Cardiorespiratory - Logan Class of December 2011



Nutrition

1-9-04

Pretest

1. Nutrients that directly affect the cell membrane potential of receptors are Na, K, and EFA (essential fatty acids). TRUE A decrease in any of these (especially EFAs) will increase pain.

2. The threshold of pain receptors can be affected by an acidic environment, EFA deficiency and chemical irritants. TRUE (Increases pain levels, EX: histamine).

3. Natural alternatives for reducing pain instead of NSAIDS include bromelain, ginger, tumeric, antioxidants and an alkaline diet. TRUE

4. D. D. Palmer stated that the determining causes of diseases are traumatism, poison and autosuggestion. TRUE

5. A healthy diet is anti-inflammatory. TRUE

6. A diet-induced inflammatory state is promoted by a diet with inadequate intake of K, Mg, and EFA. Mg = muscle relaxation. Ideal Ca:Mg ratio is 2:1.

There will be an assignment that’s not on the syllabus – she’ll give it out next week.

Clinical Nutrition

1-15-04

Baseline nutrition –

Multiple - necessary

Magnesium – need a 1:1 ratio

EPA/DHA – fish oil – Omega 6 and Omega 3

CoQ10 – antioxidant – daily – need antioxidants, whether from CoQ10 or some other source

Look at the patient – what are your findings? Blood tests, UA, PE, history, etc.

Special needs

Zymain – digestive problem – look at the gall bladder and digestive system

Ginger – anti-inflammatory in nature – some cultures eat ginger on a weekly/daily basis

Probiotics – usually short term usually after antibiotic treatment, high fevers, diarrhea, etc.

Saw Palmetto – males for prostate

Flavonoids – for protective factors for tissues – protects against free radicals which can be a precursor to a lot of diseases, i.e. cancer.

ALA/GLA – evening primrose oil, etc

Glucosamine sulfate (also glucosamine chondroitin) – for joint damage

Ostivone Hydroxyappetite Calcium – specialized calcium

Eat more fruit and veggies; one small grain serving per day; lots of water, use olive oil and butter (not margarine – avoid hydroxylated fats/trans fats); drop all junk for 3 months.

Grains aggravate the inflammatory proceeses. Trans fats have a half life of 60 days to 3 years (depends on which study you look at) – can take a long time to repair the damage.

Where to Start with a Patient – Flow Chart – copy in the reserve file

Changes in symptoms will begin in about 21 days – re-evaluate in about a month. Fine tune it over the next 2-3 months.

Nutritional Supplementation – Baseline

1. Multiple Vitamin/mineral

2. Magnesium – up to 1000 mg/day (divided doses) Mg:Ca++ ratio of 1:1 (20 minutes before meals) – Ca++ is better absorbed in an acid environment

3. Bioflavonoids/antioxidants: 1-2 grams/day plus Vit C (500-1000 mg/day – divided)

4. Coenzyme Q10: 150-300 mg/day. Made in body from Acetyl-CoA. Increases cardiac function, increases exercise capability, decrease angina. ATP and electron transport.

5. Ginger (anti-inflammatory botanical)

Powdered: 500 mg 4x/day

Fresh: 10gr/day

Extract: standardized for 20% gingerol and shogoal (100-200 mg 3x/day) – See Dr. Ware – use for muscle strains – we have it at Montgomery Clinic

6. Fish Oil: Standard EPA – 180 mg or 330 mg

Standard DHA – 120 mg or 220 mg

7. Chondroitin/glucosamine product (1000-1500 mg/day) – can be as soon as 1-2 weeks, may take as long as 6 weeks – if it hasn’t helped in 6 wks, it probably isn’t going to help them

8. Bromelain: 250-500 mg between meals/evening – taken between meals breaks down inflammatory process in the gut; taken with meals helps the digestive process

Acute sprain/strains/injury – for 1 week

9. Vitamin E: 400 mg/day (particularly with taking fish oil) – Vit E is needed to make the fish oils work best

Nociception and the Subluxation Complex – Chapter 1

Pain and inflammation relationship –

Swelling causes mechanorecptor compression

Chemical mediators/responses in the inflammatory cascade can be caustic to the nociceptors, i.e. histamine.

The inflammatory stage is the beginning of the disease process.

According to Faye:

Neuropathophysiology

Kinesiopathology

Myopathology

Histopathology

Inflammatory biomechanical changes

According to Lantz (revised Faye’s description)

Kinesiopathology

Neuropathology

Myopathology

SEE HER NOTES IN THE LIBRARY

In summary:

Nociceptors are stimulated by biochemicals found in injured tissue, leading to:

Sympathetic hyperactivity

Reflex muscle spasm

Autonomic concomitants or symptoms

Pain

“Nociception does not equate with pain”

Spinal Structures with Nociception

All tissues are innervated by C-fiber EXCEPT

Articular cartilage

Nucleus pulposus

Inner 2/3 of the annulus

Sympathetic Hyperactivity

The precise mechanism by which the sympathetic… (SEE HER NOTES IN THE LIBRARY)

Her notes will be in the Reserve File in the Library and on the school website. I will only take notes for special things like guest lecturers or reviews.

Clinical Nutrition

1-16-04

Dianna’s Notes

Article – “Chiropractic and the Dorsal Horn” – in the library

Adjust, rehabilitation, exercise and attitude

Causes of disease – in 1910 DD Palmer said

1. Traumatization

2.

3.

Modern pathology texts such as Robbin’s lists more

Subluxation vs. joint complex

Subluxation affects more than the nerve, i.e. muscles

Conceptual issues related to nutrition

Food allergies

Kocka pulse test – for food allergies

Candida

Questionnaires

Pathogenic

Fatigue

Cheese, bread and carbs feed it.

Treatment – clean the colon and the liver

18-24 hours is a good transit time

Liver Detox

Hepatic detox profile

Allergies, sinus problem, joint pain

Tired

GI problems

Prescription drugs 2 or more times per year

Use insect spray

Infections

Toxins

Lifestyle

Hormonal aberration

Psychosocial factors (stress, coping skills, etc.)

Test liver detox – 2 phases

1. Oxidation – caffiene clearing

2. Conjugation – no such test

Deficiencies – zinc, copper, selenium, magnesium

Nutritionally balanced

Rice powder – carbohydrate

Medium chain triglyceride

Adequate vitamins and minerals

Enhance hepatic Cytochrome P450 activity

Optimal pH

Clinical Nutrition

1-22-04

Pulse Test –

Record pulse over a few days

Single food test – take pulse before eating and after eating food – retake 15 minutes after

Candida Albicans – pathogenic in GI

Liver detox - >40 patients on questionnaire take zinc, copper

Combination of foods – vegies and fruit – not recommended -> creates gas

Eat fruit on an empty stomach (berries are not gas formers) with nothing else

Protein and starches don’t go well together

Notes off school site.

Where do you begin with a patient?

Lots of things in the physical exam can give us clues as to what the deficiencies may be.

Split nails – not handling the proteins well

Ridged nails – insufficient iron (will also have blanching of the inside of the lower eyelid)

TISSUE INJURIES

Three stages of healing

Acute inflammatory phase – first 48 - 72 hours –

Primary nutrient in this stage is proteases (proteolytic enzymes). Works with sports injuries, disc herniations - bromelain, ginger extract, tumeric, boswelia – Thorne product – Phytoprofen; Discat – Chiro-Manis, Inc.; Metagenics; Standard Process; will reduce the healing time by 50%. Superdose the first dosage –

Initial Loading – up to 10 tablets on an empty stomach

Follow-up – 3-5 tablets 4x/day on empty stomach

Individual enzymes can be effective. Need enteric coated.

Repair – 48 hours – 6 weeks – continue bromelain for up to a week then add chondroitin and glucosamine sulfate.

Enzymes – 2 tablets 3x/day (for approximately 1 week)

Vitamin/mineral complex: any deficiency can alter healing

Vit A – epithelial tissue

Manganese – synthesis of proteoglycans

Antioxidants – inflammation generates free radicals

Purified chondroitin sulfates - 2-3 grams divided doses daily.

Phase III – Remodeling

3 weeks to 12 months (ligaments can take 1-3 years to return to original strength)

1. Vitamin C, copper and Vit B6 for collagen synthesis

2. Purified chondroitin sulfate for proteoglycan production

3. Antioxidants for free radical suppression

4. B Complex vitamins and minerals necessary for growth and healing new tissue

Primary minerals: Calcium, Magnesium, Manganese, zinc and copper (organic forms of minerals)

Sports Injuries, tendonitis and bursitis

High potency multiple vitamin/mineral formula

Vit C – 500-1000 mg 3-4x/day

Flavonoids (choose one)

Grape seed or pine bark extract – 50-100 mg 3x/day

Citrus bioflavonoids – 500-1000 mg 3x/day

Diet – avoid a pro-inflammatory diet

Tissue Injury

Acute Inflammation (AI) – chemical mediator release, vascular phase I and II, cellular phase -> physiological debridement -> yes -> resolution of AI -> repair -> remodeling, If NO -> chronic inflammation – missed what feeds into this process.

Anti-Inflammatory Agents (COX1 and 2 Inhibitor)

Aspirin

Ibuprofen (Advial, Mortrin, Nupri)

Side-effects – gastric – loss of intestinal integrity

Acetominophen – Tylenol

4 grams per day is the limit – excess can cause liver damage

Side effects – possible liver damage. NO reversal of symptoms with toxicity (approximately 10 grams – with possibility of death – irreversible symptoms)

Corticosteroids – blocks all eicosanoids (prostanoids and leukotrienes)

Side effects – avascular necrosis especially of the hip – lipid metabolism – tendon rupture – arthropathy – vertebral osteoporosis – infectious arthritis – bursitis.

Muscle relaxants –

Used for spastic muscles – Valium, Dantrum, Lioresal – side effects – CNS depression

Acute Muscle Spasms – Flexoril, Paraflex – side effects – CNS depression

ALTERNATIVES

Inflammatory stages – use those products, balance Omega 3 and 6; antioxidants, glucosamine,

Calcium/Magnesium 1:1 ratio – for the balance now. Historically it has been 2:1 – don’t exceed that. The increased Ca++ along with an increase in flaxseed oils and/or fish oils will help prevent sunburns.

Magnesium can be dosed to bowel tolerance like Vitamin C. This is helpful in the acute inflammatory stage. Don’t keep the patient on them long term.

Walnuts are high in the Omega 3s and are as good as the fish oils. Flaxseed, borage, evening primrose don’t go through the whole process.

Clinical Nutrition

1-23-04

Dianna’s notes

Review arachidonic acid cycle

Can be converted to adrenic acid and DPA

Enzymes inhibited – phosphlipase A2, cyclooxygenase (COX), lipoxygenoase

Diet Induced Pro-inflammation

Increased acid, low potassium, low magnesiusm, free radicals, fatty acid imbalance, food sensitivity

Driven by the chemicals: PG2, Leukotriene B-4, Histamine, 5-HTP, Bradykinin

RA patients will improve with a low inflammatory diet

Fruits and vegetables – decrease chronic diseases – all are inflammatory conditions (????)

Increase pH - 8.0 – body can’t survive

Ischemic tissue – ph of 5.4 and causes nerve firing and activates bradykinin (most potent) which is pro-inflammatory

Disc surgery – pH ranges 5.7 – 7.5; pain with pH less than 7.0; proteoglycan synthesis affects with pH below 6.8

80:20 ratio for alkaline:acid is best.

Clinical Nutrition

1-29-04

Pro-inflammatory state – Inadequate Potassium Intake

K depletion causes decreased insulin secretion; affects acid-base balance; lack of vasodilation of small vessels – results in ischemia and hypoxia (microcirculation); impairs glucose utilization (Trigger Points in fibromyalgia – 17% decrease in ATP); C-fibers – autonomic system

High in fat, sugar, laxitives, Na+ -> decrease in K – we can get up to a 75% decrease

Decrease K = pro-inflammatory

Meq??? Decrease -> increase in free radicals

Decreased Mg = decrease in ATP; enhances lactic acid production; increases tissue hypoxia; increases platelet aggregation; decrease in meq??? Enhances the stress response

Supplement with vegetables, fish, whole grains and nuts

Ca++:Mg ratio should be 2:1

Magnesium – inorganic; organic

Pro-inflammatory leads to chronic degenerative states through free radical production

Anti-oxidants – family of nutrients found in fruits and vegetables – scientific research focuses on individual?????

Phytochemicals needed for complete benefit

Citrus fruit ????

Anti-inflammatory (????)

Pro-inflammatory – arachadonic acid

There are 3 fatty acids that are part of the cell membrane –

Linoleic acid, linolenic acid, arachadonic acid

Vegetarians have an increase in arachadonic acid

Trans fatty acids are pro-inflammatory – found in vegetable oil

Monosaturated fatty acids – need to be ½ of the total fat intake – oilice oil

Glycemic index foods

Get rid of white foods

The Zone Diet – 40:30:30

55%-70% carbs

10%-15% protein

20%-30% fat

Insulin – anti-catabolic hormone (??)

Glucagon

Epinephrine and cortisol – counter regulatory hormones of insulin

Pure protein meals – insulin will increase slightly

DM patient – 55:15:30 – decreases blood sugar regulation, increases triglycerides

High carb diet – 60:15:25 – decreases HDL, increases plasma levels of insulin, tri???glyceral

Low carb diet – 40:15:45 (10 saturated – 10 poly??? – 20-25 monounsaturated)

DM recommendation is to decrease carbs and increase monounsaturated fats

Low glycemic index foods

High carb

Obesity, NIDDM (???), HTN, CAD

Insulin stimulation (??) D-5-D and D-6-D (glucagon depresses)

Hyperinsulinemia contributes to:

Hypofibrinolytic state include:

Cortisol release when stressed

Someone may wake up with low blood sugar

???decrease REM, depressed immunity, depressed osteoblasts, increase GFR

Cortisol will increse fat in the mid-body – saliva test is the best

Great Smokies Diagnostic Laboratory – they offer a newsletter

Diagnos-Techs, Inc.

Exercise enhances insulin sensitivity

Increase fruits and vegetables and decrease grains

1 serving of rice = ½ cup

Maintain a 3:1 or 2:1 carb:protein ratio

1:1 for Omega 6:Omega 3

Increase fiber

Garlic, onions and ginger decrease inflammation and platelet aggregation

Insure adequate intake of vitamins and minerals, particularly Mg, K, Biotin, Chromium and Vit E

Exercise regularly

Drink 6-8 glasses of water (6-8 oz. each)

Clinical Nutrition

1-30-04

STUDY GUIDE was passed out – keep in mind the Basic 4 nutrients – know these – check the library folder for additional information

Where do you start with a patient? Handout in library

Go through the book and the study guide together – it will help narrow down what we need to know

Figure 1-1 – nociception diagram

Most potent chemical – Bradykinin

Know the other chemicals that can alter the nociception

Figure 1-2 – subluxation complex – review the components

Figure 2-1 – subluxation complex

Figure 2-2 – nociception

Food allergies and sensitivities – specific numbers in the notes are important

Physiologic pH – she won’t ask numbers but you need to know that to be able to design a diet – 80:20 alkaline:acid

Liver Detox – Phase I and Phase II – Figure 2-3

80% of the questions are from the notes and overheads –

Chapter 3 – Inflammatory process

Three phases of repair – Figure 3-1

Acute phase with the proteolytic enzymes

4-Phase approach to rehab – no test questions – just information for clinic’

Chapter 4 – pharmacology

Figure 4.1 – where do the NSAIDs block the prostaglandin pathways (CO = COX enzymes on the picture) – what can we eat to replace that process – keeps it from going into the arachadonic acid cycle

Foods sources of Omega 3, Omega 6 and arachadonic acid

Chapter 5 – Diet induced Pro-inflammatory state

Figure 5-1 – through this process we see how the anti-oxidants are being utilized – Vit E -> radical -> with Vit C can be reused – point is we need multiple supplements to be able to get through the entire process – it could be blocked at a particular stage if we only take oe.

Figure 6-1

Format is T/F, multiple choice, 30 questions – test first hour free the second hour.

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