rectum cancer
|
|
|
What are the risk factors for colon, rectum cancer?
|
Red meat, alcohol, high BMI, greater adult height, frequent eating, animal fat, processed meat
|
|
|
What are protective factors of colon, rectum cancer?
|
Veggies, PA, and maybe fiber
|
|
|
What did the Nurses Health Study find in regards to the RR of meat?
|
3.57 RR for red eat consumption 5X or more per week increased risk of cancer
|
|
|
What are the 4 colon bacteria? Which ones are bad and good?
|
Methanogenic
-breakdown of CHO to produce SCFA which are used by colon for energy Sulfur-reducing -produces toxic substances 7-alpha hydroxylating bacteria -converts bile into toxic substances -high fat stimulates liver to produce bile Lactobacilli-good, others bad -produces lactic acid which suppressed the growth of harmful bacteria |
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|
What are the recommendations to prevent cancer?
|
1) Body fatness - Maintain normal wt
2) PA-at least 30 mins a day, limit sedentary habits 3) Foods and drinks that promote wt gain-avoid sugary foods, consume fast foods sparingly 4) Plant foods-limit refined starchy foods, eat at least 5 svgs 5) Animal foods-consume less than 500g/week 6) Alcohol-No more than 2 drinks a day for men and one for women 7) Preservation, Processing, and Preparation-avoid salt, limit processed foods, don't eat moldy cereals 8) Dietary supplements-Not recommended for cancer prevention |
