Clincial Nutrition II-CL09702



Clinical Nutrition II CL09702

Study Guide for Exam 3 – Hair analysis, GI 1-3, Saliva tests

Gallbladder problems

1. associated wth nausea and vomiting

2. order salivary thyroid panel

3. order adrenal stress index

4. order male hormine profile

GI and its involvement in many pathological conditions

1. ???????????

IBS

1. poorly understood condition relating to functional abnormality of lower GI

2. 20% of the adults in the US suffered from it

3. Symptoms - abdominal cramps, painful and explosive diarrhea, and/or constipation, mucous in the stool, bloating, gas, not able to completely empty bowel or feel like it is not completely empty

4. Diagnosed by ruling out physical causes

5. No known cause, No known cure

a. Meds for symptom relief - antispasmodic, laxative, antidepressants

6. Certain foods can cause symptoms—sub-clinical gluten intolerance

7. Food sensitivity and dysbiosis are considered suspects by many alternative health professionals

8. Stress’ also considered as a major trigger

9. Imbalance of gut hormones especially serotonin may be key to solve mystery

10. Prozac can cause diarrhea and constipation depends on the dose.

11. The drug, Zelnorm acts as a serotonin agonist, stimulates GI tract motion

12. What in nature can cause an imbalance of the serotonin system? Any addictive stuff.

13. Sugar is universal.

Mold and antibiotic exposure

1. Allergy and Immune Stress Study - University of Michigan study

a. mice were given antibiotics in drinking water for five days to weaken gut bacteria

b. then injected with candida yeast, to mimic response of antibiotics produce in humans.

c. Finally, mice's nasal passages were exposed to aspergillus

i. mold spore that is a common allergy trigger in humans

d. mice that received antibiotics showed increased sensitivity to mold spore in respiratory systems

i. mice that did not receive antibiotics did not develop sensitivities to mold

e. reaffirms concept of what goes on in gut can play an important role in regulating immune responses--even in lungs, since they too secrete mucus. And, to take the concept one step further, if a problem in the lungs is found to originate at another site in body, there is possibility that other chronic diseases have their roots in gut or other parts of body not thought of previously.

The enteric nervous system

1. enteric system produces 99% of serotonin (5HT)

2. the gut forms the Enteric Nervous System

a. Connected to brain via vagus nerve

b. Can function independently - brain dead patients can continue to digest and absorb intubated feeding indefinitely

c. gut produces all neurotransmitters and hormones that the brain does plus more

d. GI tract is highly susceptible to stress of any kind

i. emotional, physical and toxins

Vitamin B12 deficiency

1. Megaloblastic anemia

2. B12 absorption is dependent on adequate HCl in the stomach, pancreatic enzymes and healthy brush border.

3. Increase serum homocysteine , an inflammatory marker

4. Emotional and psychological signs and symptoms

The 4R program - protocol to restore digestive health

1. Remove - Remove pathologic microbs

a. Yeast, parasites, bacteria, virus

b. Coconut oil, olive oil have antimicrobial activities

c. Antimicrobial herbs:

i. Zymex (SP) – yeast

ii. Zymex II (SP) – parasites, wormwood, black walnut hull, turmeric, garlic,

iii. Articin (Thorne) – parasites

iv. SF722 (Thorne) – yeast, enzymes, Cat’s claw, Olive leaf extract.

2. Re-Inoculate

a. A good source of beneficial bacteria

b. Lactobacillus, bifidobacterium

c. Lactobacillus sporogenes

d. Hemostatic soil organisms (HSO)

e. Lacto-fermented dairy, vegetables, vinegars, Kombucha

f. Lactic acid yeast

3. Replace - To aide digestion while repairing the GI tract, support digestive enzymes activities and gallbladder function.

a. HCl

b. Bile salt

c. Beet leaves extract

d. Plant enzymes—bromelain, papaya enzyme

e. Proteolytic enzymes

4. Repair

a. Herbs or nutrients that speed the healing of damaged gut mucosa

b. Slippery Elm bark, Aloe vera, Clostrum, Coconut oil, N-acetyl-cysteine, L-glutamine, Quercitin, Antioxidant, vitamins (A, C, E), MVM

Leaky gut syndrome

1. Increase intestinal permeability

2. Absorb middle and large molecular particles

Hair analysis - mineral ratios indicating endocrine and metabolic functions

1. Hair Analysis Worksheet

a. Ratio < 3.3 = Magnesium loss, may also have blood sugar issues, hidden Na/K inversion 2.5 – 3.3 = Moderate, < 2.5 = Extreme

b. Ideal ratio = 6.67, Good range = 3.3 - 10

c. 10 – 13 = Overeating carbs, tendency towards Insulin Resistance

d. > 13 = overeating carbs, emotional defensiveness/conflict, defending a lifestyle imbalance that is not in their best interest, cognitive dissonance

e. 13–18 = Moderate, > 18 = Extreme

f. High Ca = Protection, defended, defensive, lowered cell permeability, calcium shell Ca > 150 = Mild, >200=Moderate, >250 Extreme

2. Ca/K Thyroid

a. High ratio = Decreased thyroid effect (at the cellular level), 8 - 50 = Moderate, > 50 = Extreme

b. High Ca = Protection, defended, defensive, lowered cell permeability, calcium shell Ca > 150 = Mild, >200=Moderate, >250 Extreme

c. Low K (50

d. Ideal ratio = 4, Good range = 3 - 8

e. Low ratio = Increased thyroid effect (at the cellular level) and/or toxicity 1-3 = Moderate, 20 = Extreme

c. Ideal ratio = 4.17, Good range = 3 - 6

d. Low ratio = decreased adrenal effect, chronic stress, exhaustion reaction

e. 1- 2.5 = Moderate, 12 = Extreme

c. Ideal ratio = 2.5, Good range = 2.3 - 5

d. Low ratio (inversion) = decreased adrenal effect (exhaustion), chronic stress, lowered energy & energy reserves, decreased immunity, protein catabolism, poor digestion, allergic tendencies, carbohydrate intolerance, diabetic tendency, liver & kidney stress, cardiovascular stress, tendency toward degenerative disease, frustration, resentment, hostility

e. 2 – 2.3 = Moderate, 1 – 2 = Severe

f. 15 = Extreme

b. Female or male hormone imbalance, cardiovascular stress, tendency toward atherosclerosis, Zn loss, look for hidden Cu.* (See below)

c. Ideal ratio = 8, Good range = 6.5 - 10

d. Low ratio = below 6.5 - Cu toxicity (see for in-depth info. on Cu toxicity) Estrogen Dominance, female or male hormone imbalance, emotional problems, PMS, volatile, depressed, detached, cardiovascular stress, tendency to bruise, tendency for blood vessel weakening 3 – 6.5 = Moderate, < 3 = Extreme

e. Zn roughly correlates with progesterone effect in women, testosterone effect in men.

f. Cu roughly correlates with estrogen effect in both sexes.

g. *Hidden Cu Toxicity in slow oxidizers occurs when ANY of the following are present: Cu 50, Hg >.06, Na/K ratio < 2.5, K < 4 Fast oxidizers usually have a true low Cu & Zn.

h. NOTE: With hidden Cu, the symptoms of a low Zn/Cu ratio will be present.

6. Ca/P – Sympathetic/Parasympathetic and Protein Usage

a. High ratio = > 2.7 - parasympathetic state, 2.7 – 8 = Moderate, > 8 = Extreme

b. Ideal ratio = 2.5

c. Good range = 2.3 – 2.7

d. Low ratio = < 2.3 - sympathetic state, 1.5 – 2.3 = Moderate, < 1.5 = Extreme

e. PROTEIN USAGE - PHOSPHORUS (P) LEVELS INDICATE PROTEIN USAGE, PROTEIN RESERVES, & TISSUE BREAKDOWN. WHEN P IS HIGH OR LOW ASK THE FOLLOWING QUESTIONS:

i. Eating enough protein?

ii. Good protein sources?

iii. Digesting protein (HCl)?

f. Low P = protein deficiency, excessive tissue breakdown, impaired digestion, poor source of protein, (low P is worse than high), impaired protein synthesis (tends to be worse with low Zn)

g. High P = a pubic hair sample or excessive tissue breakdown, impaired digestion

Fast and slow oxidizers, what minerals indicate?

1. Ca and Magnesium: high = slow oxidizer

2. Na and Potassium: high = fast oxidizer

3. Ca and Na: high = mixed oxidizer

What ratios indicate sympathetic and parasympathetic dominance?

1. Ca/P – Sympathetic/Parasympathetic

a. High ratio = > 2.7 - parasympathetic state, 2.7 – 8 = Moderate, > 8 = Extreme

b. Ideal ratio = 2.5

c. Good range = 2.3 – 2.7

d. Low ratio = < 2.3 - sympathetic state

e. 1.5 – 2.3 = Moderate, < 1.5 = Extreme

Saliva tests, know what tests to order for the conditions discussed in class.

1. allows quick, easy, inexpensive and relatively accurate information to aide physician in diagnosing hormone related and other conditions

2. Continual monitoring

3. Must not be used as the sole means of evaluating the patient, but in conjunction with a history, physical exam and other lab tests as indicated

Commonly Used Tests

1. Adrenal Stress Index

a. Pt with significant adrenal symptoms marked in SSF

b. GI and liver/gallbladder symptoms

c. Osteoporosis, Chronic fatigue, Chronic infections, Fibromyalgia, Insomnia

2. Pre-menopausal Female Hormone Profile

a. Pre-menopausal women with many female only symptoms marked in SSF

b. Menstrual problems, Infertility

c. Adrenal and thyroid disorders refractive to adrenal and thyroid supports

3. Expanded Postmenopausal Hormone Profiles - ePHP

d. Determine pituitary-ovarian axis for patient not on exogenous hormone augmentation

e. Provides a breast and uterus proliferative potential index

i. One random sample

ii. Baseline levels of estradiol, estrone, estriol, DHEA, Testosterone, Progesterone, LH, FSH

4. Postmenopausal hormone panels

f. PHP1 (short)

i. Similar to ePHP, except LH and FSH are not measured

ii. One random sample

iii. Determine hormone levels for augmentation therapy

g. PHP2 (Long)/Perimenpausal

i. Two samples: baseline and post hormone challenge, 6-7—14 days apart

ii. Determine dosage and effects of HRT or other hormone modulating protocol

iii. Determine if a woman is menopausal if the two profiles are very similar, not if they are very different.

5. Order PHP When…

h. Post menopausal female patients with female only symptoms heavily marked in SSF

i. Assessing menopausal status

j. Monitoring hormonal balancing protocols or HRT

6. Expanded Male Hormone Profile

k. One random sample

l. Measures: Testosterone, DHT, DHEA, progesterone, estrone, FSH, LH

m. Evaluate the pituitary-gonadal axis

n. Standard baseline in male patients

o. Used to determine the need for hormone augmentation therapy

7. Male Hormone Profile

p. Similar to eMHP except FSH and LH are not included

q. Monitoring hormone levels in patients on exogenous hormone augmentation therapy

r. Note Testosterone to Estrogen ratio, normal is 50:1

s. Normal T level but with low T/E ratio is estrogen dominance, a relative low T state

8. Order MFP When…

a. Male only symptoms heavily marked in SSF

b. Chronic fatigue, fibromyalgia

c. Osteoporosis

d. GI/liver/gallbladder, adrenal and/thyroid problems refractive to nutritional support for those areas

e. Andropause

9. Salivary Thyroid Panel - STP

a. Evaluate free fraction of T3, T4, TSH and thyroid microsomal antibody

b. Identify functional problems of pituitary-thyroid axis

c. Screen for possible autoimmune thyroid conditions

10. Order STP When…

a. Patients with heavily marked hyper or hypothyroid symptoms marked in SSF

b. Depression, Osteoporosis, Adrenal fatigue refractive to adrenal support, CF/FMS, Weight problems, ADD/ADHD, Liver/Gallbladder/GI problems

11. Four Foods Test

a. Major food intolerances

b. SIgA for corn, soy, gluten and casein

c. Indicated for patients with significant adrenal dysfunctions

12. GI Health Panels

a. 15 or 22 conjoint parameter analysis

b. Intended to evaluate gastrointestinal function and health non-invasively.

c. The panel employs three stool and two saliva specimens.

d. Need for GI Health Panels

i. Inflammatory bowel disease

ii. Chronic loose stool or constipation

iii. Fat, grain, and food intolerance

iv. School & pool associated GI problems

v. Chronic abdominal discomfort/pain

vi. Chronic fatigue and fibromyalgia

vii. Excessive eating pattern/Anorexia

viii. Post travel loose stool/diarrhea

ix. Sudden changes in bowel habits

x. Bloating, maldigestion, heartburn

xi. Excess gas and flatulence

xii. Chronic skin conditions

xiii. Hyperactivity

xiv. Poor sleeping habits

13. Prioritization

a. Adrenal and blood sugar disorders

b. GI problems and food sensitivities

c. Liver detoxification

d. Essential fatty acid imbalance

e. Micronutrient deficiencies

14. Summary

a. Salivary hormone testing is an effective and inexpensive method to assess patient

b. Always use these tests in conjunction with other diagnosing modalities

Precautions when collecting samples

1. Before collecting saliva, rinse mouth with cold water, chewing gum to stimulate saliva production is fine

2. Take a vile provided by the lab and fill it halfway with saliva (approx. 3-4cc)

3. Label vile with name, time and date

4. Do not cough and fill vile with throat mucous

5. Put all samples into mailing envelop along with payment, requisition form, name of referring dr.

6. Mail to lab immediately after all specimens have been collected, preferably in the beginning part of the week.

7. Smoking, coffee, exogenous hormones and certain drugs will significantly alter lab findings

Bolded topics listed in the syllabus between weeks: 9-11

Female Complaints

Cervical Dysplasia pp. 109-113

Fibrocystic Breast Disease pp. 181-184

Menopause pp. 319-326

Menorrhagia pp. 327-331

Nausea and Vomiting of pregnancy pp. 352-354

Pelvic Inflammatory Disease pp. 383-391

Premenstrual Syndrome pp. 411-422

Vaginitis and Vulvovaginitis pp. 472-483

Hormanal balancing with nutriton

Male Complaints

Benign prostatic hyperplasia pp. 90-94

Epididymitis 164-168

Male Infertility pp. 310-318

Week 10:

Metabolic Disorders

Alcoholism pp. 20-27

Gout pp. 202-207

Obesity pp. 355-363

Week 11:

Systemic Syndromes

Chronic Fatigue Syndrome pp. 125-130

Fibromyalgia

Chronic Candidasis pp. 120-124

HIV/AIDS pp. 224-236

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