Download The final exam includes information presented in the following

Nutrition Review
FINAL
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Intimidation
The final exam includes information presented in the following lectures:
Functional Endocrinology part 1-3
10-12 questions
Understand the signs and symptoms of insulin resistance
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Symptoms of Insulin Resistance
– Fatigue
– Cravings for sugar
– Unable to lose weight
– Constant hunger
– Fatigue after meals
– Migrating aches and pains
Signs of IR:
– Elevated fasting or post-prandial glucose
– Elevated fasting or post-prandial insulin
– Elevated triglycerides
– Cholesterol:triglyceride ratio > 1
– Low HDL
– Elevated uric acid
– Increased waist to hip ratio
– High blood pressure
– Central obesity
The physiological impacts of IR to other systems
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A state in which insulin receptors become unresponsive to the stimulation of insulin
– Defects in ligand/receptor binding
– Signal transduction
– Intercellular communication
– Polymorphism
– Found in 25-35% of population in westernized nations
– Major contributing factor to diabetes, CVD, sleep apnea, hormonal imbalance, obesity
and certain kinds of cancer
Blood pressure affected by the plasma levels of insulin in positive direct relationship.
Hyperinsulinemia may alter coagulation proteins involved in fibrinolysis
Plasminogen activator inhibitor 1 is elevated in hyperinsulinema
Insulin up-regulate HMG-CoA reductase
Impacts cholesterol ester transfer protein(CETP), lowers HDL levels
Increased BP, blood clot and cholesterol, lowers HDL
Nutritional and herbal support for IR, adrenal fatigue, liver detox, thyroid
dysfunctions
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Gymnema sylvestre—reduces IR, decrease fasting blood glucose, enhance insulin action, may
regenerate beta-cells
Chromium—depleted in refined carbohydrate diet, common deficient in US diet, co-factor in
glucose tolerance factor which is important for insulin on receptor site and improve cellular
glucose uptake, normalize post-prandial glucose and insulin levels, glycated Hgb, serum
cholesterol
Vanadium—insulin-like impact on receptor sites, improves function of glucose transport,
improves intercellular transduction reactions, reduces IR
Alpha-Lipoic Acid—a sulfur-containing substance, improves insulin function by activating
glucose transporters (GLUT1 and 4) which enhance glucose disposal and reset signaling
response to insulin, powerful antioxidant, improves ATP production
Vitamin E—improve insulin sensitivity, lowers triglycerides and LDL, antioxidant that prevents
oxidative complications associated with diabetes
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Last FINAL EVER!!!
Nutrition Review
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Magnesium—deficient in IR patients, optimizes insulin secretion, activate glucose transporter,
improves insulin intercellular transcriptional response
Biotin—improves insulin response to GTT, lowers post-prandial glucose levels, upregulate
glucokinase (first step in liver glucose utilization)
Zinc—protect beta-cells, increase insulin sensitivity, insulin metabolism, diabetics excrete zn
Inositol—ability to re-establish normal myoinositol levels in deficient neurons, helpful in diabetic
neuropathy
Niacin—a component of GTF, potential to prevent the onset of type 1 diabetes, inhibits
macrophage and interleukin-1 mediated beta-cell damage, inhibits nitric oxide, has antioxidant
function
L-Carnitine—enhance whole-body glucose uptake and increase gluconeogenesis, improves
peripheral nerves and vascular function, improves serum dyslipidemia in diabetics
Dandelion—improves liver and gallbladder function, promote bile production and secretion to the
GB, contraction of GB
Milk Thistle—increase bile solubility, reduces bile concentration, potent antioxidant protects
against phase 1 free radical damages to the liver, prevent glutathione depletion, anti-inflammatory,
inhibits PGE2 and leukotriene, promote liver cells regeneration
Ginger—increase bile production (cholagogue), reduces hepatic cholesterol
Lipotropic agents—Beet root and leaves (beataine HCl), taurine, vitamin C, lecithin
(phosphatidylcholine)
Centella Asiatica—improves histological findings of liver cirrhosis, venous insuffciency, venous
hypertension
Panax Ginseng—improves liver function, reverse fatty liver in animal models, anti-hepatotoxic
properties, promotes Kupffer cells, increases nRNA, rRNA and mRNA synthesis
Multiple vitamins and mineral to insure nutritional co-enzymes and co-factors sufficiency
B-complex, Mg, Zn, Mo, Se, K
Characteristics of liver detox problems
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– Neurological disorders
– Chemical sensitivity
– Adverse drug reactions
– Autoimmune problems
– Hormonal imbalance
– Blood sugar imbalance
– Fatigue
Especially important for the chronically ill
Liver detox imbalance will make any endocrine problem patterns more difficult to evaluate and
unresponsive to treatment
Many times hormonal imbalance occurs as a result of compromised detox function
Patients usually presents with contradicting symptoms, history of toxin overload and drugs
exposure (HRT)
Phase I and phase II detox pathways
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Phase 1 and phase 2 detoxification pathways
Phase 1—oxidative/reduction reactions involves the cytochrome P-450 enzymes pathway
Uses oxygen and NADH to add a reactive group such as a hydroxyl radical
Either complete neutralize the compound or renders it more reactive to bind with the phase 2
conjugation moiety
Intermediates of phase 1 detox is more reactive and much more toxic—free radicals
Phase 2—conjugation of phase 1 intermediates
Neutralized toxins or make them more water soluble in order to be excreted via urine, sweat or
bile
6 main pathways: glutathione conjugation, glycine conjugation, methylation, sulfation,
acetylation and glucuronidation
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FINAL
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Thyroid hormones peripheral conversions
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Antiperoxidative compounds—lipid peroxidative and antioxidant enzymes systems play a
profound role on the peripheral thyroid hormone conversion. Substances (alpha lipoic acid, Nacetyl cysteine, protein, B-complex) that support the synthesis of glutathione and decrease freeradical and oxidative stress (antioxidants, bioflavonoids, polyphenol, OPC) will improve thyroid
hormone conversion and thyroid function
Thyroid medications
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Desiccated Thyorid—generic or brand name desiccated pig thyroid (Armour Thyroid, Westroid,
Naturethroid, Proloid)
Cytomel—brand name for synthetic T3
Levothroid—brand name for synthetic T4
Levothyroxine—generic T4
Levoxyl—brand name T4
Synthroid—brand name synthetic T4 (most Rx drug in the US)
Thyrolar—brand name fixed-ratio mix of synthetic T3 and T4
Functional vs. clinical endocrinology
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Clinical
The branch of medicine dealing with the endocrine glands and their hormones
Identify organs or glands that are deficient or non-functioning and use some type of
pharmaceutical agent or hormone to replace, suppress or support the dysfunction glands
Specific for certain genetic disorders and disease patterns that alter hormone production or
functions pathologically
Functional
Identifies alterations in the endocrine systems at subclinical states prior to the point of clinical
diagnosis
Typically not considered for treatment by conventional/allopathic medicine
Subclinical problems are not considered diseases and left untreated
Conventional blood and urine tests and reference ranges may not detect functional endocrine
imbalances
Left untreated, functional imbalance will progress to disease states
Patients typically suffer from multiple organ dysfunctions, fatigue and depression for prolong
period of time until objective measurements are evident in lab tests
Increased risks for many disorders
Various adrenal stress stages
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Alarm reaction
– Initial response
– Hyperfunctional
– Increased cortisol with normal DHEA
Resistance stage
– Prolonged stress
– “Prenenolone steal”
– Increased cortisol with low DHEA
Exhaustion Stage
– Adrenal cannot adapt to stress—final stage
– Normal cortisol with low DHEA, hyper or hypo with normal DHEA, when depleted, low
cortisol and low DHEA, finally, low cortisol and normal DHEA
Lifestyle adjustments for IR, adrenal stress, liver detox, thyroid dysfunction
estrogen dominance
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Nutrition Review
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Adrenal Stress
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Stabilize blood glucose
– Do not skip breakfast
– Eat a high quality protein based breakfast
– Snack on low glycemic foods—proteins
– Avoid concentrated sugars—refined sugars, fruits and carrot juices
– Avoid adrenal stimulants
– Eat well balanced meals—whole food, vegetables, meats and whole grains
– Eat frequent small meals
Exercise in aerobic heart range
– Low impact aerobic
– Yoga
– Weight lifting
– Walking
– Swimming
– Cycling
– Taichi
– If you still feel tired after 24 hours, you overdid it.
Avoid adrenal stimulants
– Refined sugars
– Caffeine
– Nicotine
– Alcohol
– Allergic foods
– Trans fat
– Artificial sweeteners (excitotoxins)
– pollutions
– Overtraining
– Inadequate sleep
Stress management
Wholesome diet
Relaxation techniques
Body work
Adequate sleep, 8 or more hours
Chiropractic adjustment
Acupuncture
Emotional energy techniques
Lifestyle for IR
Low carbohydrate diet with whole foods
Pure water
Reduce stress—chemical toxins, emotional toxins, nutritional deficiencies, overtraining
Regular exercises—weight training especially helps increase insulin sensitivity
Nutritional supplementation
Liver Detox
Increase fruits and vegetable, cholesterol, whey protein (sulfur containing foods)
Exercises
Sauna—sweating and circulation
Skin brushing
Epsom salt bath
Colonic
Coffee enema
Liver and gallbladder flush
Fasting
Effects of IR on EFA metabolism
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Decreases cellular uptake of glucose  decreased citric acid cycle pathway
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Nutrition Review
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FINAL
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Shift cells metabolism into an energy requiring lipogensis pathway
Produces an inflammatory state which will further short circuit the CAC and uncouple
oxidative phosphorylation pathways lead to lowered ATP production
Alters EFA metabolism which inhibits lipolysis and beta-oxidation
Alters female hormone metabolism towards androgen dominance and estrogen dominance
4-10% women of reproductive age suffers from PCOS—leading cause of infertility
Symptoms of PCOS: hyperandrogenism, insulin resistance, chronic anovulation, irregular periods,
infertility, unexplained weight gain, fluid retention, fatigue, mood swings, acne, hair loss,
unwanted hair growth, estrogen proliferative cancers, acanthosis nigricans, increased risk of CVD
and dyslipidemia
Hyperinsulinemia induces hypercortisolemia
Shifts progesterone conversion to cortisol
Progesterone protects the prostate in males, impacts nervous system function and has a role in
osteoblast activity
Increases androstenedione and lowers DHEA—decrease vitality, weight gain and lowers
testosterone level
Androstenedione has high affinity to testosterone receptors and acts as a testosterone antagonist at
high levels
Open Book: 13-15 questions
Bolded topic listed in syllabus from Week 9-14
Week 9:
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
Exam 3
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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FINAL
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Week 12:
Pediatric
PDD
Attention Deficit Disorders pp. 77-81
Autism pp. 82-85—the DAN protocol
Otitis Media pp. 378-382
Food allergies and intolerances
Week 13:
SPECIAL TOPIC: Breast Cancer Prevention
Week 14:
Nutritional support for the elderly
Sport nutrition
Eating disorders
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Last FINAL EVER!!!
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