DTN301 Lecture Notes - Lecture 5: Bariatric Surgery, Diabetes Mellitus Type 2, Kiwifruit

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7 Apr 2020

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If avoiding hypoglycaemia - healthy low gi snacks may be recommended. One diet does not fit all: diabetes australia published a statement on diet recommendations for people with diabetes, https://static. diabetesaustralia. com. au/s/fileassets/diabetes-australia/7310ffa7-ecb6-4bfb-89e9- Almonds: almonds may have the additional benefit of reducing cardiovascular risks as they have been associated with lower levels of fasting insulin and fasting glucose - beneficial effects on adiposity, glycaemic control, and the lipid profile. It is the flavanols that are proposed to be the key active component, which are also found in green tea. Anthocyanins: anthocyanins are phytochemicals found in fruits and vegetables, particularly pink, red, blue, and purple, they significantly improve insulin sensitivity, the possible mechanism being the anti-oxidant and anti- inflammatory properties. Curcumin/turmeric: curcumin is the main colouring component of turmeric and has anti-inflammatory effects, this component was more effective than turmeric at attenuating diabetes, turmeric has been associated with reduced blood glucose and oxidative stress.

Related Questions

The people of Malaysia belong to three communities: the local people called Malays, immigrants from South India called Tamils, and immigrants from China. During the early 20th century, the Malays lived mainly in coastal villages, the Tamils worked on rubber estates, and the Chinese worked in tin mines. In general, the people were very poor and they consumed a limited variety of foods.[1] Rice was the staple diet of all three communities and therefore the key source of caloric and nutrient content. Malays typically grew their own rice and dehulled it before consuming it; dehulling partially removes the aleurone layer of the rice seed. Following their South Indian food habits, the Tamils ate parboiled rice, and the Chinese ate polished white rice imported from Thailand. It was found that among the three Malaysian communities, the Chinese community was much more prone to suffer from some degree of sub-optimal thiamin intake. Out of every 1,000 Chinese inhabitants, about 120 had mild thiamin deficiency, about 80 had severe thiamin deficiency, and about 16 people had died of it. Suboptimal intake of thiamin was rare in Malays and was not reported at all in Tamils.[1] Thiamin, also called Vitamin B1, is required for all tissues, and its deficiency causes the disease Beriberi. Less severe deficiency results in non-specific symptoms such as weight loss, malaise, irritability, and confusion. Although the origin of the word Beri-beri is disputed, it is believed to be a Philippine word meaning âI canât, I canâtâ and was probably coined to refer to the lack of neuromotor coordination in people afflicted with this disease.[2] Thiamin is water-soluble and is stable in the acidic medium. It is unstable to heat, oxygen, and UV light in neutral and alkaline medium. The active form of thiamin is thiamin pyrophosphate (TPP). This active form is a cofactor for pyruvate dehydrogenase and transketolase enzymes that are involved in the metabolism of carbohydrates. These enzymes play an important role in the biosynthesis of a number of cell constituents such as neurotransmitters, pentoses, and reduced equivalents, used in oxidant stress. The human body cannot store thiamin and therefore requires a continuous supply of the vitamin. The thiamin in an individual on a thiamin-free diet typically depletes in fewer than two weeks. Thiamin absorption is affected by compounds, called thiamin antagonists or anti-thiamin factors, that alter the structure of thiamin. These compounds include alcohols, polyphenols, flavonoids, and thiaminase, a heat labile enzyme found in certain foods.[2] In affluent countries, where the diet is rich in thiamin, the most common cause of thiamin deficiency is excessive alcohol consumption. Alcohol intake affects thiamin status in two ways. First, alcoholics get a significant percentage of their daily energy intake from alcoholic beverages, which are nutrient deficient. In other words, alcoholics replace their consumption of nutrient dense foods that are part of their normal diet with the consumption of nutrient deficient alcohol. Second, alcohol inhibits the intestinal ATPase involved in the absorption of thiamin.[4] Sub-clinical thiamin insufficiency associated with excessive alcohol consumption produces an encephalopathy called Wernicke-Korsafoff syndrome. Patients with this syndrome have a higher than normal incidence of abnormal transketolase, which has a very low binding affinity to TPP. This problem can be overcome by putting patients on high-dose thiamin therapy. Some patients, however, might have a form of abnormal transketolase that does not bind at all with TPP. Such people do not respond to high-dose thiamin therapy.[4] Thiamin deficiency is observed in individuals who have low thiamin intake and a diet rich in polished rice, especially if their diet also consists of anti-thiamin factors such as tea, coffee, raw fermented fish, and betel nuts. The minimum amount of thiamin needed by the body can increase because of increased physiological or metabolic demands arising from pregnancy and lactation, heavy physical exertion, illnesses like cancer, liver diseases, hyperthyroidism, and surgery. Since TPP is required for carbohydrate metabolism, the recommended dietary allowances for thiamin are based on the assumption that its intake is related to total energy intake. The recommended dietary allowance in the United States is 0.5 mg/1000 Kcal.

Questions
1. Thiamin deficiency was observed only in the Chinese community even though all three
communities had the same staple (rice) diet. Explain.
2. On packages of enriched rice sold in supermarkets, the rice preparation directions state that the
rice should not be washed before cooking. Explain.
3. Severe metabolic acidosis caused by high levels of lactate is often associated with thiamin
deficiency. Explain.
4. Provide two plausible explanations for what might cause above normal levels of pyruvate in blood
and urine. How can one determine which of the two explanations is correct?
5. Why does thiamin utilization increase among cancer patients?
6. A negative correlation exists between the need for thiamin and the amount of fat in the diet.
Explain.

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10. The organs associated with the Alimentary Canal share which similarity/similarities? They all belong to the lymphatic system They all belong to the gastrointestinal system Food does not pass directly through them during the process of digestion Food does pass directly through them during the process of digestion Both B and D \

11. Of the five basic functions of the digestive system, which one occurs first? Excretion Absorption Ingestion Peristalsis Digestion

12. The elimination of indigestible material from the body is called _______________. Peristalsis Absorption Defecation Ingestion

13. The pancreas helps to regulate metabolism and blood sugar levels through the release of insulin. Insulin tells the liver to stop sugar production to keep levels regulated within the blood stream. If a personâs pancreas does not function properly, they have a condition called diabetes, a metabolic disease that often requires monitoring of oneâs diet. People with Type 1 Diabetes have a pancreas with damaged islet cells, meaning no insulin is produced. People with Type 2 Diabetes have a pancreas that produces insulin properly, but their cells are resistant to this insulin due to various factors that often include but are not limited to obesity, lack of exercise, or poor diet choices. Certain foods, specifically starches and sugars, affect diabetics in different ways. Type 1 diabetics must limit their consumption of sugars in order to keep their blood sugar levels stable. Type 1 diabetics often achieve regulation of blood sugars through injections of insulin. Type 2 diabetics must still pay attention to their diets, but not all of them are dependent on manual injections of insulin. Because Type 2 Diabetes is often brought on through a poor diet, Type 2 diabetics are advised to monitor their food choices to prevent weight gain and achieve a more balanced diet overall. Approximately 90% of Americans with diabetes have Type 2. Which are contributing factors to developing Type 1 Diabetes? Poor liver function Poor pancreatic function Sedentary lifestyle All of the above

14. There are five activities that occur within the gastrointestinal system: â¢ Ingestion â the taking in of food or drink â¢ Peristalsis â the movement of food along the digestive tract â¢ Digestion â the breakdown of food and drink by both mechanical and chemical mechanisms â¢ Absorption â the passage of food into the cardiovascular and lymphatic systems â¢ Defecation â the elimination of substances the body canât use Many digestive disorders and diseases can be tied to an activity within the gastrointestinal system. For example, inflammation of the digestive tract, commonly known as inflammatory bowel disease, is an example of a gastrointestinal activity breakdown. An inflamed digestive tract means digestion is painful and hindered in some way, affecting the rest of the gastrointestinal activities coming after it. An inability to break down lactose, or âlactose intolerance,â is another example of a breakdown that can occur within the gastrointestinal system. Another example of a breakdown in gastrointestinal activities is an eating disorder, where food is either withheld or ingested at a fast rate. Some disorders include the elimination of food through vomit, in essence reversing some of the activities of the gastrointestinal system. A final example of a breakdown in gastrointestinal activities is constipation, which can often lead to further problems such as bowel impaction if not corrected immediately. A balanced diet is recommended to keep the gastrointestinal system functioning properly, and many over the counter medications can help to correct some breakdowns if caught early enough. Foodborne illness, or food poisoning, happens when spoiled or contaminated food is consumed. A common symptom of food poisoning is vomiting. Though microbes can move from the stomach and into the intestines after vomiting occurs, the food itself gets thrown up, stopping its travel through the gastrointestinal system. During which activity is the food thrown up? Peristalsis Absorption Ingestion Digestion

15. The skin is a vital organ that covers the entire outside of the body, forming a protective barrier against pathogens and injuries from the environment. The skin is the body's largest organ; covering the entire outside of the body, it is about 2 mm thick and weighs approximately six pounds. It shields the body against heat, light, injury, and infection. The skin also helps regulate body temperature, gathers sensory information from the environment, stores water, fat, and vitamin D, and plays a role in the immune system protecting us from disease. The color, thickness and texture of skin vary over the body. There are two general types of skin; thin and hairy, which is more prevalent on the body, and thick and hairless, which is found on parts of the body that are used heavily and endure a large amount of friction, like the palms of the hands or the soles of the feet. Basically, the skin is comprised of two layers that cover a third fatty layer. These three layers differ in function, thickness, and strength. The outer layer is called the epidermis; it is a tough protective layer that contains the melanin-producing melanocytes. The second layer (located under the epidermis) is called the dermis; it contains nerve endings, sweat glands, oil glands, and hair follicles. Under these two skin layers is a fatty layer of subcutaneous tissue, known as the subcutis or hypodermis. The skin contains many specialized cells and structures: â¢ Basket Cells: Basket cells surround the base of hair follicles and can sense pressure. They are evaluated when assessing overall nerve health and condition. â¢ Blood Vessels: Blood vessels carry nutrients and oxygen-rich blood to the cells that make up the layers of skin and carry away waste products. â¢ Hair Erector Muscle (Arrector Pili Muscle): The arrector pili muscle is a tiny muscle connected to each hair follicle and the skin. When it contracts it causes the hair to stand erect, and a "goosebump" forms on the skin. â¢ Hair Follicle: The hair follicle is a tube-shaped sheath that surrounds the part of the hair that is under the skin and nourishes the hair. It is located in the epidermis and the dermis. â¢ Hair Shaft: The hair shaft is the part of the hair that is above the skin. â¢ Langerhans Cells: These cells attach themselves to antigens that invade damaged skin and alert the immune system to their presence. â¢ Melanocyte: A melanocyte is a cell that produces melanin, and is located in the basal layer of the epidermis. â¢ Merkel Cells: Merkel cells are tactile cells of neuroectodermal origin located in the basal layer of the epidermis. â¢ Pacinian Corpuscle: A pacinian corpuscle is a nerve receptor located in the subcutaneous fatty tissue that responds to pressure and vibration. â¢ Sebaceous Gland: Sebaceous glands are small, sack-shaped glands which release an oily substance onto the hair follicle that coats and protects the hair shaft from becoming brittle. These glands are located in the dermis. â¢ Sensory Nerves: The epidermis is innervated with sensory nerves. These nerves sense and transmit heat, pain, and other noxious sensations. When they are not functioning properly sensations such as numbness, pins-and-needles, pain, tingling, or burning may be felt. When evaluating a skin biopsy, total number, contiguity, diameter, branching, swelling, and overall health of the sensory nerves are assessed. â¢ Stratum Corneum: The stratum corneum is outermost layer of the epidermis, and is comprised of dead skin cells. It protects the living cells beneath it by providing a tough barrier between the environment and the lower layers of the skin. The stratum corneum is useful for diagnosis because in some conditions it will become thinner than normal. â¢ Sweat Gland (Sudoriferous Gland): These glands are located in the epidermis and produce moisture (sweat) that is secreted through tiny ducts onto the surface of the skin (stratum corneum). When sweat evaporates, skin temperature is lowered. If you use a product to moisturize your hair, which part of the integumentary system are you targeting? Hair follicle Hair shaft Blood vessels Melanocyte

salmonraven953

Based on âMorgan: A case of Diabetesâ by Lisa Rubin and Clyde Freeman Herreid (National Center for Case Study Teaching in Science)

The Patient:

Morgan Water is a 27-year old Native American that lives on a reservation in Oklahoma. Nearly Â¼ of Morganâs tribe has diabetes but she has no direct family history of diabetes, heart disease, or other serious conditions. She is however obese (BMI = 32) and leads a sedentary lifestyle. Morgan has been suffering from an increasing persistence of symptoms including unusual thirst, dizziness, blurred vision, and numbness in her right foot. The symptoms have been developing over several months but as she is planning her wedding she attributed them to nerves. She is finally persuaded to see her family doctor. Her non-fasting blood glucose level was elevated so the doctor has her return the next morning for a fasting blood sample so they could more accurately measure her blood glucose and insulin. Her blood results are below:

Test	Morganâs values	Normal range	Pre-Diabetic range	Diabetic range
Plasma glucose, mg/dl	260	70 -139	140 - 199	â¥ 200
Fasting glucose, mg/dl	140	â¤ 99	100 - 125	â¥ 126
A1C, %	7.6	~ 5	5.7 â 6.4	â¥ 6.5
Fasting Insulin, mIU/ml	34	2 - 10	10 - 20	â¥ 20

The recommendation of Morganâs doctor was to improve her exercise, good nutrition, and weight loss. He recommends meeting with a nutritionist to assist Morgan in her weight loss goals. When Morgan got home and told her family the diagnosis they however had LOTS of suggestions on how she can lose weight. Below is a description of the advice given to her by three family members.

Best friend Savannah:

âYou know how Iâve been losing weight? Well, Iâve been on the Atkinsâ Diet. I heard about it on TV. Itâs great! You get to eat steak, chicken wings, and all the good stuff. All you have to do is limit carbohydrate intake. You should definitely give it a try. This diet has been around for years and it has worked for lots of people, including me.â

*Note: Atkinâs Diet recommends: 10% carbohydrates, 55% fats, 35% protein

Brother Alan:

âI think the best thing for you to do is exercise and stop eating all of that pizza and candy and food filled with fat. Our people never used to eat that junk. I say eat meals that are nutritionally balanced and high in fiber and low in refined sugars and saturated fats. And run a lot. Stop sitting around the house.â

Grandfather:

âMorgan, it is true that it is best to live in harmony and balance â to eat a nutritionally balanced diet that includes carbohydrates, proteins, and âgoodâ fats to meet your bodyâs needs. That is good. But look to your heritage. Our people were never overweight before we started eating âcivilizedâ food. Look to our native diet. I think you should look to traditional herbal remedies for help. What Alan says is true. Exercise is good. But it is sometimes not enough. Our people have always looked to natural medicine for cures. They will lift your spirits and energize you. Then you will lose weight and you will be healthy again. I hear the herbs from the diet shop are safe and good. But you must take them like the medicine label says. It canât hurt to try them.â

*Note: these herbal supplements Morganâs grandfather is recommending contain the herb

ephedra (ephedrine).

Question 5:

Given Morganâs metabolic state, what is the primary fuel source for her cells currently?

A. Carbohydrates (glucose)

B. Fats

C. Proteins

D. It is a balance of all three

Question 6:

Metabolic ketoacidosis is a common problem with diabetics, which is caused by which of the following?

A. Excessive oxidation of fatty acids, leading to an accumulation of ketone bodies in the blood.

B. Excessive oxidation of glucose, leading to an accumulation of ketone bodies in the blood.

C. Excessive oxidation of proteins, leading to an accumulation of ammonia in the blood.

D. Hyperglycemia.

Question 7:

Which weight loss suggestion is designed to achieve some level of ketosis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

Question 8:

One major side effect of the herbal supplement can be hot flashes and increased perspiration due to increased thermogenesis, what is the likely cause of the heat production?

A. Increasing the activity of phosphfructokinase-1.

B. Increasing the activity of the pyruvate dehydrogenase complex.

C. Increasing the activity of citrate synthase.

D. Increasing the activity of uncoupling proteins.

Question 9:

Would substituting fiber and complex carbohydrates (larger % cellulose) for the simple sugars and starches (high sucrose and amylose/amylopectin) help Morgan lose weight, why?

A. Yes, because complex carbohydrates like cellulose are largely indigestible so they pass through

the digestive tract without being absorbed.

B. Yes, cellulose contains less glucose residues than amylose or amylopectin.

C. Yes, because the fructose in sucrose is much more responsible for weight gain than the glucose.

D. No, because cellulose, amylose, and amylopectin are all composed of glucose so it doesnât

matter.

Question 10:

Which weight loss suggestion will lead to an increased need for gluconeogenesis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

DTN301 Lecture Notes - Lecture 5: Bariatric Surgery, Diabetes Mellitus Type 2, Kiwifruit

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