BMS 305 Exam 2 Review Guide.docx

BMS 305 C LINICAL N UTRITION D R . B ERGMAN R EVIEW G UIDE – E XAM 2 1. Discuss the body’s use of glucose and how it is metabolized within the human body for energy. - glucose is used throughout the body to produce energy (ATP). Essential for the brain, nervous system and red blood cells. Once split it can resemble but if split into smaller pieces it's irreversible. 2. What is Ketosis? - Burning fat creates ketones meaning a shift in body’s metabolism towards fat b/c you are not giving it glucose which causes a disruption of acid-base balance (affects pH of blood, ect..) 3. What is the DRI minimum of digestible carbohydrates? - The minimum is 130g/day of healthy carbs to protect the muscle 4. Describe how glucose is regulated using insulin and glucagon. How is glucose stored and accessed in the body? - Glucose regulation involves insulin and glucagon, two hormones produced by the pancreas. - Insulin promotes the uptake of glucose by cells, lowering blood glucose levels (Signals body tissues to take up glucose) - Glucagon stimulates the release of glucose from storage sites like the liver, raising blood glucose levels. Glucose is stored in the liver and muscles as glycogen, which can be accessed when energy demand is high. (Triggers breakdown of glycogen) 5. What occurs to excess glucose after it is absorbed into the blood stream? - Excess glucose absorbed into the bloodstream is either used immediately for energy, stored as glycogen in the liver and muscles, or converted to fat for long-term storage. 6. Define glycemic index and glycemic load. How are both used by doctors regarding diabetic patients? - Glycemic index (GI) measures how quickly a carbohydrate-containing food raises blood glucose levels, while glycemic load (GL) considers both the quality and quantity of carbohydrates in a food. Doctors use these measures to help diabetic patients manage blood sugar levels by choosing foods with lower GI and GL. 7. Summarize the causes and management of diabetes (both type I and type II). - Type I diabetes is an autoimmune condition where the body's immune system attacks the insulin-producing cells in the pancreas, requiring insulin therapy for management. - Type II diabetes involves insulin resistance and impaired insulin secretion, often managed with lifestyle modifications, medications, and insulin therapy if necessary. 8. What is an example of modifiable vs non modifiable risk of diabetes? - Modifiable Risk (physical activity, obesity, food, ect - Non-modifiable Risk = genetics, ect 9. What is the blood sugar range for a pre-diabetic vs a non diabetic?

- non-diabetic individual (without diabetes), the fasting blood sugar level is typically below 100 mg/dL - pre-diabetic individual (those at risk of developing diabetes), fasting blood sugar levels may range from 100 to 125 mg/dL - diabetic individual (those diagnosed with diabetes), fasting blood sugar levels are usually above 126 mg/dL 10. Discuss the consequences/complications (both acute and chronic) for diabetes mellitus. - Consequences of diabetes mellitus include both - Acute complications like hypoglycemia and hyperglycemia, as well as Diabetic Ketoacidosis, Hyperosmolar hyperglycemic nonketotic state, Dawn phenomenon and Somogyi effect. - Chronic complications such as cardiovascular disease, neuropathy, nephropathy, and retinopathy. 11. How does metformin work in type 2 diabetes? - Liver Control: It curbs excessive glucose production in the liver. - Better Insulin Sensitivity: It helps muscle and fat cells respond more effectively to insulin, allowing them to absorb glucose from the blood. - Reduced Intestinal Absorption: It might also lower the absorption of glucose from the intestines into the bloodstream after meals. - Overall, metformin helps regulate blood sugar levels by curbing liver glucose production, enhancing insulin sensitivity in tissues, and potentially decreasing the uptake of glucose from the intestines. It's a go-to treatment due to its effectiveness and safety. 12. What is Neuroglycopenia? - The loss of consciousness, brain damage, even death due to hypoglycemia. Could be induced by overgiving insulin. 13. What is Hyperosmolar hyperglycemic nonketotic state? - serious complication of diabetes characterized by extremely high blood sugar levels, severe dehydration, and an increased concentration of blood osmolality. Unlike diabetic ketoacidosis (DKA), HHNS typically occurs in type 2 diabetes and is characterized by the absence of significant ketosis. It can be triggered by factors such as infections, certain medications, or inadequate fluid intake. HHNS requires immediate medical attention and treatment to normalize blood sugar levels and restore hydration. 14. What is the Dawn phenomenon and how is it different in diabetic individuals? - The Dawn phenomenon is a natural rise in blood sugar levels that occurs in the early morning hours, usually between 3:00 AM and 8:00 AM, in both diabetic and non-diabetic individuals. However, in diabetic individuals, this rise in blood sugar can be more pronounced due to a combination of factors, including the release of hormones such as cortisol, growth hormone, and adrenaline during the early morning hours. This can lead to higher-than-normal blood sugar levels upon waking, which may require adjustments in medication or lifestyle management to maintain glycemic control. 15. What is the Somogyi effect? - The Somogyi effect, also known as rebound hyperglycemia, is a phenomenon observed in some people with diabetes. It occurs when blood sugar levels drop too low

- Cravings and Overeating: Foods high in added sugars may contribute to increased cravings, overeating, and addictive eating behaviors, leading to further health complications. 21. What are sugar alcohols? - Nutritive sweeteners meaning they are carbs that contain calories. SA provide about half the calories in regular sugar. 22. Which sugar alcohol is lowest in terms of calorie content? - Erythritol at 0.25 calories per gram 23. What are Non-Nutritive sweeteners and how many are there? - Non-nutritive sweeteners are sweeteners that do not provide calories/energy. - 8 total approved - Aspartame (Equal), Saccharin (sweet n low), sucralose (spelnda), stevia (truvia), Ace-K, Neotame, Monk Fruit extract, Adventame 24. Which of the non-nutritive sweeteners is the sweetest? - Advantame is 20,000x sweeter than sucrose. 25. What role does added sugars have in regards to diabetes? - Excessive consumption of added sugars can contribute to the development of type 2 diabetes by causing weight gain, insulin resistance, and high blood sugar levels. 26. Discuss sugar availability and consumption rates in the U.S. - The U.S. has high availability and consumption rates of added sugars, primarily from sugary beverages, processed foods, and snacks. This high intake is associated with various health issues, including obesity and diabetes. 27. Discuss the role liquid calories play in both diabetes and obesity. - Liquid calories, especially from sugary beverages like soda and fruit juices, can contribute to weight gain, insulin resistance, and an increased risk of type 2 diabetes and obesity due to their high sugar content and rapid absorption. 28. What is insulin resistance and what appears to cause it in most Type II diabetics? - Insulin resistance occurs when cells become less responsive to insulin's action, leading to elevated blood sugar levels. In most cases of type 2 diabetes, insulin resistance is primarily caused by a combination of genetic factors, sedentary lifestyle, excess body weight, and poor dietary habits. 29. How has fructose been used primarily in the US? How does fructose differ from glucose in terms of metabolism? - Primary Use of Fructose in the US: Fructose is primarily used in the form of high fructose corn syrup in the US as a sweetener in processed foods and beverages, including sodas, candies, and baked goods, due to its high sweetness level. - Difference Between Fructose and Glucose in Metabolism: Fructose and glucose are both types of sugar, but they differ in their metabolism. Glucose is metabolized by all cells in the body and is readily absorbed into the bloodstream, leading to an increase in blood sugar levels. Fructose, on the other hand, is metabolized primarily by the liver and excessive consumption of fructose stimulates body fat making pathways and can contribute to insulin resistance, liver fat accumulation, and other metabolic issues. 30. What is non-alcoholic fatty liver disease?

- NAFLD is the accumulation of fat in the liver of individuals who drink little to no alcohol. It's linked to obesity, insulin resistance, and type 2 diabetes. It can range from simple fatty liver to more severe conditions like NASH, which involves inflammation and liver cell damage. NAFLD can progress to cirrhosis and liver cancer. 31. Based upon what you learned, do you believe that fructose negatively impacts human health? Why or why not? Discuss in terms of intake levels of high-fructose corn syrup versus fructose naturally found in fruit. - Fructose can negatively impact health when consumed in excess, especially in the form of high-fructose corn syrup (HFCS) commonly found in processed foods and sugary beverages. Excessive intake of fructose has been linked to obesity, insulin resistance, fatty liver disease, and other metabolic disorders. However, fructose from whole fruits, which also contain fiber and other nutrients, is less concerning because the fiber slows down its absorption and mitigates its negative effects on blood sugar levels. Therefore, moderate consumption of whole fruits is generally considered beneficial for health, while excessive intake of HFCS and added sugars should be limited. 32. Define heavy episodic (binge) drinking, heavy drinking and moderate drinking. - Heavy episodic (binge) drinking refers to consuming a large amount of alcohol in a short period, typically resulting in a blood alcohol concentration (BAC) of 0.08% or higher. - Heavy drinking generally refers to consuming more alcohol than the recommended limits over time, often defined as more than 8 drinks per week for women and 15 drinks per week for men. - Moderate drinking refers to alcohol consumption that falls within recommended guidelines, typically defined as up to 1 drink per day for women and up to 2 drinks per day for men. 33. Define the term Proof in terms of alcoholic beverages. - The term "proof" in alcoholic beverages refers to the measure of the alcohol content. It is a measure of the concentration of alcohol in a beverage and is often expressed as twice the percentage of alcohol by volume (ABV). For example, a beverage that is 80 proof contains 40% alcohol by volume. 34. What is the standard definition for one alcoholic drink? Knowing the standard for ethanol, what volume is considered a drink for beer, malt liquor, wine, distilled spirits (i.e. whiskey, vodka)? - The standard definition for one alcoholic drink typically contains approximately 14 grams (0.6 ounces) of pure alcohol, which is equivalent to: - 12 ounces of regular beer (with about 5% alcohol content) - 8-9 ounces of malt liquor (with about 7% alcohol content) - 5 ounces of wine (with about 12% alcohol content) - 1.5 ounces (a "shot") of distilled spirits or liquor (with about 40% alcohol content) 35. Discuss any potential benefits of moderate alcohol consumption. - Some studies suggest reduced risk of heart attacks, strokes, and diabetes - Mental acuity in aging - Higher intakes not associated with benefits of any kind - Health benefits of red wine - resveratrol (antioxidants)

- Causes disturbances in nutrition, empty calories, beer belly (dietary purines), Malnutrition (A, B12, D, & Thiamine)(Wernicke-Korsakoff syndrome (B1 def.)) 43. Compare the physical and chemical properties, and the functions of the three classes of lipids. Triglycerides: - Made of glycerol and three fatty acids. - Used for energy storage and insulation. Phospholipids: - Have hydrophilic heads and hydrophobic tails. - Form cell membranes. Sterols: - Have rigid carbon ring structures. - Play roles in cell membranes and hormone synthesis. 44. Explain the usefulness of lipids in the body and in food. Lipids in the body: - Provide energy storage, insulation, and cushioning for organs. - Form cell membranes and act as signaling molecules. Roles of fats in food: - Enhance flavor and texture. - Provide satiety and increase palatability. - Act as carriers for fat-soluble vitamins and essential fatty acids. 45. Define triglycerides (triacylglycerols) and how differences in chain length and saturation affect them. - Triglycerides are the main type of fat found in the body and in food. - They consist of a glycerol molecule bonded to three fatty acid chains. - Differences in chain length (number of carbon atoms) and saturation (presence of double bonds) affect triglycerides' physical properties and health effects. - Shorter chain lengths and higher saturation lead to more solid fats, while longer chain lengths and lower saturation result in more liquid oils. 46. Characterize saturated and unsaturated fats and provide examples of each. - Saturated fats are solid at room temperature and have no double bonds in their fatty acid chains. Examples include butter, lard, and animal fat. - Unsaturated fats are liquid at room temperature and have at least one double bond in their fatty acid chains. Examples include olive oil, avocado oil, and nuts. 47. What are some of the general differences between coconut oil and medium-chain triglycerides (i.e. MCT oils)? - Coconut oil contains a mix of fatty acids, including medium-chain triglycerides (MCTs). MCT oils, on the other hand, contain only MCTs, which are shorter in length and metabolized differently in the body compared to long-chain fatty acids. 48. Characterize phospholipids and sterols and their respective roles. - Phospholipids are a type of lipid that form the structural basis of cell membranes and act as emulsifiers in the body. They consist of a glycerol molecule, two fatty acids, and a phosphate group.

- Sterols, such as cholesterol, are another type of lipid found in cell membranes and are precursors for hormones and bile acids. They play crucial roles in membrane structure and cell signaling. 49. Explain the processes of digestion and absorption of lipids in the human body. Digestion - Mouth and Stomach - lingual lipase - Small intestine - Bile - synthesized in the liver (Gallbladder - stores it) Absorption - Fatty acids split from glycerol - pancreatic lipase (Fatty acids, phospholipids, and monoglycerides) - Bile shuttles lipids across mucus layer - Efficiency of absorption process - 95-98% (speed of digestion: more fat = slower ) digestion 50. Define emulsification and how bile works in the process. Know where bile is produced and stored in the body. - Emulsification is the process of breaking down large fat droplets into smaller droplets, allowing for easier digestion and absorption. - Bile, produced by the liver and stored in the gallbladder, contains bile salts that aid in emulsification by surrounding fat droplets and breaking them into smaller particles, increasing their surface area for enzymatic action. 51. Discuss the differences in transportation between shorter and longer-chain lipids. - Shorter-chain lipids are transported via the bloodstream directly to the liver, while longer-chain lipids are transported by lipoproteins like LDL and HDL. 52. Discuss how fats are stored and used by the body. - Fats are stored in adipose tissue as triglycerides and used by the body for energy during times of need. 53. Define cachexia and its effects on both fat and muscle. - Cachexia is a condition of severe weight loss and muscle wasting often seen in advanced cancer patients, leading to depletion of both fat and muscle stores. 54. State some of the health implications of some of the dietary fats, both negative (i.e. saturated and trans), and positive (i.e. unsaturated). - Negative health implications of dietary fats include increased risk of heart disease with saturated and trans fats, while positive implications of unsaturated fats include improved heart health. 55. Provide generalized recommendations for lipid intakes for the average healthy person. - Generalized recommendations for lipid intake suggest consuming unsaturated fats in moderation while limiting saturated and trans fats. 56. Characterize some of the pros and cons of a high fat diet. - Pros of a high-fat diet may include increased satiety and potential weight loss, while cons may involve increased risk of heart disease and other health complications if not balanced with other nutrients.