1. Exam please check registrar’s final version of the exam schedule 180 minutes 120 multiple choice questions-120 points -4 short answer question-60 points multiple choice-lecture 7a-12c inclusive short answer-whole term

2. Note Nutrition 2106-Fall 2014- Principles of Nutrition in Metabolism Nutrition 2101-Nutritional Assessment- Theory-Fall 2014 Nutrition 2107- Introduction to Sports Nutrition-Winter 2015

3. Nutrition care plan/essay Due on time please-if problems please ensure I know in advance

4. Lecture 11a 24 MARCH 2014 Arthritis and Dermatitis

5. Osteoarthritis (OA) -involves swelling of the joints -overweight – causes wear of cartilaginous surfaces -such wear results in loss of chondroitin sulphate and glucosamine which are carbohydrate polymers

6. Rheumatoid arthritis (RA) -autoimmune attack that in part involves loss of chondroitin sulphate and glucosamine

7. Nutrition approaches to Arthritis -appropriate nutrition and exercise may prevent weight gain thus avoiding that cause of osteoarthritis

8. Nutrition approaches to Arthritis nutraceuticals -chondroitin sulphate -glucosamine -both of these nutraceuticals are meant to replace lost chondroitin sulphate and glucosamine -both readily available over the counter (OTC) and are useless

9. Nutrition approaches to Arthritis Nutraceuticals -fish oils reduce arachidonic derived pro- inflammatory eicosanoids while producing anti- inflammatory eicosanoids in RA but not OA -evening primrose oil, blackcurrant oil, and borage oil reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory eicosanoids in RA but not OA -review pathways involved for nutraceutical oils

10. Class activity-what is the best nutritional approach to arthritis? Why?

11. Dermatitis Atopic (eczema) -skin inflammation that is due to an immune response -can be due to a food allergy -solution -avoid food allergen

12. Dermatitis-nutraceutical -fish oils reduce arachidonic derived pro- inflammatory eicosanoids while producing anti- inflammatory eicosanoids -evening primrose oil and borage oil reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory eicosanoids -as with RA many of these trials include subjects that are on anti-inflammatory prescribed drugs- what is the impact of this?

13. Dermatitis Sebborheic (scaly) -can be due to biotin deficiency solution: avoid biotin deficiency - can be due to riboflavin deficiency solution: avoid riboflavin deficiency

14. Scaling eczema-like dermatitis -can be due to linoleic or  -linolenic acid deficiency -this may be a problem with long term TPN

15. Nutritional remedy for dermatitis (types above) in general -topical application of retinoids (similar in structure to vitamin A) -reduces dermatitis -avoid linoleic or  -linolenic acid deficiency

16. Dermatitis herpetiformis -causes skin lesions pruritic-itching vesicular-vesicles papular-solid elevation of the skin - all of these lesions are consistent with coeliac disease and are relieved by a gluten-free diet

17. Lecture 11b 24 MARCH 2014 Colitis, Migraine and Respiratory

18. Colitis Inflammation of the colon Diarrhea is an issue since the inflamed colon is incapable of its normal water management function- i.e. removing water from the faeces Complete bowel rest helps

19. Ulcerative colitis Treatment Complete resection (removal) of colon No nutritional implications but may be diarrhea initially This diarrhea is transient and apparently self- correcting Evening primrose oil may have some limited success for this type of colitis in terms of stool consistency but this contradicts self-correcting diarrhea

20. Diversion colitis Surgical diversion process by which the distal colon is left intact but without the stool stream This results in abdominal cramping with mucoid or bloody diarrhea Infusion of salt solution containing short chain fatty acids(scfa) (2-4 carbon fatty acids) into rectal remnant is a remedial measure but complete reanastomosis is the only complete cure

21. Migraine Dural blood vessels become dilated and the pulsatile blood flow through these vessels distends and irritates the highly pain sensitive dura mater -this would explain the throbbing nature of migraine headaches -inflammatory component to migraine headache has been proposed

22. Nutritional management of migraine Riboflavin administration Metabolites of riboflavin participate in overcoming the mitochondrial defect that that plays a role in migraine pathogenesis Avoiding foods-Certain foods in certain persons trigger migraines -however this is highly individual with one food or group of foods affecting a particular person but not another

23. Nutritional management of migraine However dietary restriction of a food or food groups may upset the principles of adequacy, moderation, variety, nutrient density, energy control, and balance

24. Migraine Foods contributing to migraine: Citrus foods Tea(flavonoids) Coffee Pork Chocolate Milk Nuts Vegetables Cola

25. Migraine -food components affecting vascular tone and causing migraine (highly individual): tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate), aspartame, caffeine

26. Migraine -foods thought to trigger migraines subsequent to hypoglycemia are: chocolate, cheese, citrus fruits, bananas, nuts, cured meats, dairy products cereals, beans, hot dogs, pizza, food additives coffee, tea, cola drinks, alcoholic drinks such as red wine, beer or whiskey distilled in copper stills

27. Migraine -solution to all this is trial and error elimination of foods including meticulous record keeping

28. Respiratory Acute respiratory failure Need sufficient energy and protein to support lung function and prevent infections without overtaxing the compromised respiratory system Fluid and sodium restrictions may be necessary to ease pulmonary edema

29. Respiratory Acute respiratory failure Overfeeding causes increased carbon dioxide which results in additional respiratory requirement- therefore reduce kcal to an appropriate level(energy to support lung function and prevent infections without overtaxing the compromised respiratory system)

30. Respiratory Aspiration pneumonia Potentially lethal lung infection Nasogastric feeding or gastrostomy or jejunostomy which allows the lower esophageal sphincter to remain closed -all this helps to reduce aspiration risk

31. Respiratory Chronic obstructive pulmonary disease (COPD) Emphysema and chronic bronchitis are the two most common examples of chronic obstructive diseases COPD patients frequently experience: -weight loss, protein energy malnutrition (PEM) and infections due to anorexia -poor food intake and high energy expenditure both due to laboured respirations

32. Respiratory Chronic obstructive pulmonary disease addressed by: Weight loss (caloric restriction combined with appropriate exercise levels) Malnourishment- gradual re-feeding as tolerated -easy to eat foods in small meals to improve food tolerance- enteral feeding may help -need fewer kcal from carbohydrate due to carbon dioxide issue Avoid overfeeding –carbon dioxide load issue

33. Respiratory Cystic fibrosis Laboured breathing- increased kcal and protein and do not restrict fat Enzyme replacements for pancreatic impairment Multivitamin including fat soluble vitamins Table salt to overcome electrolyte losses due to sweating Additional fluids to liquefy thick secretions and prevent dehydration Maintain appropriate height to weight ratio

34. Lecture 11c 24 MARCH 2014 Ulcers, Pruritis

35. Ulcers Generally refers to peptic ulcer-an erosion of top layer of cells from the lining of the esophagus stomach or small intestine Ulcers may also develop in the mouth, upper esophagus and large intestine

36. Ulcers and Nutrition Patient should: -relax during meals, eating slowly, chewing thoroughly, -avoid overeating, alcohol, caffeine and caffeine containing beverages, decaffeinated tea and coffee, and except as tolerated pepper-containing and spicy foods Evening primrose has been proposed to help but this proposal is subject to problems such as small subject numbers and poorly controlled studies

37. Pruritis -this is itch -can result from liver and kidney disease, cancers, parasites, aging and dry skin, and contact dermatitis

38. Pruritis and Nutrition - nutritionally address each of diseases generating the pruritis, address life cycle issues (aging and dry skin frequently go together) or address aging or dry skin separately as appropriate -contact dermatitis can be dealt with as per earlier mention of dermatitis -Evening primrose oil has had controversial success in this regard (i.e. pruritis)