MBooms Clinical Nutrition Exam 1

what nutritional assessments should be conducted on active patients/athletes?

anthropometrics

nutrition-focused physical exam

health and diet history

biomarkers

how are carbs stored in the body? where?

glycogen

liver and muscle (most)

what are the different carb needs for each category:

low-intensity (

3-5g/kg

5-7g/kg

6-10g/kg

8-12g/kg

before a workout, carb intake should follow what rule

#g/kg same as # hour before workout

4 hours before - 4g/kg

3 hours before - 3g/kg

closer to an event, what types of carbs should be limited

fiber

chosoe liquid/easily digestible carbs

during exercise, what kind of carbs should be taken in? how often?

for 30-75 minutes of activity use mouth rinse of glucose + electrolyte

longer duration requires glucose + fructose, 30-90g per hour of activity

after exercise, what should the carb intake be?

1-1.2g/kg per hour for 4 hours

after exercise, carbs should be taken with ___ to enhance glycogen storage

protein

who needs to carb load?

endurance atheltes

what does carb loading do

improve performance slightly

extend duration by 20%

what does carb loading involve

reft 48hr prior to event

intake carb 10-12g/kg/day

what type of exercise causing more lipid burning

low intensity, long duration

when ds the crossover effect take place

oxygen availability is high leading to fat burning

what are the general lipid recs for athletes

saturate and trans fats to MINIMUM

you want MUFA and PUFAs

do omega-3s impac athletic performance

no

what sources of fats are prefered

plant and fish

what are the lipid requirements before, during, and after exercise?

before - 20-35% lipid in diet, omega-3s several days/wk

during - not necessary

after - no recs

which method of meausring protein utilizes pigs

DIAAS

what are the best sourcesof protein

casein, whey, cows milk, egg, fish, beef, soy protein isolate

what are complete sources of protein

contain all 9 indispensable AA

all animal proteins except gelatin and some collagen

soy, quinoa, amaranth

what are incomplete proteins

deficient in 1 or more of the 9 indispensable AA

most plants

what AA is corn deficient in

lysine, tryptophan

what AA are wheat, rice, and most grains deficient in

lysine, threonine

what AA are nuts and seeds deficient in

lysine

what AA are legumes, lentils, peas, veggies deficient in

mehtionine

what is the most ocmplete plant protein

soy

what is the protein quantity that showed the best effect on protein synthesis

20g before workout

what type of whey is easiest to absorb

hydrolyzed whey

which whey is lactose-free and has at least 90% protein

whey protein isolate

what dose of protein is generally recommended at a time

about 20 grams

how much fluid intake is recommended during exercise

7-10 ounces every 10-20 minutes

what are some conditions that may increase fluid requirements

training in heat, cold, at altitude

endurance sports recovery drinks should have what ratio of carbs:protein

what are some examples

4g carbs: 1g protein

low-fat chocolate milk

1 cup low-fat milk + 1 small banana

strength sports recovery drink should have what ratio of carbs: protein

examples?

2-3g carbs: 1g protein

1 cup low fat milk + greek yogurt with granola

smoothie with milk, fruit, ice, whey

if muscle cramps are due to fatigue or overload, will dietary changes help?

no

if muscle cramps are due to heat/sweat, what changes can be made in the diet

1/2 tsp salt dissolved in 2 cups gatorade

drink half now, rest in 10-15 minutes

what water-soluble vitamins are recommended for athletes?

thiamin

niacin

vit C

B6, B12, folate

what fat-soluble vitamins are recommeneded for atheletes

vit E, A, D

what minerals are required for athletes

calcium, magnesium, sodium, chloride, potassium, iron, zinc

when training at altitude, what micronutrients are of concern

iron, vit c

what micronutrients are of concern for female atheletes

iron, calcium, vit D, vit K

what micronutrients are of concern for vegetarians/vegans

iron, zinc, B12

what micronutrients are of concern for high carb diets

high carbs - thiamin, zinc

what is aprotein that gives structure an dfunction to tendons, ligaments, cartilage, and bone

collagen

what are gelatin and vit c good for

increase collagen synthesis

does grass-fed collagen produce greater effects

no, collagen is determined by the animals genes

is bone broth a goof source of protein

no

what nutrients can be used to prevent injury

protein, Vit C E D, calcium, copper, omega-3s

how can stress fx be prevented

protein, calcium, vit D

what is most important for bone nutrition

protein

what is most important for protein synthesis

magnesium, zinc

protein imbalance in comb with ___ decreases boen mineral density

calcium

high animal protein intake + low calcium ___ the risk of fx

tripled

high protein intake ___ acid load of the diet causing ___ bone mineral density

increase, decrease

higher acid load is associated with what

lower bone mineral density

what minerals are protective and decrease acid load

potassium, calcium, magnessium, phosphorus

people with achlorhydria (using PPIs) should supplement with what type of calcium? why?

calcium citrate - calcium carbonate requires an acidi environment

excess Vitamin ___ is bad for bone

A

what is the biomarker for Vitamin D

25-hydroxy

what vitamin is required to make osteocalcin? what food sources is it in?

K

dark leafy greens

what should be avoided to protect bone

heavy alcohol intake, high caffeine intake, excessive fiber intake

what ratio of Ca:P do we want

>1

what is the energy requirement during acute phase of injury? what carb:protein ratio do we want?

2750-3250 Cal

2:1

what supplements should be used during acute phase injury

5g fish oil

creatine 20g/day

2000IU vit D

maybe HMB (leucine)

what is protein intake for functional phase of injury

collagen or gelatin (powdered) with Vit C

20g collagen + vit C 30-60min prior to training

what should be avoided in functional stage inury

bone broth

alcohol

what if nutrition for functional phase injury

carbs: 3-5g/kg (max 60% energy)

lipids: 0.8-2g/kg (20-25% energy)

protein: 2-3g'kg

what are dietary recs during TBI

25-30kcal/kg

1-1.5g/kg protein

increase dietary Vit E

add supplements of omega-3s, vit D, zinc, magnesium, creatine

are omega-3s recommened for prevention of TBI

no

what are the big 9 food allergies

peanuts, tree nuts, shellfish, egg, dairy, soy, wheat, sesame, fish

what is the difference between a food allergy and a food intolerance?

allergy - immune response, IgE

intolerance - metabolic, toxic, pharmacologic, undefined mechanism

what are symptoms of Type I allergic reactions

anaphylactic shock, urticaria, asthma

IgE mediated

what are some ways allergies can be prevented during pregnancy

healthy diet

do not avoid

fish oils may decrease risk

probiotics may decrease risk

what are some ways allergies can be prevented in infancy

breastfeed at least 4 months

no maternal dietary restrictions

infants at risk should use hydrolyzed formula

SOY formula NOT recommended

intro of allergens at 4 months

what happens in the body during the 2nd exposure to an allergic protein

plasma cell produces IgE antibodies

IgE binds to mast cell and triggers degranulation

during the early phase of the second exposure, what is happening

vesicles releasing histamine and proteases

during late phase of the second exposure, what is happening (2-8 hours later)

synthesize prostaglandins, leukotrienes, TNF, IL-4,5,13

what are some symptoms of mast cell mediators during Type I hypersensitivity

vasodilation, smooth muscle spasm, cellular infiltration

can you diagnose an adverse reaction to food without a clinical response

no

what is the gold standard for dx food allergy

oral food challenge

what two tests are used in combination to determine allergy

skin prick

serum specific IgE - blood draw

what do 95% positive predictive values tell us

we are 95% sure they have an allergy

what is an elimination diet

1. avoid food for 2-4 weeks

2. s/s disappear

3. reintroduce food

4. s/s return

5. avoid again

what is an empiric diet

1. eliminate cereal, milk, eggs, fish/seafood, peanuts/legumes, soy for 6 weeks

2. reintroduce 1 food at a time

what does the oral food challenge involve

1. elimination diet for at least 2 weeks prior

2. gradually increase amounts of suspected food

3. Doctor observing

if GI related, elimnation diet 6 weeks prior

what are some unvalidated measures of diagnosing allergies

hair analysis, applied kinesiology, allergen-specific immunoglobulin G4

if the person has high IgG, are they more or less likely to have allergies

less

what are the s/s of eosinophilic esophagitis

infants: feeding aversion, food intolerance, poor growth

toddlers: vomit

school-aged: abdominal pain

adolescents: dysphagia, food impaction

how is eosinophilic esophagitis diagnosed

biopsy of esophagus

what are some ddx of food allergies

infxn, GI disorders, celiac, cystic fibrosis, pancreatic insufficiency, IBD, anatomic defects, metabolic disorders, drugs

how are food intolerances typically diagnosed

clinical hx, skin prick, serum specific IgE, elimination + rechallenge

how are food allergies diagnosed

clinical hx, skin prick, serum specific IgE, elimination diet + rechallenge

what are the most common food intolerances

lactose (milk sugar), gluten

what are the nutrients of concern for milk alelrgy

vit D, B12, riboflavin, calcium, iodine, protein

what are the nutrients of concern for soy allergy

folate, vit K, fiber, iron, copper

what are the nutrients of concern for egg allergy

biotin, B12, selenium, Vit D, riboflavin

what are the nutrients of concern for fish allergy

omega-3s, iodine, zinc

what are the nutrients of concern for shellfish allergy

zinc, magnesium

what are the nutrients of concern for grain allergy

fiber, thiamin, niacin, magnesium, folic acid, iron

what are the nutrients of concern for peanut and tree nut allergy

Vit E, magnesium