CLINICAL NUTRITION -- KRABBE (EX 1)

Which of the following is NOT included in the new nutrition facts label? A. larger serving sizes B. New footnote C. Updated daily values D. Smaller serving sizes

D. smaller serving sizes (because americans are fat and we now have to increase the serving size to a more realistic one....packages in between 1-2 servings must label as 2 servings....packages that CAN be eaten in 1 OR multiple servings must include DUAL COLUMN LABELING)

Limitations to the FODMAP diet (FODMAP meta-analysis PDF)

Defective gut microbiota (reduce luminal bifidobacteria, reduces total bacteria) Constipation with IBS due to the restriction/elimination of many high-fiber foods

Symptoms reduced with the FODMAP diet (IBS)

Diarrhea, bloating, abdominal pain, and flatus due to their poor absorption, osmotic activity and rapid fermentation.

_____ is required for some packages that can be consumed in one sitting or in multiple sittings

Dual column labeling

Labeling packages with more than one serving

Dual column labeling is required for some packages that can be consumed in one sitting or multiple sittings *for packages that contain 200% and up to and including 300% of the standard serving size *for packages between 1-2 servings, calories and other nutrients must be declared for the entire package rather than per serving because people typically consume the entire package in one sitting

Assignment studies

Enroll subjects to either test or control groups. Two types: 1. Randomized controlled trials (RCTs) 2. Non-randomized controlled trials

ATPase levels

Enzyme that controls the breakdown and synthesis of ATP for energy TYPE 1 FIBERS = LOW TYPE 2A - MED. TYPE 2B - HIGH (atp/phosphagen system)

Glycosylation

Enzyme-controlled addition of sugars (glucose, fructose, and galactose) to protein or lipid molecules Required for the target molecule to function---help to form and hold structures together (proteins, cell membranes, RNA, DNA)

Dietary fiber (PROBABLY NOT ON THE EXAM)

FDA definition includes naturally occurring fibers and only fibers added to foods that show a physiological health benefit

Added sugars presented in nutrition facts labels

FDA is requiring grams and % daily value for added sugars Dietary patterns lower in sugar-sweetened foods and drinks are associated w/ a reduced risk of cardiovascular disease Design clarifies that added sugars are a subset of total sugars

What diet is used to treat and relieve symptoms of GI disorders?

FODMAP (elimination diet of foods high in: fermentable, oligosaccharides, disaccharides, monosaccharides and polyols ------> 1st "R" (REMOVE))

FODMAP stands for

Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols (sugar alcohols)

Fructose absorption is generally limited to ________% of that ingested and large amounts (20-50 g) can cause ___________

Fructose absorption is generally limited to 50-60% of that ingested Large amounts (20-50 g) can cause intestinal distress as the unabsorbed portion reaches the large intestine *fructose can reduce the bioavailability of specific trace minerals that may also be present in the small intestine!*

Fructose uptake by cells is governed by ______ transport proteins and is _________

Fructose uptake by cells is governed by GLUT5 transport proteins and is insulin independent FRUCTOSE = GLUT FIVE

ADA AGEs paper

Frying, broiling, grilling and roasting = more dAGEs compared to boiling, poaching, stewing and steaming Microwaving did not raise dAGE content to the same extent as other dry heating methods

What two 'hormones' increase the activity of phosphorylase?

Glucagon and epinephrine Glucagon increases the activity of phosphorylase (B) , acting primarily on hepatic glycogen stores, producing the necessary increases in available glucose Epinephrine secretion increases w/ exercises and increases the activity of phosphorylase (A), which acts on both intramuscular and hepatic glycogen stores

Phosphorylase B

Glucagon increases this acts primarily on hepatic glycogen stores

The digestion of all carbs starts in the mouth by the action of salivary amylase, except for glucose and fructose which primarily takes place in:

Glucose & fructose absorption primarily takes place in the duodenum and jejunum, with smaller amounts in the ileum

Optimal range of glucose osmolarity for increasing the rate of hydration

Glucose content of 4-7% is of normal osmolarity, optimal for increasing the range of hydration

Which AGE is clinically monitored among people with type II diabetes?

Glycosylated hemoglobin (HbA1c) GOOD INDICATOR FOR DIABETUSSSS! elevated glycosylated hemoglobin is associated w/ lower elasticity of muscle fiber and connective tissue.

Major roles in the aging process:

Glycosylation of proteins Binding of sugars to protein can lead to proteins sticking to each other (cross-linking) CROSS LINKING = MAJOR CAUSE OF CATARACTS!

Carbohydrate uptake (liver)

Hepatocytes (liver cells) travel to the liver via the portal vein. They utilized digested and absorbed monosaccharides (glucose, fructose, galactose) Liver's clearance of fructose & galactose is much greater than that of glucose! Liver stores a limited amount of glycogen from these sugars, glucose not needed by the liver circulates to the rest of the body

What is "bonking" or "hitting the wall"?

Hypoglycemia or insufficient blood glucose Dramatically impairs athletic performance

Glucose ingested simultaneously w/ fructose:

INCREASES the absorption of the fructose Raises the tolerable amount of total fructose able to be absorbed WITHOUT GI distress

What two things lag briefly after exercise and as a result, the capacity for glycogen synthesis increases?

Increase in GLUT4 transport proteins Activity of phosphofructokinase (PFK = rate limiting enzyme in glycolysis) Lag briefly after exercise

What are the benefits of glycogen's hydrophilic nature & enabling each muscle sarcomere to retain more water?

Increases overall hydration within the muscle Greater contractile force Ability to maintain electrolyte levels Enables muscle cells to eliminate metabolic wastes and clear lactic acid during intense exercise

Sugar alcohols

Industrially produced replacement sugar sources GI issues over 50g / day usually 2kcal/g Partially absorbed from the small intestine w/ absorption ranging from 0% for lactitol to 80% for sorbitol Incomplete metabolism (10-20% of sorbitol and xylitol and 30-40% of mannitol excreted in urine)

GLUT4 transport protein

Insulin dependent Utilized in skeletal muscle for the uptake of glucose

Research on the quantity and timing of carb ingestion for glycogen repletion:

It might require carb consumption of 10g/kg of bodyweight daily & 60-70% of total cals to sufficiently replete the glycogen

GLUT2 (IT DOES 2 THINGS)

Liver, pancreas, kidneys THE ONLY GLUT RECEPTOR TO BE ABLE TO: transport glucose into cells when glucose is high in the blood OR transport glucose out of cells when blood glucose is low

Mitochondria

Located in muscle fibers Produce energy aerobically (OXIDATIVE SYSTEM) TYPE 1 FIBERS: HIGH TYPE 2 A FIBERS: MEDIUM (utilizing the fast glycolytic *anaerobic* and oxidative system *aerobic) TYPE 2B FIBERS: LOW (utilizing the phosphagen system)

Phosphagen system

Location: Muscle sarcoplasm When: During short duration, high intensity activities (0-6 sec, 6-20 sec) What: Involves the breakdown of creatine phosphate (aka phosphocreatine) & stored ATP to resynthesize ATP for immediate use....ANAEROBIC Enzyme used: Creatine kinase, accelerates the creation of ATP from CP and ADP *type 2 muscle fibers store more CP than type 1* *adenylate kinase reaction/myokinase -- another reaction to replenish ATP*

Carb restriction has the disadvantages of:

Loss of lean body mass Metabolic acidosis Dehydration

Your ability to toggle back and forth between these two metabolic states (using glucose and using ketone bodies) is a good indicator of your ________

Metabolic flexibility

What is the term used for the following definition: preferential change in metabolism from the use of glucose as a primary fuel source to the use of fatty acids and ketone bodies?

Metabolic switching (metabolic flexibility: our ability to toggle back and forth from these fuel sources)

What is the simplest form of sialic acid?

N-acetylneuraminic acid *This is the only sialic acid that is normally found in human tissues & fluids*

Glucose transport into cells

Na+ independent facilitated diffusion transport system (follows concentration gradient of glucose & does NOT use Na+) called glucose transporters (GLUT)

GLUT3

Neurons (glucose uptake from the blood)

Have they done systematic reviews/meta analyses on the "4R protocol"?

No

Mallard reaction

Non-enzymatic browning in the food, higher the amount of AGEs = more browning Exogenous: browning of bread (toast) foods high in AGEs: donuts, BBQ meats, cake, dark colored soda pop

Glycation

Non-enzyme controlled Haphazard (uncontrolled) process that impairs the function of biomolecules. 2 different types of glycation: 1. Exogenous 2. Endogenous

Neu5Gc

Normally found in human tissues & fluids IMMUNOGENIC Causes the formation of antibodies in response to its presence, specifically HD Antibodies

Replace

Object: digestive factors Amplification: insufficient digestive secretory factors with oral replacements (betaine hcl, pancreatic enzymes, digestive enzymes, marshmallow root, DGL)

Reinoculate

Object: favorable microbes Amplification: employ oral dosing of viable organisms known to help control toxin-producing specie biffidobacteria and lactobacillus - heavy on the research * (PROBIOTICS AND PREBIOTICS)

Remove

Object: microbial overgrowth Amplification: use bacteriostatic / mycostatic agents of sufficient strength to reduce excessive growth rates (fodmap diet, eliminating inflammatory foods---gluten, processed foods, refined carbs, etc)

Repair

Object: tissue and immune integrity Amplification: support the growth of healthy intestinal mucosal cells, goblet cells, and immune cell responses with key nutrients (L-glutamine, zinc, vitamin C, beta glucans, etc.) colonocytes preferred fuel source = SCFA (butyrate) small intestine preferred fuel source = glutamine

What type of study is used to determine associations between certain prior exposures and outcomes of interest?

Observational studies (cohort --> exposed, followed forward to outcome) (case control --> outcome, followed back in time to see if they were exposed)

Exogenous glycation

Occurs when food is cooked---when sugars are cooked w/ protein or fat at high temp/low time or low temp/high time. FORMS: AGEs and acrylamide (potential carcinogen) AGEs can be reactive w/ any tissue that contains the receptor for AGEs (RAGE) Tissues that contain RAGE = smooth muscle, endothelial cells, cells of the immune system (lung, liver, kidney, peripheral blood)

Myglobin content

Pigment that binds to O2 Gives the fiber a red color TYPE 1 FIBERS = HIGH (1 small red ox) TYPE 2A & 2B FIBERS = LOW (2 fast white chickens)

Metabolic switching

Preferential shift in metabolism from the use of glucose as a primary fuel source to the use of fatty acids and ketone bodies (fasting)

Advanced glycation end products (AGEs)

Proteins that have been irreversibly modified by non-enzymatic attachment of glucose or short chain aldehydes w/ amino groups and/or a high degree of oxidative stress Found exogenously in both cigarettes and in our western diet, processing of foods leading to irreversible chemical modification of amino acids....leading to a loss of EAAs and decreased protein digestibility

GLUT1 "ONE BLOOD"

RBCs and BBB (blood brain barrier) (glucose uptake from the blood)

Which of the following is generally considered to be the gold standard of clinical evidence for their strong internal validity and used to demonstrate causal relationships?

Randomized control trials

4 R protocol: REINOCULATE

Reinoculate with favorable microbes -Probiotics (lactobacillus spp., bifidobacter spp., and saccharmocyes boulardii) -Supplement with prebiotics such as inulin (chicory root fiber), xylooligosaccharides (xylose [sugar alcohol] polymers), beta glucan and fiber

4 "R" Protocol

Remove Replace Reinoculate Repair

4 R protocol: REMOVE

Remove offending foods, medications, gluten (if sensitive) Reduce poor quality fats, refined carbs, sugars and fermented foods (if yeast is present) - FODMAP diet (IBS, intestinal dysbiosis) - Antimicrobial, antifungal, and/or antiparasitic therapies

4 R protocol: REPAIR

Repair mucosal lining by giving support to healthy intestinal mucosal cells, goblet cells and to the immune systems -L-glutamine, essential fatty acids, zinc, pantothenic acid, vitamin C

Digestive factors is the object of which part of the 4 R protocol?

Replace (betaine hcl, pancreatic enzymes, marshmallow root, DGL, digestive enzymes)

4 R protocol: REPLACE

Replace what is needed for digestion & absorption -Betaine HCL -Pancreatic enzymes -Digestive enzymes -Herbs that aid in digestion (DGL and marshmallow root, dietary fiber, water)

Insulin

Secreted by the pancreas in response to any significant rise in blood glucose levels Facilitates the transport of glucose into the muscle cell (GLUT4 transport protein) Moderate carb supply & release of insulin = important for muscle cell growth, repair and structural integrity

Skeletal muscle is the only major tissue to utilize ______ transport proteins for the uptake of glucose.

Skeletal muscle is the only major tissue to utilize GLUT4 transport proteins for the uptake of glucose

Case control studies

Subjects are selected based on them exhibiting a certain outcome & tracing their history back (retrospectively) to find out whether they have had a certain exposure (i.e., used a particular drug) *good for studying rare diseases*

Cohort studies

Subjects are selected based on them having received a particular exposure, then they are followed (forward in time) until a certain outcome of interest (i.e., death) occurs

Meta-analysis

Systematic reviews where the gathered data is combined, producing an estimate of the true treatment effect from the pooled data -Commonly expressed in a FOREST PLOT (shows the individual trials included in the review as well as a diamond representing the estimate of the true efficacy / safety measure of the drug)

The end all be all in assessment is

The Cochrane Collaboration's tool for assessing risk of bias in randomized trials

Bioenergetics

The flow of energy As intensity increases, duration is shortened. An energy systems rate of production and capacity usually have an INVERSE RELATIONSHIP

AGEs in food

The more browning (maillard, enzymatic browning in food after cooking), the higher the amount of AGEs food w/ high amounts of AGEs: donuts, BBQ meats, cake, dark colored soda pop

Retrogradation

The process when digestible starches are converted into resistant starches *type 3 resistant starches = when certain starchy foods (potatoes, rice) are cooked then cooled*

De novo lipogenesis

The synthesis of fatty acids from dietary carbohydrate rather than fatty acids in the liver

What of the following is the easiest diet "framework" to implement?

Time restriction

Which is the simplest dietary prescription of the three components of dietary behavior?

Time restriction (TR) Limit your eating to a window of a certain number of hours

Fats

Trans fat remains on the label FDA's final determination on partially hydrogenated oils does not impact naturally occurring trans fat "calories from fat" is not longer permitted TYPE OF FAT IS MORE IMPORTANT THAN THE AMOUNT!

Capillary density

Transport O2 and nutrients to muscle and help remove waste products TYPE 1 FIBERS = HIGH (aerobic only) TYPE 2A FIBERS = MEDIUM (anaerobic & aerobic) TYPE 2B FIBERS = LOW (anaerobic)

T or F: Carbohydrate consumption less than 150 g per day depletes total glycogen stores and can lead to further catabolism of skeletal muscle and other body proteins if sustained.

True

T or F: neither plasma glucose nor insulin levels are affected by sugar alcohol absorption and metabolism

True

4 types of resistant starch: (probably NOT on exam)

Type 1 = grains, seeds, legumes Type 2 = some starchy foods, raw potatoes and green (unripe) bananas Type 3 = formed when certain starchy foods (potatoes and rice) are cooked and then cooled, the digestible starches are converted into resistant starches via retrogradation Type 4 = man-made, formed through chemical processes

3 different type of muscle fibers:

Type 1: slow twitch -High mitochondrial content -Red muscle -anaerobic "1 slow red ox" Type 2a: fast twitch -Medium mitochondrial content -anaerobic & aerobic Type 2b: fast twitch -White muscle -Low mitochondrial content -only anaerobic "2 fast white chickens"

Ways to decrease AGEs in foods/while cooking

Using marinades

Vitamin & mineral changes

Vitamin D and potassium will be required on the label. Calcium and iron will continue to be required. Vitamins A and C will no longer be required but can be included on a voluntary basis -Daily values for nutrients like sodium, dietary fiber and vitamin D are being updated based on newer scientific evidence from the Institute of Medicine and other reports such as the 2015 Dietary Guidelines Advisory Committee Report

Side effects of sugar alcohols are dose dependent but can cause GI problems such as:

Water stool Diarrhea Nausea Borborygmi (stomach grumbling / bowel sounds)

Phosphorylase A

epinephrine secretion increases w/ exercise and increases the activity of this acts on both intramuscular and hepatic glycogen stores

0-6 second activities

extremely high intensity fueled mainly by phosphagen system ex: jumping, sprinting

low carb and carb-restricted diets require ______ to generate sufficient glucose for normal brain & neurological activity

gluconeogenesis = allows for the use of amino acids to form glucose gluconeogenesis also creates ketone bodies

HBa1c

glycosylated hemoglobin (measured to test for diabetes)

30 sec - 2 min acitvities

high intensity fueled mainly by fast glycolysis (anaerobic)

longer than 3 min acitvities

low intensity fueled mainly by oxidative system

From LOWEST quality to HIGHEST quality for evidence (research studies)

lowest strength of evidence (observational studies): case control cohort medium strength of evidence (assignment studies): non-RCT RCT highest strength of evidence (synthetic studies): systematic review meta-analysis

Carbohydrate loading

maximizing glycogen stores before an endurance event by diet and training 3-4 days of carbohydrate restriction, body attempts to compensate by increasing its production of the enzyme needed to store glycogen followed by 2-3 days of high carb intake day of comp: muscle glycogen at ~300% of what they would be otherwise

2-3 min activities

moderate intensity fueled mainly by fast glycolysis & oxidative system

Systematic reviews

present a comprehensive analysis of the full range of literature on a particular topic, typically an intervention, diagnostic test or prognostic factors *Importance of reproducibility is to reduce bias from selective inclusion of studies

Endogenous AGEs

produced in the body appear in the plasma and accumulate w/ senescence (deterioration over time, aging) in various tissues including cardiac tissue. AGEs accumulation occurs in pathological situations such as cardiac dysfunction, renal failure, and alzheimer disease, independent of diabetes. CARDIAC DYSFUNCTION ==== AGES DECREASE NITRIC OXIDE == STIFFNESS == DECREASES CARDIAC KINETICS

GLUT5

small intestine and testes, primarily a fructose transporter GLUT FIVE = FRUCTOSE

Efficiency (fuel consumption analgody)

the higher the fuel efficiency the less fuel is burned and/or less force is produced like a moped. A muscle car with a large V8 engine will produce a lot of force, but will not be very fuel efficient. TYPE 1 FIBERS = HIGH EFFICIENCY TYPE 2 A FIBERS = INTERMEDIATE EFFICIENCY TYPE 2B FIBERS = LOW EFFICIENCY

T or F: only carbohydrates can be broken down for energy w/o o2

true

6-30 second activities

very high intensity fueled mainly by phosphagen & fast glycolysis system

A patient reports great success with diet. Using diet of all celebs----low carb diet. Based on following info, what is the cause of the 11 pound weight loss in the first week?

•Glycogen's hydrophilic nature enables each muscle sarcomere to retain more water, increasing the overall hydration within the muscle, allowing for greater contractile force. •Intracellular water constitutes 53 and 65% of total body water and is responsible for each cell's ability to maintain electrolyte levels via simple or facilitated diffusion. •It also enables muscle cells to eliminate metabolic waste products more effectively and to clear lactic acid during intense exercise. Glycogen is partly made of water, so when glycogen is burned for energy, it releases water, resulting in weight loss that's mostly water. LOW CARB = LOW GLYCOGEN STORES = ADD IN CARBS = INCREASE GLYCOGEN STORES = BURNING MORE GLYCOGEN AS ENERGY = WATER RELEASED FROM MUSCLES!! WOOOO!

Randomized controlled trials (RCTs)

*gold standard of clinical evidence for their strong internal validity & are used to demonstrate causal relationships between experimental variables & outcomes -Randomly assigning patients to either treatment or control groups establishes equal groups (eliminates sample selection bias) -Prospective follow-up & the use of a control group allows for comparison of the experimental variable (i.e., a new drug) against a standard treatment or placebo

Observational Studies

-Conducted in order to determine associations between certain prior exposures (i.e., a drug) & outcomes of interest (i.e., death) -Cohort studies & Case control studies are two major types of observational studies THE LOWEST AS FAR AS STRENGTH OF EVIDENCE GOES

Synthetic studies

-HIGHEST FORM OF CLINICAL EVIDENCE -Systematic reviews & meta analysis = critically evaluate the literature by CONSOLIDATING THE RESULTS of several studies focused on the same topic -Synthetic studies are part of the trend of comparative efficacy analyses (CEAs) -- gathering data on several major drugs used for the same purpose & determining which are superior

A few studies completed found the following: 4 days of TRF (18 hr. fasting window) had ________ ketone levels. A one week 5:2 IF regimen (5 days normal eating, 2 non-consecutive days completely fasted no food intake) raised ketones levels up to _________.

0.15 mM 2.58 mM 4 days of TRF (18 hour fasting window) had 0.15 mM ketone levels.1 A one week 5:2 IF regimen (5 days normal eating, 2 non-consecutive days completely fasted-no food intake) raised ketones levels up to 2.58 mM."

Plasma ketones generally increase to ________ during the first 24 hours of fasting in humans.

0.2-0.5 mM

Carbohydrate facts (intro)

1. Carbs account for ~70-80% of the cals consumed worldwide, and ~50% of the cals in the US 2. National academy of sciences, food and nutrition board's latest DRI for americans: carbs should make up 45-65% of the cals in the diet *HUMANS CANNOT BREAK DOWN BETA 1-4 GLUCOSE*

Type 2B fast twitch fibers

1. Contract extremely rapidly 2. Forceful muscle contraction 3. Fatigue quickly 4. White fibers 5. CAN ONLY USE ANAEROBIC ENERGY SOURCES 6. Good for speed, strength and power type activities Ex: heavy weight training (1-3 reps), power lifting, and 100 meter sprints

Type 1 Slow twitch fibers

1. Contract slowly 2. Can contract repeatedly over long periods 3. Good blood supply (red fibers) 4. Endurance activities 5. Aerobic energy system 6. Smaller, develop less force Ex: walking or cycling for 30 min. at a low intensity would use mainly slow twitch fibers

Dietary behavior defined:

1. Dietary restriction (DR) "what you eat or don't eat" 2. Caloric restriction (CR) "how much you eat" 3. Time restriction (TR) "when you eat or don't eat"

Type 2A fast twitch fibers

1. Fast contraction speed 2. Aerobic energy sources and anaerobic energy sources can be used 3. White fibers, less reliant on O2 supplied by the blood for energy 4. Fatigue faster 5. Good for speed, strength and power type activities Ex: moderately heavy weight training (8-12 reps) and fast running events (400 meters)

"Effects of Intermittent Fasting on Health, Aging, and Disease" in The New England Journal of Medicine

1. IF has benefits for many health conditions -- DM, Cardiovascular disease, cancers, neurologic disorders 2. beneficial effects of IF involve metabolic switching and cellular stress resistance 3. Reducing food availability over a lifetime (caloric restriction) has remarkable effects on aging and the life span in animals 4. Periodic flipping of the metabolic switch not only provide the ketones that are necessary to fuel cells during the fasting period but also elicits highly orchestrated systemic and cellular responses that carry over into the fed state to enhance mental and physical performance as well as disease resistance

Effects of IF on health, aging and disease points out the following:

1. Many studies have shown that the benefits of IF are independent of its effects on weight loss (you don't have to lose weight to benefit from IF) 2. Ketone bodies produced from fasting are not only used for fuel, but are also signaling molecules 3. Ketone bodies have profound effects on metabolism & are known to influence health & aging

3 basic energy systems that produce ATP in mammals:

1. Phosphagen system -- m. sarcoplasm, short term, high intensity, CP + ADP = ATP (enzyme: creatine kinase), anaerobic 2. Glycolytic system -- m. sarcoplasm, anaerobic 3. Oxidative system -- m. mitochondria, primary source of ATP at rest, aerobic process

Fibers role in human nutrition:

1. Promotes satiety 2. Reduces cholesterol (lowering the risk of heart disease) 3. Whole foods naturally contain fiber (less processed) 4. Viscous fiber for the upper GI 5. Fermentable fiber for the lower GI (esp. colon)

The GI of food is affected by:

1. Protein content 2. Fiber content 3. Water content 4. Acid content of the meal WHICH ALL DELAY GASTRIC EMPTYING!

Butyrate beneficial effects on the colon:

1. Reduces pH level 2. Reduces inflammation (good for IBD: Ulcerative colitis, crohn's, constipation, diverticulitis, diarrhea) 3. Inhibits carcinogenesis 4. Promotes satiety 5. Lowers blood sugar levels after meals

Purpose of the update to nutrition facts labels

1. Reflects updated scientific info, including the link between diet, chronic diseases and public health 2. Updated serving sizes 3. Format draws attention to CALORIES & SERVING SIZES

Reduced carb diets

1. reduces the body's supply of antioxidant and phytonutrients (which help prevent cancer, heart disease and other diseases) 2. high carb diets can offer protection against obesity & other diseases---research: more carbs = lower BMI and lower blood lipid levels

Carb intake for extreme exercise program

10-12 g/kg of body weight per day

Minimum threshold level of ketosis appear to be ______ in mice

1mM

Minimum threshold level of ketosis

1mM in mice Plasma ketones generally increase to 0.2-0.5 mM during the first 24 hours of fasting in humans •The few studies completed found the following: 4 days of TRF (18 hour fasting window) had 0.15 mM ketone levels.1 A one week 5:2 IF regimen (5 days normal eating, 2 non-consecutive days completely fasted-no food intake) raised ketones levels up to 2.58 mM.2

14C-labelled experiments w/ various sugar alcohols, categorized their caloric values at approx:

2kcal g-1 energy

Current institute of medicine guidelines for carb intake

45-65% of daily caloric intake

Carb intake for moderate duration / low intensity (elliptical 3x/week, pretty sedentary)

5-7 g/kg of body weight per day

Carb intake for moderate to heavy endurance training

7-12 g/kg of body weight per day

How many g/kg/day carbs are recommended for moderate to heavy endurance training?

7-12 g/kg/day (low intensity = 5-7 g/kg/day) (extreme exercise = 10-12 g/kg/day)

AGEs in bacon

91,577

What quarter sucks the most?

9th

What is the max ingestion capacity without adverse effects for sorbitol?

>50 g per day

Glycemic index (GI) (NOT IN THE EXAM)

A measure of the speed at which various carbohydrates are digested into glucose, absorbed, and enter the bloodstream. 2 m/c used glycemic indices = white bread and glucose as references (GI=100)

Blood TSA (total sialic acid) may be regarded as a useful marker for:

A variety of cancers Could be reliable in predicting early malignant change progression & metastasis during both therapy and follow up

What is not a reason for the update to the nutrition facts label? A. the new format is cheaper B. the new format reflects scientific info, include the link between diet and diseases C. The new format draws attention to calories and serving sizes D. serving sizes were updated to reflect changes in amounts of food consumed

A. the new format is cheaper

Maillard reaction

AGEs are created through a non-enzymatic reaction between reducing sugars and free amino groups of proteins, lipids or nucleic acids. (this process = maillard reaction /browning reaction) INCREASED BROWNING = INCREASED AGEs

AGEs and nitric oxide

AGEs can inhibit NO activity through binding to RAGE, decrease the levels of NO by reducing the endothelial NO synthase activity. Reduction of NO = AGEs promote cardiac stiffness .... AGEs-RAGE interaction increase vascular permeability causing impaired cardiac wall kinetics.

The effects of intensity and duration (bioenergetics)

ATP/Phosphagen --> ATP/Phosphagen & fast glycolysis --> Fast glycolysis --> Fast glycolytic & oxidative --> oxidative high intensity / short duration --> low intensity / long duration

GLUT4

Adipose and skeletal muscle (glucose uptake from the blood) INSULIN DEPENDENT

How should you incorporate the three components of dietary behavior?

Always use one Use two often Use all 3 sometimes

Glycolytic System

Anaerobic Location: muscle sarcoplasm

colonic salvage

Anaerobic fermentation and absorption of end-products of CHO, fiber, and AA breakdown

Oxidative system

Anaerobic process Location: Mitochondria of muscle cells PRIMARY SOURCE OF ATP AT REST

Anaerobic vs. Aerobic

Anaerobic: no O2 required (ex: phosphagen and glycolytic systems) Aerobic: needs O2 (ex: oxidative system)

As blood glucose levels rise, there is a decrease in _______

As blood glucose levels rise, there is a decrease in lipolysis and the subsequent use of fatty acids for energy. Elevations in BG concentrations tend to spare the body's oxidation of fat---inhibiting weight loss.

Which of the following is MOST TRUE regarding glycation? A. glycation helps form and hold our cellular structure intact B. Glycation is non-enzyme controlled C. the two different types of glycation are homogenous and heterogenous D. Glycation is enzyme controlled

B. Glycation is non-enzyme controlled (types = exogenous & endogenous, uncontrolled process)

Motor neuron size

Bigger motor neurons allow nerve impulses to operate more quickly TYPE 1 FIBERS = SMALL TYPE 2A FIBERS = LARGER TYPE 2B FIBERS = BIGGEST

Preferred fuel of the cells that line the colon

Butyrate (a short chain fatty acid)

Some AGEs are benign. but many are reactive and are implicated in many age related chronic diseases such as:

CVD Alzheimer's disease Cancer (acrylamide) Peripheral neuropathy Deafness

Glycolytic capacity

Capacity of the muscle fibers to store & breakdown glycogen for use as a high intensity energy source TYPE 1 FIBERS = LOW TYPE 2A FIBERS = HIGH (fast glycolytic & oxidative) TYPE 2B FIBERS = HIGH (phosphagen)

Oxidative capacity

Capacity of the muscle to use oxygen for energy production TYPE 1 FIBERS = HIGH (oxidative system -- aerobic) TYPE 2A FIBERS = MEDIUM (oxidative *aerobic* & fast glycolytic *anaerobic) TYPE 2B FIBERS = LOW (phosphagen *anaerobic*)

Only ______ can be broken down for energy without oxygen.

Carbohydrates

Carbs vs. Lipids in Energy Storage

Carbs = more oxygen efficient Dietary fat = preferentially stored Dietary carbs = preferentially oxidized