Metabolism

 

The body digests certain nutrients so cells can grow and renew. They need these nutrients as energy to perform chemical and mechanical tasks.

Many illnesses are caused by nutritional mistakes, so diet plays a major role in any disease treatment. Sufficient movement is also essential in healing, as is proper breathing and life balance.

Once we eat something it is broken down into its simple substance such as glucose, amino acids, glycerin and fatty acids. These are absorbed by the intestines and enter the blood stream. The circulatory system delivers these nutrients to every cell in the body.

Digestion

Digestion takes place in the mouth, stomach and intestines. Nutrients are transported by blood and lymph.

Carbs = stomach and mouth Fat = intestines Protein = stomach and intestines

Metabolism

All the chemical reactions in the body, which break down and transform ingested food and inhaled oxygen. Metabolism breaks down, transforms and builds up.

It involves anabolism and catabolism.

Anabolism builds up from simple to complex, so cell organelles, enzymes and hormones can be produced. Energy is needed. Also known as assimilation.

Catabolism breaks down. Energy is released.

Caloric Value

This is the energy content of food. New measurement is joules. 1 calorie is 4.18 joules.

Energy Needs

Depend on:

Gender Physical work Temperature Age Size and weight

Normal is 2100 calories for a 60 kg woman doing light work. Heavy work requires around 4000 calories.

Carbohydrates

Also known as saccharides. Carbs include glucose, fructose and lactose. Small molecules, where carbon atom bonds with 6 water molecules.

Carbs are energy. If too many are eaten, the liver will turn them into fat stores.

Types of Carbs

Monosaccarides consist of glucose, fructose and galactose. Disaccharides consist of maltose, sucrose and lactose. Oligosaccharides consist of small hexose. Polysaccharides consist of hexose, glycogen and starch.

The most important is glucose. To store glucose, it has to be changed into glucogen. Stores are in the liver and skeletal muscle. This conversion process is called glycogenesis. The reverse process of cracking open glycogen into glucose is glycogenolysis.

If you only ate carbs, then the liver would produce fat and amino acids out of glucose, but the essential ones cannot be made and need to be sourced in food.

If glucose is oxidised, it is possible to bind it to oxygen. This is inner respiration. This is important in ATP. Adenosintriphosphate is stored energy. When one of the phosphates is lost, energy is released.

Glucose is used as available energy in cells. Blood sugar levels are regulated by hormones. To be healthy it has to stay at a certain level. If it is too low, not enough glucose is available to the cells. If it is too high then the excess is stored in red blood cells. Insulin lowers blood sugar levels. Glucagon, cortison and adrenalin boost blood sugar levels.

Insulin unlocks cells so glucose can enter, stores glucose as glycogen, enables fatty acids to enter the cell membrane to be stored in the liver and fat cells.

Glucagon, cortison and adrenaline increase glycogenolysis, decrease glycogenesis, increase gluconeogenesis (glucose out of non carb sources)

Lipids

Liver can produce its own or can be sourced from animal and plant based food. Fat is not a unified substance.

It is characterised by:

Water insolubility Organic solution solubility Fatty acids and glycerin as essential substances

Fat serves the body as a food reserve, in construction and as energy.

Fats and oils are almost chemically identical. Fats remain solid at room temp and oils dont. This is because oil contains a higher content of unsaturated fatty acids. The higher the unsaturated fatty acids, the lower the melting point.

Fatty acids are long hydro carbon chains with between 4-18 hydrocarbon atoms.

There are saturated, monounsatured and polyunsaturated fatty acids.

Saturated fatty acids have simple bonds, are hard at room temp, have no free binding sites, are sourced from animal fat, and cause rises in blood fat levels.

Monounsaturated fatty acids have double bonds, are sourced from plant, and have no influence on blood fat levels. If the fat is thickened then it loses its unsaturated fatty acids.

Polyunsaturated fatty acids have two or more double bonds, found in plant oils, remain liquid, have many free carbon atoms, and lower blood fat levels.

Glycogen is stored glucose Glucagon raises blood sugar levels

Fatty acids are found in food and can be produced by the body, but not polyunsaturated fatty acids. Essential fatty acids are used to build cell membranes, to regulate cholesterol metabolism and in the production of hormone like substances.

Glucose and fat are transported via the blood to cells. They enter the blood as triglycerides, cholesterin and phospholipids.

Triglycerides: 3 fatty acid and one glycerin molecule. Absorbed by the intestines into the blood. Help to predict arteriosclerosis. High values are found in obesity, diabetes, kidney disease, and acute pancreatitis. Phospholipids: two fatty acid and one glycerin molecule. Third fatty acid replaced by phosphoric acid. Important in cell membrane construction. Cholesterin: found in animal sources, but can be produced by the liver and intestinal mucous membrane, adrenal glands and gonads. Cholesterin is used for cell membrane, steroids, bile and vitamin D.

Fat Metabolism

If more fatty acids in blood than cells need, liver transforms the fatty acids and glycerin into triglycerides and stores them in the liver or fat cells. Glucose can also be used to do the same (into fatty acids and stored). People can get fat from low fat, high carb diets. If not enough glucose in body, energy is taken from amino and fatty acids, but keton bodies are the side effect.

Brain, kidneys and skeletal muscles can use keton bodies as energy, in case of emergency. It takes time to convert keton bodies into energy, which can cause low sugar levels and functional brain disorder.

Too many keton bodies leads to high acidosis and a drop in blood pH. Ketonuria is when the excess keton cannot be flushed out by the kidneys, and the acetone can only be released by exhalation. The breath smells like fruity vinegar and is used to diagnose blood sugar levels in diabetics.

Fat is water insoluble, so the transport of fat inside blood or lymph takes place by binding it to a protein to wherever it is needed or wherever it will be metabolised. This kind of binder is known as a lipoprotein.

There are two types of lipoproteins:

LDL: low density of lipoproteins and high density of cholesterin. If these types increase in the blood then the risk of arteriosclerosis will also increase. HDL: high density of lipoproteins and low density of cholesterin. It helps protect against arteriosclerosis.

To evaluate the risk of AS, check how much cholesterin is in the blood. If it is high, then determine whether it is HDL or LDL.

Normal is 120-200 mg/dl of cholesterin. High risk is over 260 mg/dl.

Some studies show low cholesterin in blood is also not good and is correlated to cancer, respiratory disease and suicide. Some high cholesterin people also lived long lives.

Proteins

The chemical elements of carbon, hydrogen and oxygen in proteins bind with amino acids. Amino acids build long chains of proteins and arrange themselves in all kinds of sequences. You need 100 amino acids to build one protein.

The amino acid chains are linked by peptide bonds. There are 20 different types of amino acids which combine to make a protein. The sequence of amino acids determine the function of the protein. 8 of the 20 amino acids are essential and need to be sourced by food, the rest can be produced by the body.

Proteins can be messengers, enzymes, antibodies, used as structure, storage and transport.

Essential amino acids are isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophane, valine, and tyrosine.

If two amino acids link they are called a dipeptide, if one more joins, then it is a tripeptide. Less than 10 are called oligopeptide. More than 10 are polypeptides and more than 100 are macropeptides. This is when it can be called a protein.

Proteins have the following tasks:

Builds muscle cells (actin and myosin) Builds enzymes as bio catalysators Builds hormones (polypeptide hormones) Builds structure like collagen in tissue Builds antibodies out of plasma cells Builds blood proteins such as globuline, prothrombine, fibrinogen, plasminogen, albumine, transferrin

Protein can be sourced from plants and animals. Every living thing has protein. During digestion, protein is broken down into amino acids. These are delivered to the cells by the blood stream. Via transamination, the liver can convert any non essential amino acids into the amino acids it needs. Protein is a last source of energy, once carbs and fats have been used up. To convert protein into energy, the nitrogen has to be removed. Ammoniac can collect, so it has to be converted by the liver into non toxic urine.

When amino acids are bound to non protein substances, they form proteides. These are quite common such as glycoproteins, nucleoproteins and lipoproteides.

Minerals

Minerals are often found in salts. Dissolved in water, they change into ions, which are electrically charged particles. If the ions have a positive charge, they are an electron. If they have a negative charge, they have eaten an electron. The body is filled with minerals.

Two types of minerals:

Bulk elements - weigh between 25g and 1kg in the human body. Include sodium, potassium, calcium, phosphorus, chlorine, magnesium and sulphur. Trace elements - weigh between 1 mg and 5 gr. Small concentration but important task. Include iron, copper, selenium, zinc, iodine, cobalt, molybdenum, chromium. Not all are essential, such as gold, silver, etc. If in excess, then can be toxic such as arsenic, cadmium, quicksilver, thalium and aluminium.

Sodium is in 98% of fluids, maintains body fluid balance, stimulates nerves and muscles.

Too little: cramps, apathy, low bp, racing heart, caused by vomiting, sweating, kidney failure, diarrhea. Too much: high bp, edema, caused by kidney insufficiency and increased salt intake

Potassium is in 98% of cells, stimulates muscles and nerves, influences heart, maintains cell water level and resting potential

Too little: caused by deficiency, vomiting, diarrhea, laxatives, symptoms include poor reflex, muscle weakness, paralysis, intestinal closure, unconsciousness Too much: confusion, paralysis, heart rhythm problems, weakness, caused by oversupply, death of red blood cells, kidney and adrenal insufficiency, potassium inhibitors

Calcium in 99% of bones and teeth and 1% in blood, helps in production of teeth and bones, softens muscle and nerve excitability, improves blood coagulation, anti allergenic and inflammatory.

Too little: increased muscle excitability, cramping, rachitis, osteomalazia, caused by kidney and pancreatic disease, hypothyroidism, vitamin D deficiency. Too much: kidneys stones and calcification, joint calcification, arteriosclerosis, muscle weakness, constipation and paralysis, caused by medication, kidney insufficiency, malignant tumor and hyperparathyroidism

Magnesium is inside the cells, and assists with enzyme reactions, reduces muscle and nerve activity, inhibits coagulation, builds bones, tendons and teeth.

Too little: muscle cramping and twitching, epilepsy, heart problems, caused by kidney insufficiency, chronic intestinal infection, hunger, strong vomiting, alcoholism, hyper thyroid and parathyroidism. Too much: laziness of muscles, paralysis, breathing and heart stoppage, caused by kidney failure, uraemia, increased intake, and hypothyroidism

Phosphorus inside all cells, builds bones and teeth, and important in ATP, too little causes rachitis and too much caused hyperactivity.

Iron found in hemoglobin and myoglobin in muscle cells. Builds hemoglobin, oxygen and carbon dioxide transport, too little causes iron anemia, and too much leads to liver and pancreatic cirrhosis, as a result of hemochromatosis and alcohol abuse.

Zinc found in many enzmyes, improves the immune system, helps with protein, fat and carb digestion and hormone metabolism. Too little impairs growth, causes skin horning and inflammation, liver and spleen swelling, gonad deficiency and too much causes vomiting, headaches, nausea and metallic taste in mouth.

Selenium found in many enzymes, reduces influence of toxic heavy metals, too little causes acceleration of aging process, breast cancer and heart attack risk, too much causes hair loss, secondary anemia, and liver, kidney, gastrointestinal and heart damage.

Chromium, manganese, cobalt and copper are involved in activating enzymes or are an essential part of enzymes.

Vitamins

Vitamins are bonds that cannot by produced sufficiently in the body, and must be sourced in food. Vitamin A and D can be produced by provitamins in the skin after being out in the sun. Provitamin is a precursor to a vitamin, which can be converted by the body. Most B complex vitamins and vitamin K can be synthesised by intestinal flora. Vitamins are either water or fat soluble.

Water soluble: C and B. If too much they will be flushed out of the body.

Fat soluble: EDEKA, can be stored in the body, and can lead to toxicity if too much. Can only be digested if sufficient bile and fat absorption in the intestines is healthy. Lack of fat soluble vitamins can cause Sprue or Crohns disease.

Vitamin deficiency is caused by:

Bad nutrition or malnutrition Maldigestion or malabsorption Intestinal flora disorder Liver damage Increased need Alcohol abuse

Vitamin B12 deficiency is often caused by severe stomach disease such as chronic atrophic gastritis or stomach cancer. Intrinsic factor cannot be produced properly in this case, and cannot help B12 pass through the intestinal wall. Vegans may have a problem with B12, as it is produced by micro organisms, can be found in fermented products.

Medication causes vitamin toxicity. In a balanced diet there is no excess.

A retinol found in animal and plant based products, helps skin and mucous membrane, eyes and placenta, too little causes night blindness, skin and mucous membrane atrophy, fetal deformation due to alcoholism, malabsorption, maldigestion, crohns disease, sprue or fat intake disorder. Too much causes acute headaches, dizziness, nausea, vomiting, hair loss, painful periost swelling, increased blood building, fetal deformation, and is due to medication.

B1 found in plant and animal products, is a nerve vitamin, too little caused by fat intake disorder or alcoholism and causes beriberi, psychological changes, edema with heart muscle weakness, too much caused by medication and causes intolerance and anaphylactic shock.

B12 found in fermented plant based food and animal products, produced by micro organisms, builds blood, maintains nervous system, part of enzymes and builds DNA/RNA, too little is caused by a strict vegan diet, intrinsic factor deficiency, ileum changes, fat digestion disorder, alcoholism, and causes pernicious anemia and neurological failure; too much is caused by excessive excretion.

Biotin is found in yeast, liver and kidneys, has the task of building skin, hair and nails. Too little is caused by fat digestion disorder and alcoholism, and causes skin changes, brittle nails, hair loss, tiredness, loss of appetite, anorexia, depression, nausea and dermatitis; too much is unknown.

Folic acid is found in plant and animal products, has the task of maturing red blood cells and building DNA/RNA; too little causes folic acid deficiency anemia, reduction in leuco and thrombocytes, atrophy of mucous membrane which leads to malabsorption, spina bifida, and is caused by pregnancy, infancy, puberty, alcohol, medication and chemotherapy; too much is caused by medication and leads to gastrointestinal complaints, loss of sleep, psychological problems and allergies.

Vitamin C is found in fruit and veggies, builds resistance, improves wound healing, increases iron intake, builds connective tissue, teeth and bones, catches free radicals and protects against cancer, too little is caused by malnutrition, smoking, alcohol, pregnancy and dialysis, and causes infection, anemia, tiredness, as well as increased gum bleeding, gum infection, tooth loss, delayed wound healing, joint pain; too much causes short term diarrhea and is caused by overeating.

Vitamin D is found in animal products and the body can produce enough using cholesterol thanks to sunlight, helps improve calcium storage in bones and calcium absorption in the intestines; too little causes leg and skull deformation, rachitic rosary, vertebral and thorax distortion, frog belly, muscular hypotonia, square head and head sweating and in adults osteomalacia, and is caused by increased air pollution, high UV absorption, brief trips outdoors; too much is caused by medication and causes arteriosclerosis, kidney stones, calcification of the kidneys and joints.

Vitamin E is found in plant based oils, soya beans, nuts, grains, veggies, and has the task of catching free radicals, slowing the aging process, works against cancer, reduces arteriosclerosis and increases fertility; too little is caused by a lack of bile and increases arteriosclerosis, coronary heart disease and cancer; too much is caused by medication and causes liver parenchym damage, increased bleeding and immune weakness.

Vitamin K is found in green plants, cauliflower, liver and intestinal flora, and has the job of coagulating the blood; too little increases bleeding tendency (gum bleeding) and is caused by a lack of bile or antibiotics; too much causes thrombosis, hemolysis and anaphylactic reactions and is caused by high dose injections.

Water

The human body is made up of 60% water. The percentage decreases as we age. Women have about 50% water and a higher fat content than men. The body’s cells are 50% water, the space inside the cell is called intracellular space. The water here makes up about 40% body weight. The fluid surrounding cells in the intercellular space or interstitium consists of 90% water.

Intracellular space = 40% body weight Intercellular space = 15% body weight Intercelluar fluid = 10% body weight Intravasal fluid (blood, lymph, bile) 5% body weight

Reduction in water as we age can dry out cells and cause calcification. Those with high adipose have limited water content as fat is water deficient.

Water is taken in in food and drink and excreted out as urine, sweat, breath and intestines.

The kidneys are vital in water regulation. They control how much is excreted by electrolyte retention and excretion. 1.5 litres of fluid is released as urine each day, 200ml in stool, 300 ml in sweat and 500ml in exhalation.

Hormones

Hormones are also vital in water regulation and electrolyte content.

ADH (antidiuretic hormone) is produced by the hypothalamus, sent to the posterior pituitary lobe, where it is stored and released into the blood on demand. ADH causes the kidneys to retain water.

Renin-Angiotensin-Aldosterone System: renin is a substance that is excreted by the kidneys when pressure is too low. In the blood, renin combines with angiotensin (blood protein produced by liver). If the angiotensinogen is inactive, renin activates it.

Angiotensin contracts vessels and stimulates the adrenal cortex to release aldosterone, which causes the kidneys to retain sodium so increased water can stay in the body.

An adult takes in about 2 litres of fluid daily, which is broken down into 1.5 litres of drink and 500 ml food.

Overhydration causes edema and high blood pressure and is seen in people with heart and kidney disease.

Dehydration is when not enough fluid is taken in, or too much fluid and sodium are excreted.

There are 3 different types of dehydration: isotone, hypertone and hypotone.

Isotone dehydration

Loss of water and sodium. Caused by insufficient fluid and sodium intake, diarrhea, vomiting, and blood loss.

Hypertone dehydration

Loss of water. Caused by fever, diabetes mellitus and insipidus.

Hypotone dehydration

Loss of sodium. Caused by burns, sweating and laxative abuse.

Dehydration symptoms include skin folds, low bp, dry skin and tongue, rings under eyes, oliguria.

Carb digestion

Carbs are found in starchy food, rest in animal based glyocgen. Alpha amylase digests carbs and is found in the duodenum and mouth. It breaks carbs down into glucose. But most people dont chew their food long enough and so carbs are broken down into dextrin and maltose only.

In the duodenum alpha amylase is released by the pancreas and disaccharidase of the small intestines break dissacharide into glucose.

Glucose is absorbed into the blood and makes its way to the liver. If too much glucose in blood, liver stores it as glycogen.

Fat digestion

A small part takes place in the stomach courtesy of the lingual lipase but the main digestion is in the small intestines.

Bile is released into the duodenum. Fat is emulsified into fat droplets.

Lipase digests the fat droplets into fatty acids and glycerine.

The fatty acids are either short or long chain acids. 10% of short chain fatty acids are absorbed by capillaries. 90% of short chain fatty acids are transported via lymph with long chain fatty acids.

In small intestine cells are protein shells that pass through the villi and into the lymph vessels. These fat droplets are chylomicrons. This is how the fatty acids reach the blood.

Protein digestion

Digested in the stomach and small intestines.

Protein swells in the hydrochloric acid of the stomach. This makes it an easy target for enzymes and breaks down the long protein chains. This is called denaturation and means the protein cannot do its original function. Gastric acid also converts pepsinogen into pepsin, which then divides protein into polypeptides.

From here proteins are broken down into amino acids in the small intestines. The enzymes trypsinogen and chymotrypsinogen are released by the pancreas. They are changed into trypsin and chymotrypsin by enterokinase. This enables the polypeptide to be changed into an oligopeptide.

This digestion takes place in the duodenum, otherwise the enzymes would digest the pancreatic cells and protein.

The polypeptides are changed into amino acids and this process is supported by aminopeptidase.

Amino acids reach the blood and liver. The liver uses these amino acids to build proteins, and convert one amino acid into another type.

Active and Passive Transport

Nutrients exit the small intestines and make their way into the blood or lymph capillaries which travel along the blood to every cell in the body. This transport is either active or passive.

Active: energy is used. Carrier molecules are used. These sit on the cell membrane and convert substances into fat soluble types so they can penetrate the cell. This is how glucose is brought into a cell. Transport takes place regardless of whether the substance is surrounded by a higher concentration inside the cell than outside.

Passive: no energy used, concentration gradient such as diffusion, filtration or osmotic pressure is used.

Metabolic Disorders

We live in an age of excess, but there is also the opposite, with people who suffer from eating disorders. Many systems are employed to understand what constitutes a normal body weight.

Broca Formula

Normal weight = minus 100 from one’s height. Ideal weight = minus 15% from normal for women and 10% for men. Adipositas = is 10% above normal weight.

Body Mass Index

Created by American life insurance industry. Dependent on age and height of person. Body weight in kilos is divided by person’s height and divided by two. Total is compared to age norm. Not a reliable judge, does not indicate total fat volume and total muscle volume.

WHR

Pays attention to risk of arteriosclerosis based on adipositas of hip quotient. Measure waist and hip and divide them.

Android adipositas = fat stored in abdomen Gynoid adipositas = fat stored in hips and thighs

Gynoid form has lower risk of arteriosclerosis, but weight affects joints and spine.

Eating Disorders

Anorexia Nervosa

Most common type of malnutrition. Women mostly affected. Disease starts age 12 - 20. Wishes to be slim and fears being fat. Distorted body image. Some do intensive sport, sometimes appetite inhibitors, diuretics, laxatives and self induced vomiting are employed.

The cause or reason for anorexia nervosa is due to puberty, social pressure, ideal body image, constant dieting, obsessive thoughts about one’s weight, family factors such as an aggressive mother, ambitious parents, personal trauma such as sexual abuse and separation anxiety, and low self esteem.

Consequences of weight loss and malnutrition are: lack of menstruation, low blood pressure, slowed pulse, low body temperature, hypovitaminosis, hypokaliaemia, tooth decay, extreme hunger.

10% die from their disease, while 30% remain chronically anorexic. The rest heal after therapy.

Therapy is difficult as there is no true clarity or understanding of the disease. Many don’t go to a therapist, and the therapist is seen as the enemy. Many lies are told about eating habits. In life threatening situations the person must be transferred to a clinic.

Bulimia nervosa

Affects young girls and women, 18-35 years. Women are normal or slightly overweight. Can occur with binge phases, self induced vomiting, purging and fear of becoming too fat. The person feels guilty after. Set weight limits are set, dieting is common, and many use laxatives and diuretics to reduce weight. Food is constantly thought about. A positive indication that someone is affected by this disease is that they are focused on calorie poor food, or healthy food such as salads and vegetables. They can hide their disease without anyone knowing. To be considered bulimic, there must be two situations per week over a period of 3 months. Compensatory measures also must be included.

Consequences are tooth decay, hypovitaminosis and hypokalemia.

Many anorexics are bulimic and therefore makes it difficult to differentiate between the two.

Binge Eating

This is a stand alone disease since 1994. 2% of the population is affected, and very common. Regular binge eating occurs, with a loss of self control. The difference to bulimia is that no compensatory measures are taken, such as laxatives. The person becomes obese, they feel ashamed and depressed. They don’t eat the right food and they risk malnutrition.

Therapy include behavioural and systemic therapy.

Adipositas

This is when body fat is above the norm. The normal is 19-24 in women and 20-25 in men. Obesity is when the calorie intake exceeds daily energy needs. Unused energy is stored as fat. Fat deposits are in subcutaneous fatty tissue, peritoneum, between muscles, around the kidneys and heart, liver.

Causes are primary and secondary. Primary = increased calorie intake caused by little activity and bad eating habits. Secondary = an organic cause such as hypothyroidism, Cushing disease, congenital metabolic disorder. Only 3-5% of cases are organically caused.

Symptoms include: heart insufficiency, accelerated pulse, nightly edema, breathing difficulties, coronary heart disease, angina pectoris, heart death, hypertonia, diabetes mellitus, arthrosis, gall bladder disease, kidney disease such as gout, kidney stones, and gout.

A deadly quartet is adipositas, diabetes, hypertension and blood fat excess.

Diagnosis must rule out secondary adipositas. Physical examination can recognise hypothyroidism, Cushing disease, congenital metabolic disoder.

Exam blood fat levels, diabetes, blood pressure, uric acid levels. Eliminate the yoyo effect, as it is better to be stablely overweight than always fluctuate between weight. Make sure the patient does not lose more than 0.5 kilo each week for a 3-6 month period. Good to keep it stable and balanced, and for the patient to attend a support group if they want to be disciplined.

Fat and Purin Metabolism disorder

Hyperlipidemia and Hyperlipoproteinemia

Lipids in blood are bonded and transported together with protein carriers such as LDL and HDL. This can increase the blood fat level and create hyperlipoproteinemia. Hypercholesterinemia is the increase of blood fat in cholesterine.

Any increase in blood fat is a risk of arteriosclerosis, as well as coronary heart disease, kidney disease, cerebral arteriosclerosis, peripheral circulatory disorder, retinal disease.

Causes are twofold:

Primary: inherited Secondary: appears as a result of adipositas, liver disease, diabetes, hypothyroidism, biliary stasis, gout.

As long as the situation has not developed into organ damage or arteriosclerosis, then the patient will not experience any side effects, but sometimes outer changes can occur such as:

Xanthoma: bean sized fat node, where tissue does not circulate well, such as knee, backside and finger base joint. Xanthelasma: plate shaped node on eyelids, can be white or yellow. Corneal ring: fat deposits in peripheral cornela cells. Ring formed. Whitish grey.

Why has blood fat level increased? This will help your treatment approach. Cholesterol and saturated fatty acids must be avoided. Physical activity increased. Eat oat fibre with muesli, yoghurt.

Hypolipidemia

Primary or secondary causes. Primary is a rare genetic defect that delays growth, weakens muscles and disturbs nervous system. Secondary is a result of hyperthyroidism, malabsorption, liver disease and hunger.

Gout

Metabolic disease, uric acid crystals in joints, kidneys, tissue, mucous sac. Middle aged men affected mostly. Gout has very specific signs and symptoms such as big toe joint being affected. Rise in uric acid does not always mean gout. Could instead be hyperuricemia without any joint problems etc.

Cell nucleus and DNA in liver cells is digested. Purine released which turns into uric acid. Increase signals kidney insufficiency (98% of cases). Other causes are disturbed enzyme function, or eating too much purine containing food, or cell death caused by cytostatics and fasting.

Primary and secondary causes. Primary is hereditary. Nutrition also plays a role. Oestrogen protects women against gout, except when in menopause. Secondary is kidney insufficiency or medication.

Several stages:

Latent stage: hyperuricemia, with uric acid 7mg/dl and above in blood. Acute stage: gout occurs suddenly and randomly. Big toe affected. Chronic stage: develops from acute form.

Gout begins at night with big toe. Other joints are also affected. Localised in heel, hand, elbow and knee. Joint is red, swollen, sensitive and sore. Lasts weeks. Fever. Blood shows leucocytosis, accelerated BSR and rise in CRP.

Triggers can be rich food, alcohol, fatty food. Too much physical activity, fasting and medication.

Gout nodes are uric acid depots in tissue. Poor circulation of tendons, mucous sacs and bones near joints. Nodes are fat and uric acid. If crystals reach kidney, then there is inflammation, reduced kidney function, and uric acid depots can cause kidney failure.

Uric acid stones can damage kidneys, cause congestion and withhold urine. Kidney damage can also be caused by bladde damage.

Conventional medicine uses non steroidal antiphlogistika and cortisone. Allopurinol is used when there is no pain or ailments. Uricosurica is used to encourage uric acid excretion.

Naturopathic medicine uses acupuncture and homeopathy. Change of diet also helps, and no eating of meat, oily sardines, anchovies, fried herring, tuna and offal. Lentils and green peas avoided and alcohol. Drinking of water increased to 2-3 litres.

Very high purine content is 200m/100g, such as lentils, green peas, white beans, oats. Limited intake is around 50-100mg/100g which is brussel sprouts, spinach, oyster mushrooms, canterelle, lambs lettuce, asparagus.

Need to measure uric acid value in blood during treatment. Must be under 6mg/dl. Conventional medicine may be required.

Bone Metabolism Disorders

After growth, the bone is a highly metabolic organ which constantly regenerates. The bone cells are responsible for this. Osteoblasts build new bone out of periost and add to compacta. Osteocytes maintain metabolism in finished bone. Osteoclasts live around the endost and digest old bone cells.

Function of bone cells is regulated by hormones:

Parathormone: comes from parathyroid, releases calcium out of bone to boost calcium levels in blood.Calcitonine: comes from C cells in thyroid, stores excess calcium in bones.

Oestrogen: comes from ovaries and constructs bones.

Vitamin D plays an important role in bone protection and metabolism. Improves calcium absorption in bones and intestines, and also stops bone being digested and broken down.

Osteoporosis

Massive reduction of bone tissue. Thick compacta becomes weak and brittle. Bone breakage is high.

Primary and secondary causes. Primary is menopause. Lack of estrogen, exercise, tissue and muscle mass. Secondary: men are affected, caused by Cushing disease, diabetes, alcoholism, malabsorption, liver and kidney disease.

Risk factors: estrogen deficiency, early menopause, no childbirth, reduced activity, underweight, reduced calorie, malabsorption, nicotine, family.

Symptoms include back pain, especially cervical and lumbar, reactive muscle tension, improper posture, upper plate collapse in spine, deformation, bone fractures with upper leg often affected, spontaneous even.

Diagnosis includes rounding of back, sleeping skin folds on back, torso shrinkage. Early detection using bone thickness measurement. Xray not suitable, only useful once 30% loss has occurred.

Therapy for secondary type depends on underlying cause. Sufficient calcium and vitamin D, exercise. Conventional medicine uses estrogen, fluoride, gene manipulation.

Osteomalacia

Mineralisation disorder of bone tissue. Too little calcium and phosphorus stored. Weak bones that can bend and warp. Thickness remains same. Osteoporosis and osteomalacia can occur simultaneously. In kids its called rachitis.

Causes: vitamin D deficiency or metabolic disorder, lack of sunshine, hyperactive parathyroid releases too much calcium out of bone, malabsorption, maldigestion, kidney insufficiency loses calcium.

Symptoms: sensitive ribcage, skeletal pain during exertion, deformation and muscle weakness. Gait disorders.

Measure bone thickness and use xrays. Blood test shows alkaline phosphatase is high, parathormone normal or high.

Therapy includes vitamin D replacement. Same as with osteoporosis.