Nutritional Therapy – Mid-term & Final Exam – Flashcards

Nutrition is a science: Focused on the interactions between living organisms and their food "live food" Includes the study of biological processes used in consuming food and our body's ability to use the nutrients contained in that food How utilizing nutrients in the food to keep the organism functioning overall

Water (macro) Carbohydrates (macro) Proteins (macro) Fats (macro) Vitamins (micro) Minerals (micro)

○ Most abundant macronutrient ○ Transport nutrients ○ Improves oxygen delivery to cells ○ Enables cellular hydration ○ Moistens oxygen for easier breathing ○ Cushions bones and joints ○ Absorbs shocks to joints and organs ○ Regulates body temp ○ Removes wastes ○ Flushes toxins ○ Prevents tissues from sticking ○ Lubricates joints ○ Improves cell-to-cell communications ○ Maintains normal electrical properties of cells ○ Empowers the body's natural healing process

○ Provide fuel for the brain ○ Provide a quick source of energy for our muscles ○ Help regulate protein and fat metabolism ○ Provide a source of fiber, which helps with regular elimination of waste materials ○ Along with proteins and fats, carbohydrates: 1. Help fight infections 2. Promote growth of body tissues such as bones and skin 3. Lubricate the joints

○ Building blocks of many tissues of the body ○ Enzymes - managers and catalysts for all biochemical processes ○ Antibodies - Proteins that help fight infection ○ Hemoglobin - Specialized proteins in the form of red blood cells that carry oxygen ○ Hormones - Proteins that regulate our metabolism and almost every function in the body

○ Makes food taste good ○ Provide a source of energy ○ Building blocks for cell membranes and hormones ○ Required for the absorption of the fat-soluble vitamins, A,D,E,K ○ Required for the adequate use of proteins ○ Serve as a protective lining for the organs of the body ○ Play a role in slowing the absorption of food for proper energy regulation

○ Function primarily as coenzymes, or helpers, in metabolism ○ Essential for growth, vitality, and health. ○ Helpful in digestion, elimination, and resistance to disease ○ Depletion can lead to a variety of specific nutritional disorders and general health problems

○ Act as cofactors for enzyme reactions ○ Maintain pH balance in the body ○ Maintain osmotic pressure ○ Facilitate the transfer of nutrients across cell membranes ○ Maintain proper nerve conduction ○ Contract and relax muscles ○ Regulate tissue growth ○ Provide structural and functional support

• The Agricultural Revolution: (12k years ago) Went from hunter-gatherer to cultivators. Greater ability to feed larger groups of people. Many people working hard, produced enough food for a larger population - freeing others up for other functions. This abundance of food did not improve people's health - increase in infant mortality and decrease in lifespan as well as increase in infectious disease. • Refined Sugar: (400 years ago) Went from people with diets primarily consisting of proteins and fats to the carbohydrates in sugars. • Industrial Revolution: (early 1800s): Had the ability to mechanize the food processing industry. Foods no longer were properly prepared, instead they were adulterated. • Food Giants: (late 1800s, early 1900s) With urbanization and factories centralizing production, people moved off farms and into large urban areas. Impetus to figure out ways to preserve foods - such as processing grains to keep for a long period of time (e.g. milling out nutrients to keep microbials and insects from eating them) • WWII and advent of Chemical Revolution: (1939-1945) Hydrogenated oils, food processing. Increased need to produce food; with the war we needed to feed ourselves and our allies. Because distances were great and supply chains were weak, necessary to produce foods that last a long time. Nitrogen rich bomb materials to be used for fertilizers after the war ended. Beginning of herbicide and pesticide revolution. • Fast food & low fat revolution: (1950s & 60s) Partially hydrogenated oils increased heart disease, creating idea that too much fat was the culprit.

• There are a great variety of diets that are healthy • There are certain dietary laws that are inflexible and unchangeable ○ Must get the fat soluble factors from animal sources ○ In order to be healthy, foods must be properly prepared and in their whole forms • Dr. Price's greatest disappointment was that he could not find a vegan culture that was truly healthy. • All diets contained whole foods only, raw animal products, culutured foods. Processed foods (foods of commerce) introduced degradation to cultures. • Balance of fatty acids, bone broths, making use of every piece of harvested animal to get the most nutritional benefit • Soaking, sprouting, fermenting; fat soluble vitamins, use of animal products

• Not in the first-generation cats, but in the next two generations • The de-generation of the cats is a mirror image of our current social and health situation ○ Structural deformity ○ Social stress ○ Allergies ○ Reproductive problems • Dr. Pottenger reversed the diets of the first and second processed milk cats ○ It took four generations for the cats to return to normal

• 40% carbohydrates ○ Low-glycemic veggies - raw or lightly cooked ○ 2-3 fresh whole fruits (not juice) ○ Occasional starchy carbs - whole grains, potato, brown rice (<15%) ○ Organic, local whenever possible. • 30% protein ○ Grass-fed beef ○ Wild meats ○ Organic, free-range poultry ○ Whole, raw, cultured dairy ○ Lamb ○ Pastured eggs ○ Low toxicity seafoods • 30% fat ○ Raw, soaked nuts and seeds ○ Raw, cold-pressed oils from nuts and seeds ○ Cold-pressed, extra virgin olive oil ○ Saturated fats from healthy sources

1. Initial interview a. Determine how you can help the client and build rapport b. Gather the information you need to understand their health concerns 2. NAQ and Food Journal a. Gather symptom and dietary information 3. Functional Evaluation a. Gather clinical information 4. The Plan/Nutritional Recommendations a. Communicate recommendations 5. Follow-up Sessions a. Monitor and track progress

Anatomy: the study of the body's parts or the body's structure Physiology: the sturdy of how the body parts work or how the body functions Structure determines function; function determines structure - they're inseparable.

1. Chemical We are chemical machines, wondrous containers of millions of chemical reactions Atoms are the smallest possible piece of an element Body is composed of atoms bonded together in various formations Chemical atoms bond together to form a molecule or compound - first structural layer of the body 2. Cellular Cells are made up of many different types of molecules While you breathe, cells exchange bad air for good While you eat, cells produce enzymes that digest food Fundamental unit of life In the mitochondria, metabolic reactions within the cell convert the nutrients in our food (the fuel) to the cell's usable form of energy, adenosine triphosphate or ATP. "Cell Energy" Requires good nutrition to fuel the cell's energy. 3. Tissue Tissues are made up of cells that work together and perform the same function 4 classes: Connective Epithelial Muscle Nerve 4. Organ Collection of a variety of tissues create an organ An organ performs a specialized physiological function 5. System An organ system is a group of specialized organs working together to achieve a specific function 6. Organismal All the systems of the body combined make up the organism or human Continuously fine tuning itself to maintain or restore balance among systems - homeostasis Stress creates a need for adaptation, which means the cells don't work at the optimal level

pH stands for power of hydrogen. Represents the acidity or alkalinity of a substance. The more hydrogen the more acidic The more hydroxide the more alkaline A balance is neutral Falls on scale of 0 - 14. 0 is most acidic, 14 most alkaline/basic Each pH unit represents a tenfold difference of the H+/OH- concentration That means a H of 2 is not twice as acidic as a pH of 4, it is 100 times more acidic than a pH of 4 A pH of 2 is 1000 times more acidic than a pH of 5 Take the difference between the pHs and add the number of 0s of the difference after to determine the number of times difference pH of 1.2 - 3.0 is gastric juices

The anatomical position is to be the person face forward, looking forward, arms hanging by the side with the palms facing forward.

Superior: toward the head, upper part of structure (head superior to shoulder, shoulder to navel, knee to ankle)

Inferior: away from the head, lower part of structure (heart inferior to eye socket, feet to knee, knee to hip joint)

Proximal: nearer to the point of attachment to the body (elbow proximal to the wrist, wrist to fingertips)

Distal: farther from the point of attachment of the body (hand distal to elbow, elbow to shoulder)

Medial: toward the midline of the body (navel is medial to the shoulder joint, heart medial to the lungs)

Lateral: outside or side of the body (lungs lateral to the heart)

Anterior: toward the front or face side of the body (clavicle anterior to the shoulder blade)

Posterior: toward the back of the body

Ipsilateral: two things on the same side of the body (right hand and right foot)

Contralateral: two things on the opposite side of the body

Superficial: toward the surface or on the surface of the body

Deep: away from the surface of the body

Bilateral: relating to or having two sides (a palpation occurring on both sides)

Unilateral: occurring on only one side

1. Digestion is a North to South process 2. The big three organs from a nutritional standpoint are (GPS): a. Stomach b. Pancreas c. Gallbladder 3. Digestion is Fundamental to nutritional therapy Mnemonic: SLiP - (Golly!) North to South off your Foundation

Brain activates salivary glands to secrete saliva Mouth begins mechanical and chemical breakdown of food Bolus travels to the stomach Stomach begins mechanical and chemical digestion Introducing digestive juices Pepsin aids in breakdown of proteins Neurons trigger mechanical churning Bolus breaks down to chyme Chyme passes to upper portion of small intestine (duodenum) Triggers gallbladder to release store of bile to mix with fats Assimilates some of the nutrients Pancreas releases pancreatic juices Sodium bicarbonate and enzymes Small intestine to Large intestine Large intestine responsible for recycling water, vitamins, minerals Produces butyric acid to feed cells of colon, vitamin K for beneficial bacteria, fiber

1. Brain a. "People not eating in a parasympathetic state which doesn't allow adequate introduction of salivary amylase or activation of gastric juices from signals in the brain" b. Sympathetically stressed i. Need to be parasympathetic to digest food 2. Mouth a. "People don't chew their food, leading to poorly digested carbohydrates that ferment in the stomach." b. If we don't chew our foods (~30s), we're not breaking down our food enough to allow enough time for brain to trigger proper digestive processes c. Food does not get broken down enough, placing a burden on the stomach d. The production of saliva is not triggered 3. Saliva a. Saliva is complex mixture of electrolytes, hormones, and enzymes b. Without the proper nutrition, the proper enzymes may not be secreted in the saliva during the process i. Salivary amylase begins breakdown of starches ii. Pancreatic enzyme cannot complete the breakdown of starch in small intestine, leaving undigested starch entering the colon that feeds candida and dysbiosis 4. Stomach a. "In the stomach a common dysfunction is a lack of stomach acid which can lead to overgrowth of parasites or poorly digested proteins leading to a leaky gut situation" b. H Pylori - Vitamin C deficiency c. Ability to produce stomach acid compromised i. Stress, excessive carbohydrate consumption, nutrient deficiencies, allergies and excess alcohol consumption can inhibit 5. Small Intestine a. "Gallbladder is impaired by viscous bile not being secreted not being secreted into the small intestine preventing the breakdown of fats which damage the microvilli of the small intestine. Lots of people have pancreatic insufficiency - pancreas has been worn out from sugar handling burden/overeating leading to too frequent release of pancreatic enzymes which lead to malabsorption of enzymes" b. Carbs, Fats, and Proteins begin to rot and reduced acidity chyme passes through to the small intestine and the pancreas is not appropriately triggered to release sodium bicarbonate. The chyme burns the mucosal lining of the intestines because it's not alkaline enough, but not acidic enough to trigger the pancreas i. Lack of acidity also keeps the gallbladder from releasing bile, appropriate breakdown of fats doesn't happen resulting in an essential fatty acid deficiency ii. Undigested proteins impact the villi of the small intestine and the ability to absorb nutrients 1) Proteins abnormally sized, the body tries to pull the proteins through which perforates the lining and passes through creating Leaky Gut Syndrome. Maldigested fats, carbs are then able to pass through as well and the body attacks creating a cycle of an autoimmune response 6. Large Intestine a. Leftover maldigested foods are full of parasites, protozoas, microorganisms tries to pass into the colon, the illiocecal valve can get jammed. This creates inflammation and a mess of parasites jam open the valve creating a backflow into the small intestine. Waste can run back into an area reserved for nutrient absorption overwhelming the immune system. b. Maldigested food can disrupt the balance of healthy vs. not so healthy bacteria in the gut, creating dysbiosis. Fermented/cultured foods can help balance this dysbiosis. Probiotics can also supplement. Lack enough healthy bacteria to create butyric acid which results in a weakened large intestine that will stretch and collapse on itself or not allow the assimilation of B12, K, or other vitamins. This is also inflammatory and painful - can lead to diverticula and loss of tone.

Based on north to south process of digestion as well as whether or not a point LNTs and how high of a priority the indicators are.

1. Digestive Reaction a. Looks like a digestive problem b. Examples: diarrhea, cramping, heartburn, constipation c. Reaction: Support the digestion 2. Sensitivity and/or allergic reaction a. Looks like a sensitivity or allergy symptoms b. Examples: rash, hives, congestion c. Reaction: Find an alternative therapy 3. Healing Reaction a. Looks like the symptoms you're trying to fix b. Examples: flu-like symptoms if you're working on immune function or nausea if you're working on gallbladder c. Reaction: Mild to Moderate, give the client the option to cut back dose or work through it. Severe symptom, recommend the client call you.

a. The primary Organs that regulate blood sugar are (PAL): i. Pancreas (secretes hormones) ii. Liver iii. Adrenal Glands (secretes hormones) b. Never before in the history of mankind, have we had an Emergency need to LOWER blood sugar. (That is, until we started consuming large amounts of refined carbohydrates/sugars). c. Americans are Inundating their bodies with sugar and refined carbohydrates i. Average is at least 196 pounds of refined sugar in a year d. Consumption of refined sugars causes severe Deficiencies in the nutrients that help regulate blood sugar, especially thiamine (B1) Mnemonic: Orange Elephants Inundate Downtown/PAL

Eat foods which elevates blood sugar. Pancreas releases insulin which signals to the liver to store glucose as glycogen for later use (adipose tissue, muscle). Blood sugar starts to decrease until it dips. Another hormone from the pancreas called glucagon signals the release of the stored energy. Convert the glycogen back into glucose back into the bloodstream to bring the blood sugar back into the mid-range. When there's an emergency, there's a big energy requirement. Uses glucose quickly, plummeting the glucose. The adrenals need to fire to deliver their glucocorticoids (cortisol) which sends signal to liver and muscles to release more glucose into the bloodstream. As glucose levels plummet, the pancreas will try to bring the blood sugar back into the normal range, but in emergency situations the glucagon cannot signal enough sugar back into the bloodstream so the adrenals kick in. "During normal blood sugar regulation, only the pancreas and liver are involved. The pancreas sending hormone signals to store or release and the liver being responsible for making sure that happens. When the blood sugar gets dangerously low, the adrenals must kick in with their regulatory hormones to bring blood sugar back into the normal range. This is supposed to be exclusively for the emergency situations only, but in modern day this is happening far more often."

"A diet high in refined carbs leads to elevated glucose levels which will over time burden the organs responsible for blood sugar regulation" "A diet high in refined carbs lacks the necessary slower to digest, slower to assimilate fats and proteins which moderates the absorption of sugars into the blood stream"

"Wearing out the organs of blood sugar regulation, also becoming resistant to own hormones such as insulin, exhausted capacity to respond to insulin which leads to Type 2 diabetes potentially being medically/clinically diagnosed."

a. Cravings for sweets b. Sleepiness c. Irritability d. Mentally sluggish e. Hungry even after eating a meal

a. Index: numerical value of a food measuring the blood glucose response into the bloodstream after consuming a fixed amount (50 grams) i. The rating is based on a reference food (pure glucose or white bread), which is given an arbitrary value of 100 ii. Does not tell you about the portion of the food b. Glycemic Load: considers the actual average portion someone might eat of a food. Represents the blood glucose effect of a standard serving of food rather than a fixed amount of carbohydrate c. Index measures rate of glucose entry into the body based on a fixed amount of food versus load is against the average portion

1. Healthy fatty acid deficiency is Epidemic a. Allergies, skin problems b. Musculoskeletal issues c. Endocrine issues d. Depression e. Immune issues f. Cardiovascular issues 2. Inflammation can be effectively managed with nutritional therapy, therefore reducing healing time 3. Fatty Acids are an important component of managing inflammation Mnemonic: epidemic/medic; need a medic for inflammation

1. Linoleic acid (LA) - precursor to all the other Omega 6 fatty acids 2. Alpha-linolenic acid (ALA) - (three words so it's an Omega 3) - precursor to all the other Omega 3 fatty acids

1. Critical makeup of the cell membrane 2. Provide a source of energy 3. Are required for the absorption of the fat-soluble vitamins: A,D,E,K 4. Are required for the adequate use of proteins 5. Serve as a protective lining for the organs of the body 6. Play a role in slowing the absorption of food 7. Makes food taste good

"When low in Omega 3 and 6 fatty acids, at risk for longer healing time because they lack the necessary precursors to make PG1 and PG3 (the anti-inflammatory prostaglandins)." Prostaglandins - hormone like substances your body can't live without. Longer carbon chain molecule (20 carbons in length). Put together by conjugating fatty acids together. Communicators - open and close doors on cells to allow cells to maintain homeostasis Following the prostaglandin pathway down, you're not contributing enough fatty acids to be conjugated to make PG3 anti-inflammatory hormones. You have less of an ability to anti-inflame, leading to inflammation in the body and perpetuating inflammation getting out of control and leading to a disease state Low in LA, less likely to conjugate fatty acid chains for PG1 anti-inflammatory pathways. A diet low in these acids, the body has less ability to anti-inflame and slow the healing process. Your ability to recover from a disease state will be lessened.

• Proper Digestion • Proper Liver function • Enzymes ○ Delta-6-desaturase ○ Amino Acids ○ Vitamin B6 ○ Magnesium ○ Zinc

Calcium is a game of co-factors: (SHHOVED) ○ Systemic pH ○ Hormonal function ○ Hydration ○ Other minerals ○ Vitamins (fat soluble) ○ EFAs ○ Digestion Almost everyone gets enough calcium. They are missing the cofactors that allow the body to absorb/use it.

• Act as cofactors for enzyme reactions • Maintain pH balance in the body • Facilitate the transfer of nutrients across cell membranes • Maintain proper nerve conduction • Contract and relax muscles • Regulate tissue growth • Provide structural and functional support

Osteoclasts and osteoblasts break down and rebuild bone tissue, called remodeling. When the body needs more calcium, it calls on the osteoclasts to break down bone tissue to make the calcium available for other tissues.

1. Systemic pH 2. Hormonal function 3. Hydration 4. Other minerals 5. Vitamins 6. Fatty acids 7. Digestion

Water is the most common deficiency in the American population (COMMON)

Improve oxygen delivery, transport nutrients, enable cellular hydration, cushion bones and joints, regulate body temperature, remove wastes, flush toxins, lubricate joints, improves cell to cell communication, empowers body's natural healing process

Early signs: Fatigue, anxiety, irritability, depression, cravings, cramps, headaches Mature signs: Heartburn, joint pain, back pain, migraines, fibromyalgia, constipation, colitis

Body weight divided by two = minimum number of ounces of water. Add 12-16 ounces of water to make up for each cup of diuretic (number of oz of diuretics, times by 1.5 and add to body weight divided by 2)

Coffee, tea, juice, alcohol. If you drink an 8 oz diuretic beverage, add 12-16 oz of water to your daily intake. Make sure to get adequate electrolytes.

1. Always address the Foundations first... Healthy digestion is key to healthy immunity. 2. To improve immune function, strengthen the defenses and remove the stressors. 3. To resolve food intolerances, address the true allergies along with sensitivities. (ASRAS (think of Ass Rash as an immune response) Always Strengthen Remove Allergies Sensitivities)

1. Nonspecific Resistance/Barriers: meant to stop the entrance of invaders 2. Nonspecific or "Innate" Immunity: white blood cells and other biochemical substances that provide a rapid response to a wide range of invaders. This is your surveillance team. 3. Specific or "Adaptive/Acquired" Immunity: white blood cells that mount an attack to target specific invaders that escaped the nonspecific defenses

1. Innate response 2. Adaptive/Acquired response

1. Blood sugar balance: a. A stress response by the adrenals depresses the immune system. b. Consistently high blood sugar reduces white blood cell activity and depresses the immune system in general 2. Mineral balance: a. Ionized calcium supports white blood cell activity b. Zinc is a component of the enzymes required to heal wounds. Zinc also provides a general boost to the immune system and helps protect against free radicals. c. Iodine is a natural anti-bacterial and anti-viral agent 3. Fatty acid balance: a. The appropriate mix of fatty acids is critical for the management of inflammation b. An imbalance of the proper fatty acids actually assists in the formation of inappropriate antibodies (food allergies) 4. Hydration: a. Water is needed by the lungs to keep air passages moist and prevent them from drying up as you breathe. b. Good hydration supports good lymphatic flow and proper blood viscosity c. Dehydration can exaggerate histamine activity for the purposes of water regulation, which can play a role in asthma and allergies. 5. Digestion: a. Gut is location of 70-80% of our entire immune system. b. The lining of the small intestines is full of lymph nodules (Peyer's Patches)

• Allergies: according to the medical definition, a person can only be truly allergic to some type of protein-based substances. • Food sensitivities: However, many people experience "allergic-type" reactions to other foods that are not protein-based.

1. Is the problem caused by something the client needs to avoid? What is making it worse (e.g. wheat or milk allergy)? 2. Is the problem caused by something that needs to be eliminated or detoxified (e.g. mercury toxicity) 3. Is the problem caused by a deficiency in something? What must be done to get better? (e.g. essential fatty acid deficiency)

1. Digestive reaction: looks like a digestive problem (e.g. diarrhea, cramping, heartburn, constipation) 2. Sensitivity and/or allergic reaction: these look like sensitivity or allergy symptoms (e.g. rashes, congestion) 3. Healing reaction: looks like the symptoms you're trying to fix (e.g. flu-like symptoms if you're working on immune function or nausea if you're working on gallbladder)

1. Take pulse for 60 seconds 2. Put food/supplement for 30 seconds but do not swallow 3. Take pulse for 60 seconds - 6 beats or more, indicates allergic response

Lipid Soluble 1. Steroid Hormones (derived from cholesterol, include cortisol, estrogen, progestrone) 2. Thyroid Hormones: T4 throxine and T3 Water Soluble 3. Amines: modified amino acids, include glucocorticoids, adrenoline, noradrenoline, histamine 4. Peptides and Proteins: hormones made up from peptides or proteins, include human growth hormone, insulin, glucagon, CCK, gastrin, oxytocin, ADH 5. Icosonoids: derived from fatty acids

1. The system is very complex, so we have to look at the whole system as well as focusing on the parts. 2. The endocrine individuality of each client will be different. 3. Always address the foundations first. (CIA: Complex, Individuality, Always)

• Digestion: Provide good digestion of proteins and fats which are precursors to the production of endocrine hormones. • Mineral Balance: Every endocrine organ has a mineral on which it is particularly dependent (Thyroid/Iodine, Prostate/Zinc, Pituatary/Manganese, Pancreas/Chromium, Gonads/Selenium, Adrenals/Copper) • Fatty Acids: ○ EFAs and other fats are critical to the entire endocrine system ○ Endocrine factories are inside the cells and phospholipids control what goes in and out of the cell ○ A healthy cell membrane is also needed for the cellular/hormonal communication to take place • Hydration: ○ Hydration supports the efficient transport of hormones throughout the body ○ Hydration ensures proper viscosity of the blood and interstitial fluids • Blood Sugar Balance ○ Any attempt to address hormonal issues is futile unless the blood sugar regulation is addressed. Organs of blood sugar regulation are also endocrine glands. ○ Don't wear out the endocrine organs that have other functions - when liver is asked to consistently break down excess cortisol, it no longer has the capacity to break down other hormones.

• Chronic stress response begets chronic output of cortisol. Elevated cortisol wreaks havoc with the entire body. Elevated cortisol exhausts the adrenals which impacts the entire system. • Elevated cortisol levels decrease the effectiveness of the liver pathways that perform the conjugations • Elevated cortisol levels puts a strain on the pancreas, insulin receptors on cells do not respond adequately to insulin, putting a strain on the pancreas to secrete more in order to transport glucose into the cells leading to high insulin levels • Adrenal glands will steal pregnenolone from the endocrine system to support chronic stress causing dysfunction.

• When exogenous hormones are given to the body, you can directly squelch the negative feedback loop from the pituitary and the hypothalamus. Giving an exogenous hormone for a period of time, stops the signaling of the body to create additional hormones. • When a consistent dose of hormones is given over time, the receptor sites can shut down, collecting the hormones in the tissues.

1. Heart disease results from the overconsumption of processed foods. 2. The health of the heart reflects the health of the body. Always address the foundations first. 3. Inflammation is a significant cause of the most common forms of heart disease.

1. Diet: a. Properly prepared nutrient dense foods are fundamental for a healthy heart 2. Fatty acid balance: a. The truth is that good fats are the best source of energy for the heart b. The appropriate mix of fatty acids is critical for the management of inflammation c. Remember that fatty acids are an essential art of the cell membranes that make up the tissues of the heart and the coronary arteries. 3. Blood sugar balance: a. Blood sugar imbalances lead to an overproduction of cortisol during the "fight or flight" response b. This can lead to insulin resistance, which compromises mineral uptake by the cells. c. High insulin also blocks the PG1 pathway for prostaglandin anti-inflammatory production. 4. Mineral balance: a. Magnesium and calcium are essential for a healthy heart. i. Calcium triggers contraction and relaxation. ii. Without the appropriate cal-mag ratio, the calcium will not work. 5. Hydration: a. Good hydration supports good lymphatic flow and proper blood viscosity. b. Dehydration causes the vascular system to selectively close some of its vessels, which leads to hypertension c. Hydration impacts how efficiently proteins and enzymes function within the body. 6. Digestion: a. Good protein digestion is critical to make the amino acids needed by the heart available (like taurine and carnitine) b. Proper stomach pH is needed to absorb calcium and digest the B vitamins c. Proper liver/gallbladder function enables you to digest healthy fats and the fat-soluble vitamins d. Proper bowel flora is needed to produce vitamins B1, B2, B12, and K

1. Kidney function/hydration 2. Liver/biliary stasis 3. Adrenal 4. Sugar handling imbalances 5. Mineral imbalances 6. Fatty acid imbalance 7. Allergies and food sensitivities 8. Thyroid 9. Circulatory 10. Emotional 11. Structural 12. Obesity 13. Lack of exercise

1. B-type: Vitamin complex based in naturally occurring thiamine (B1, B-factor) a. Type of person: hypotensive, crave sugar, feel bad/run down, sick often, tends toward CHF 2. G-type: Vitamin complex based in riboflavin and associated B vitamins (B2, G-factor) a. Type of person: hypertensive, craves alcohol, feels good/pumped up, does not get sick, tends toward MI

When inflammation is triggered in your body, your immune system releases various immune system cells. In cases of chronic inflammation, the production of these cells remains ongoing and the cells can eventually migrate into the arteries. There, they can start consuming fatty deposits, changing from stable cholesterol plaques to unstable lesions known as vulnerable plaque

1. Detoxification is a parasympathetic process. 2. Detoxification frees vital cellular and organ activities to function productively and efficiently. 3. NEVER detoxify without addressing the Foundations... all elimination pathways must be open. (PECO - Pete Eats Cucumbers and Onions - Parasympathetic Elimination Cellular Organ)

1. Diet: a. Processed, lifeless food is seen by the body as a toxin. b. Too much food (volume) uses too much energy, and doesn't leave enough for "house cleaning" c. Ingestion of the proper Macro and Micro nutrients all play an important role in the body's ability to detoxify 2. Digestion: a. If a person isn't digesting, even the most perfect diet can clog the body's detoxification pathways b. Specific amino acids play imperative roles in the proper functioning of the specific detoxification pathways in the liver. c. Poor fat digestion clogs the lymph and therefore the liver. 3. Blood sugar regulation: a. Elevated cortisol and general blood sugar imbalance stress the liver b. Blood sugar imbalances deplete the B vitamins. c. Chronically high blood sugars create a buildup of free radicals and a general catabolic state, which robs the nutrients needed by the body to detoxify properly. 4. Fats: a. Fat tissue helps the body to store difficult to remove toxic waste b. The liver metabolizes fats into their usable forms. Proper ingestion and digestion of fats causes less liver stress. c. The bile is built of healthy fat. The bile is the "river" by which toxins are removed from the body via the intestinal tract. d. The proper balance of dietary fat helps to create a properly permeable membrane, allowing wastes to be removed from the inside of the cell in a timely manner. 5. Minerals: a. Detoxification processes can create acidic blood. Minerals help to buffer this condition. b. Toxins deplete minerals like magnesium, which can lead to deficiencies of enzymes which are necessary in healthy Phase I liver detoxification. c. Certain minerals help keep heavy metals from collecting in the tissue. d. Molybdenum and manganese activate metabolic and detox enzymes. e. Chelation agents deplete minerals, requiring replacement. 6. Hydration: a. We must keep properly hydrated to keep the body flushing appropriately, moving bowels and urine regularly b. Perspiring requires proper hydration c. Proper hydration helps to keep our lung tissue moist so that we can respire healthfully. d. Proper hydration keeps the blood fluid so that toxic material may be delivered to the lymph and liver.

1. Address the Foundations (especially diet) and keep the client on the initial protocol for 2 - 3 months. 2. Recommend supportive therapies to help with circulation/elimination: a. Dry brush massage b. Bouncing exercises c. Enemas/colonics/purgatives d. Sweating therapies 3. On a follow-up visit, conduct the balance and point tests. 4. If the client performs poorly on these tests, consider a more in-depth detoxification protocol.

(Digestion) (Z ↓ 1" L) One anatomical inch inferior and lateral to the Xiphoid process, on the medial margin or edge - not on top of, the left rib cage. Press medial to lateral M>L. One finger (or thumb) palpation.

(Digestion) (6th L) Found in the left 6th intercostal space, mid-mammary line, slightly lateral - The 6th is almost always under the bra band on women. One finger palpation, A>P.

(Digestion) (Z ↓ 1" R) One anatomical inch inferior and lateral to the Xiphoid process, on the medial margin or edge - not on top of, the right rib cage. Press medial to lateral M>L One finger (or thumb) palpation.

(Digestion) (6th R) In the right 6th intercostal space, mid-mammary line, slightly lateral - The 6th is almost always under the bra band on women. One finger palpation, A>P.

(Digestion) (under ribs R) Position client with knees bent; place finger tips 1.5-2" away from curvature of ribs; Ask client to take deep breath in and when they exhale palpate A>P. Ask the client to take one more breath and on the exhale gently change the direction of your palpation more deeply, Inferior to superior I>S and under the rib cage. With your hand still under the ribcage, ask them to inhale one last time. This allows the diaphragm to push the gallbladder into your fingertips. Be sure to watch client's face and stop the palpation at any point when they feel discomfort or you cannot fairly easily go further. Rate either tenderness and/or tension.

(Digestion) Feel the right thumb web on the edge of the skin web and the muscle RIGHT next to the bone at the base of the thumb; To locate pinch the muscle and then slide off and back onto the web until client indicates tenderness or you feel nodulation, much like a BB.

(Digestion) (Palpate 2-3" around umbilicus)Draw imaginary circle 2-3 anatomical inches around the umbilicus and divide into 4 quadrants. FIRST PALPATION: palpate with the flat of your fingers gently in all 4 quadrants - you are feeling for resistance or congestion; SECOND PALPATION: change to a deeper palpation, A>P, & imagine you are separating the tissue as you work deeper. Have the client indicate tenderness for each quadrant.

(Digestion) (8, 9 & 10) Check for tenderness in the spaces between the 8th, 9th, 10th ribs right and left. Work from the back and draw your hands around the sides letting your fingers fall into the spaces between the tips of the ribs; if the client is ticklish, hold the client's hands and have them do the palpation on themselves.

(Digestion) With the edge of your fingers palpate deeply feeling for resistance/congestion or until the client feels tenderness in the surrounding lymphatic tissues. Start just inside the ASIS, right side, palpate side to side and concurrently A>P across the colon, upward to the rib cage (ascending colon), then across the abdomen, palpating in an upward and downward motion, (transverse colon) and then down the left side, side to side motion, (descending colon). On the exam form the point are indicated A-B and B-C (A being the ASIS on the right, B the midpoint of the abdomen and C the ASIS on the left) Record any tenderness in corresponding areas.

(Digestion) The iliotibial band runs down the exterior of the leg from the hip (greater trocanter) to the knee in the same place as the stripe on a band uniform. This mirrors the Large Intestine palpation. If you dissected the colon in the middle of the abdomen and drew the ends down the iliotibial band, the palpations for tenderness on the iliotibial band would likely mirror the tender points on the colon. The Chapman should validate your findings for the Colon; If only the iliotibial band is tender at the mid-point, this is likely an indicator of prostate/uterus weakness, not a colon indicator.

(Digestion) Palpate ½ the distance between the right ASIS and the umbilicus. Palpate A>P feeling for tenderness. Using a slight circular motion (clockwise) to help move the tissue as you probe deeper.

(Sugar Handling) Have client lie on their back & take a resting blood pressure. Ask client if they ever get dizzy when standing quickly. Advise that if they should become dizzy during the test, you will have hold of their arm for support. Pump the cuff up 15-20 mm/Hg higher than the first systolic reading and, while supporting the client's arm, have them stand up quickly. As they are standing quickly release the BP cuff valve to get a second BP reading. You must take the reading within 5 seconds of their feet hitting the floor for accuracy. If you take longer than 5 seconds you miss the "event" which is the adrenal response for a need to raise/stabilize blood pressure when you stand quickly from a resting position. The indicator is the Systolic reading only.

(Sugar Handling) Ask client about eye surgeries, head injuries and contact lens color (eyes will respond differently if contact color is not the same in both eyes ) Instruct client to look at fixed point in the distance; position pen light 6-12" from head & move light from the side of the head (180 degrees). to a 45-degree angle in front of the eye. Observe for 20 seconds. Result: Pupil constricts & holds for 20 seconds = Excellent; Constricts & holds for 10 seconds and then pulses = Fair; Constricts & pulses, then enlarges at 5-10 seconds = Poor; Constricts, pulses and enlarges almost immediately = Fail; Constricts, immediately becomes larger or fails to constrict = Adrenal Exhaustion.

(Sugar Handling) (2" →↑ umbilicus) Client on back with abdominal muscles tightened by lifting the head as if doing a "sit-up." Palpate 2 anatomical inches lateral and 2 anatomical inches superior to the umbilicus. Palpate with one finger, A>P as you are feeling for small "pea-like" nodules that sit on top of the abdominal muscle. Record each side.

(Sugar Handling) Position the client either face up or face down. Either GENTLY pull on the legs to help straighten their position or ask the client to push their heels together and release - this will help straighten their position. Then holding the client's feet together, determine if one leg is shorter than the other) by placing your thumbs or fingers on their medial maleolus (anklebones). You can compare the anklebones or compare the seams of the shoes where the heels attach.

(Sugar Handling) Always ask permission before palpating a sensitive area. The Inguinal Ligament runs between the ASIS and the lateral edge of the pubic bone. You are palpating the entire ligament by drawing your fingers back and forth across it like a bow on a violin at a 90 degree angle. Press A>P while doing so. If there is pelvic instability, the ligament on one side will be tight and the other side flaccid. Palpate both sides for tenderness and tension.

(Sugar Handling) (7th L) Reflex for the Pancreas/Spleen: 7th intercostal space on the left, mid-mammary line. Find the 6th intercostal space and move down and slightly lateral. When locating the 7th intercostal space if you move to the xiphoid, you will be below it. Single finger palpation, A>P. This point is also expressed in the 7th intercostal space on the left, lateral/coronal portion of the ribcage. Move to the far lateral/coronal portion of the ribcage. Single finger palpation, A>P.

(Sugar Handling) Draw a circle around the right thenar pad. Directly in the middle of this imaginary circle there should be a slight indentation. Probe deeply into this point. Palpate for tenderness. Often the indicator is a sharp pain.

(Sugar Handling) This is NOT a spinal indicator! It is a reflex located on the right side of the spine only! Locate the bottom of the scapula (wing) either right or left side which is directly across from T7. Cup it with the palm of your hand, (palm facing up). As you roll your hand upward, and with your palm now flat against the client's back, palpate right next to the spine (RIGHT SIDE), with your first 3 fingers. Posterior to Anterior P>A. You are checking for congestion or tenderness on the right side only. Compare against the left side to determine if there is a difference. If there is the same amount of congestion, then this is not an indicator. (+/-)

(Sugar Handling) (R) Dr. Dejarnette's sign. Start on the clavicle, mid mammary line, RIGHT SIDE, and count down until you are on top of the 3rd rib. (The clavicle counts as the first rib.) On the 3rd rib on the right move slightly laterally to the point where the bone turns to cartilage (chondracostal junction). Palpate A>P checking for pain and rigidity. You can verify findings by checking the 3rd rib on the left to compare .IF THEY ARE THE SAME, THIS IS NOT AN INDICATOR.

(Fatty Acids) Dr. George Goodhart's observations. Client should not eat, smoke or drink anything but water within 30 minutes of the test. Tear off a 2" piece of pH test paper. Don't touch the end going into the client's mouth. Have the client wet the paper with saliva and allow you to pull it out of the mouth with their lips apart. Compare quickly against the chart. Score the test. 7.2 - 7.4 = sufficient.

(Fatty Acids) (20x) It's important to explain the test before you begin. First test to find an "intact" muscle - one that can hold a lock. This can be a postural or non-postural muscle. Once the muscle has been "tested" for a lock, explain that this is not a strength test but rather a test of muscle recovery. The client should resist just to the point of lock, like a "dance." Timing is important - each challenge should be one second or slightly longer. Time by saying one, one-thousand; two, one-thousand; three one-thousand, etc. This test is rated by indicating the number of satisfactory "locks" before the muscle could no longer recover. As the muscle fails, it may tremble or the body may involve other, neighboring muscles to help keep the muscle from failing. Watch the body for the recruitment of other muscles and stop the test at this point. If client fails non-postural but passes postural try folic acid. If client fails postural but passes non-postural try iron. RATING: >20 reps = no deficiency. 15-19 reps = mild deficiency 9-14 rep = moderate deficiency. 0-8 reps = severe deficiency. Students must demonstrate the test on both a postural and non-postural muscle.

(Tissue Mineral Status) First, ask the client if they have any contraindications: (Phlebitis, edema, thrombosis, vascular or any other circulation problems in the legs) With elderly or frail clients, do not inflate above 180mm. With the client sitting on the edge of the table place the BP cuff around the largest portion of the calf of the leg. Instruct the client to advise you when they feel the steady ONSET of a cramp. Inflate the BP cuff slowly with a smooth needle. Once the client's threshold is reached, deflate the cuff quickly. Wait 30 seconds (so that blood can profuse the tissue) and repeat the test on the same leg. You are attempting to reach 240 without cramping. 150mm = Very Deficient; less than 200 = Deficient; more than 200 = Sufficient; over 240 = Optimal NOTE: Clients who are hyperadrenic/fast oxidizers/highly sympathetic can skew this test.

(Tissue Mineral Status) Always ask the client if they are sensitive to iodine or if they have any thyroid conditions before you begin. Apply 2-3" square patch of brown 2% iodine tincture to forearm, abdomen or thigh.( thin skinned areas ) Instruct client to watch patch over the next 24 hours and make note of the time (in hours) when the patch faded. Advise okay to bathe but not to soak or scrub and to be certain to check before bed.

(Tissue Mineral Status) Client should not have had anything to eat or drink (except water) within 30 minutes. Explain to the client that they will swish 1 TBS liquid zinc around in their mouth for up to 30 seconds and to let you know immediately when it tastes like something other than water by shaking their head. With the zinc in clients' mouth, practitioner should read the list of taste sensations slowly to pace with 30 second timing. 1. Strong unpleasant taste, 2. Definite taste that gets stronger; 3. No immediate taste but slightly minerally, dry or furry; 4. No specific taste after 30 seconds 5. Sweet taste after 30 seconds. RATING •EXCELLENT: A strong and unpleasant taste is noted immediately. Client normally grimaces. •FAIR: a definite, though not strongly unpleasant taste is noted almost immediately and tends to intensify with time. •POOR: No immediate taste is noted, but develops in 10-15 seconds variously described as: "dry", "minerally", "furry", or "sweet". •DEFICIENT: No specific taste or sensation is noted, even after the solution has been held in the mouth for up to 30 seconds..."Tastes like water". •EXTREMELY DEFICIENT: Tastes sweet when held in the mouth for up to 30 seconds.

(Tissue Mineral Status) Hold the clients hand palm up. Place your fingers across the clients fingers at the second knuckle and exert light pressure bending the fingers away from the palm and towards the floor. Observe the creases and lines in the finger and palms. If the lines brighten and red there is no deficiency. If the lines do not brighten and stay pale this indicates a deficiency. (+/-)

(Hydration) Instruct the client to stand with their hands at their side. Visually check and palpate the veins on the top of the right hand. Place the clients left (or right) hand at the level of their heart (5th intercostals space). Keeping their arm straight, slowly help the client raise the opposite arm to a level even with their other hand (heart). Check the veins (palpate) again to determine if they are: Excellent = Veins are the same Fair = Veins are reduced Poor =Veins are no longer visible or palpable.

(Hydration) Practitioner should verbally ask the client about their daily intake of water regardless of the fact that they may have already noted this information in the Food Journal or NAQ form. Rule for water consumption: Body weight divided by 2 = # of ounces of water.

(Hydration) Practitioner should inquire about diuretic intake regardless of the fact that the information may have been documented elsewhere. This is a good place to quickly explain that for every 8 oz of diuretic beverage, it must be replaced with 8-12 oz of good water to maintain good hydration. (This education is not required for the exam, just the question.)

(Kidneys) With client on their back, ask them to tighten their abdominal muscles by lifting their head slightly. The Chapman Reflex Kidney points are 1" lateral and 1" superior to the umbilicus. They are tiny "pea-size" points that sit on top of the abdominal muscle. These are each a single finger palpation, A>P.

(Endocrine) The practitioner may ask the client to palpate their own breast tissue being sure to palpate all quadrants of the breast and ask them to describe any tenderness. For maximum client comfort, Practitioner may demonstrate the palpation on their own breast tissue and ask the client to do the same. If client is female, precede test with the question "do you experience breast tenderness during your period?", and if so, "Are you currently having your period?" Rate tenderness 1-10.

(Endocrine) Locate the ridge between the eyebrows and find a small soft spot just above (the 3rd eye). Check for tenderness or spongy feeling. Another way to find the point is to start with your index finger in the middle of the forehead and gently drag your finger to the "V" formed by the bone structure between the brows. Palpate for tenderness, A>P.

(Endocrine) You may use either the medial edge of the hand in a rocking motion, or the fingertips. Palpate the mid mammary line, at the point where the bone changes to cartilage. (Costal/Chondral Margins) Start at the clavicle, mid-mammary line, and move down the rib cage (costal/chondral junction). FOLLOW THE LINE OF THE RIB CAGE. Finish by palpating across the bottom and up the medial aspect of both ribs. This is a "general tenderness" rating. Client should rate the overall tenderness on a scale of 1-10. Must be tender all the way down to be an indicator.

(Endocrine) (2nd R-L) Bilateral. Second intercostal spaces, next to the sternum. Palpate A>P, for tenderness. Record R and L indicators. *There is theory that the point on the right is more of a Thyroid indicator and the left side, Heart. This is NOT absolute.

(Endocrine) Locate the flattest part of the tibia about ¼ to 1/3 of the way between the ankle bone and the knee. Press firmly into the bone for 2-3 seconds then run your finger back over the spot very lightly to feel for a depression. The deeper and longer-lasting the depression, the more significant. Rating: NONE - Disappears immediately, or very shallow MILD - Disappears within 10 seconds SEVERE - Remains longer than 10 seconds

(Endocrine) Bilateral. Locate the point halfway between the medial malleolus (ankle bone) and the medial aspect of the calcaneus (heel bone). Feel for a small indentation (not the valley just posterior). Press laterally and rate tenderness. .Record both R and L indicators.

(Endocrine) Chapman Reflex Prostate/Uterus - this point overlaps part of the Chapman Colon Reflex. It is middle third portion along the iliotibial band at the point where the client's hand will reach when held against the side of their leg. Palpate approximately 2" superior and 2" inferior to their fingertips. Check for tenderness and nodulation.

(Endocrine) Chapman Reflex Prostate/Uterus - Always ask permission to palpate in this area or use the client's own hands to palpate. Begin by asking the client to find the top edge of their pubic bone. Place both index fingers, or thumbs together at the mid-point of the pubic bone and then move them laterally the width of 1-2 fingers. The palpation is on the superior edge of the bone, pushing down (inferior) S>I toward the feet, NOT A>P. Record both R and L indicators

(Endocrine) Bilateral. While holding the clients foot with your hands, bend the foot slightly to reveal the apex of the arch (the highest point). The point is not on the side of the foot nor is it on the bottom of the foot, it is on the transition point between the two (the edge of the bone). Palpate for tenderness and congestion. Palpate for tenderness by pressing directly into the foot. Record both R and L indicators.

(Endocrine) Chapman Reflex Ovaries/Testicles - Always ask permission to palpate in this area or use the client's own hands to palpate. Begin by asking the client to find the top edge of their pubic bone. Place both index fingers together at the mid-point of the pubic bone. The palpation is on the superior edge of the bone, pushing down (inferior) S>I toward the feet, NOT A>P. Check for tenderness. Record both R and L indicators

(Immune & Allergy) It's advisable to rinse the mouth before beginning the test. (This step may be skipped for the Practical Exam). Briefly explain the process to the client before beginning. Have the client stick out their tongue and dry it with a piece of gauze. If the client is unable to hold their tongue steady, you may help by holding the tongue with the piece of gauze (never touch the client's tongue directly with your hand unless you have rubber gloves). Place 1 drop of the dye on the tongue avoiding any creases. As soon as the dye has dispersed, begin counting to determine when the dye has completely decolorized or 60 seconds has lapsed. If the dye runs into cracks in the tongue, disregard the color in those areas. The more quickly they dye disappears, the more sufficient the client is. SCORE: Excellent - 1- 10 seconds Fair - 11-20 seconds Poor - 20-30 seconds Fail - 30+ seconds

(Immune & Allergy) A screen for allergic tension. Helps determine if Coco Pulse testing needed to identify specific allergens/sensitivities. Take 1 full-minute pulse sitting and then have the client stand and wait 15-30 seconds before taking a second full-minute pulse. Compare the two. A rise of 6+ BPM indicates allergic tension. If having difficulty getting a good steady pulse reading, try using a point along the neck directly below the jaw (carotid artery).

(Immune & Allergy) (5:00 5th & 6th R) The best way to find this point is to locate the 6th intercostal on the right side only and move up one rib and over lateral from the sternum. The Histamine Point sits on the edge of the pectoralis muscle at a 5:00 position. Or Locate the tip of the Xiphoid and draw an imaginary line to the nipple. The Histamine Point is located half-way between the Xiphoid and the nipple.

(Immune & Allergy) Used to LNT if the Histamine Point is "hot." For the exam, you must perform BOTH tests. Toe Touch - Ask client if they have any problems with their low back. Ask client to stand, feet shoulder width apart. Then direct them to bend forward and attempt to touch their toes without undue strain, hinging at the hips, keeping back straight. Measure the distance from the floor to the tips of their fingers with a ruler or simply eyeball it. Record the distance. Note, if the client can easily touch their toes, then use the Hip/Foot Rotation test as a better indicator of flexibility. Hip/Foot Rotation - first ask if there are any knee, ankle or hip issues. With the client on their back, cradle each ankle with your hands with your thumbs supporting the outside of the ankle. Gently twist the feet inward testing for resistance. Feel for and eyeball the degree of flexibility. Note changes in range of motion with LNT procedure.

(Immune & Allergy) (1st L/R) Bilateral. To locate the point drop into the first intercostal space both right and left below the clavicle. Starting at the sternum, Nutritional Therapy Association, Inc.® All rights reserved. 2004 Page 7 of 8 move your hands laterally until you find a natural "hole" that is on either side. Palpate A>P for tenderness. Record R and L indicators.

(Immune & Allergy) (3rd-4th L/R) Bilateral. Third and fourth intercostal spaces, next to the sternum. Palpate for tenderness A>P. Record R and L indicators for both intercostal spaces.

(Immune & Allergy) (5th R) This point is located in the 5th intercostal space on the right side only. Find the 6th intercostal space and move to the sternum, then up into the 5th intercostal space. Palpate A>P for tenderness. Right Side Only. This point can also found by counting down from the clavicle. This point is also expressed in the 5th intercostal space on the right, lateral/coronal portion of the ribcage. Move to the far lateral/coronal portion of the ribcage. Single finger palpation, A>P.

(Cardiovascular) Transpose the BP information from the Sugar Handling/Adrenal section and the Pulse from Immune/Allergy.

(Cardiovascular) To locate T1, find the most prominent bump (spinous process) at the base of the neck, on the spine. Place your finger sideways BETWEEN the most prominent bump and the next one above it. Ask the client to move their head back and forward. Feel which of the "bumps" moves. It will move posterior to anterior. This is C7. T1 is the vertebrae immediately below the one that moves. Move up a space and down a space until you find C7. Move your thumbs one inch lateral to T1 spinous process and palpate each side, posterior to anterior. Next move to T2, and repeat. Test result is either Positive or Negative for tenderness/congestion. (+ or -) You are palpating the TRANSVERSE Processes, so move 1-1/2 " lateral to the spine on each side. Record general + or -, as these do NOT LNT.

(Cardiovascular) Draw an imaginary circle around the Left Thenar Pad. Directly in the middle of the circle there should be a slight "hole." Go into the depth of the tissue palpating for tenderness. Often the indicator is a sharp pain. Same as pancreas palpation, opposite side.

(Cardiovascular) (2nd L/R) Bilateral. Second intercostal spaces, next to the sternum. Palpate A>P, for tenderness. Record R and L indicators. *There is theory that the point on the right is more of a Thyroid indicator and the left side, Heart. This is NOT absolute.

(Neurological/Detox) Have the client stand next to a table or chair. Give instructions as you go, do not give them all in the beginning!! Ask them to stand straight and get their balance. Have them lift one leg off the ground and then let go of the table. You may do this along with them. Count the number of seconds the client can maintain a steady balance. If they can remain steady for 20 seconds, repeat the test with their eyes closed. . SCORE:- with eyes open: Excellent - 20+ seconds; Satisfactory - 11-19 seconds Poor - 5-10 seconds Fail - 0-5 seconds * If the client cannot maintain balance for at least 10 seconds with eyes closed, you would LNT the appropriate supplement

(Neurological/Detox) Have the client close their eyes. Lightly touch a point on the client's upper arm (2 spots inner arm and 2 outer arm). Ask the client to touch the same spot. Measure the proximity of the two points in inches. Then touch a point on the client's forearm (2 points inner and 2 outer) and repeat as above. It may be of value to check both sides of the body as this involves Nutritional Therapy Association, Inc.® All rights reserved. 2004 Page 8 of 8 neurological function side to side. Only one arm necessary for the Practical Exam. Score: Excellent - Within 1" Satisfactory - Within 2" Poor - 2"+

- Anytime you are palpating a sensitive/private area, ask specific permission and explain where you will be palpating. If there is any concern, use the client's own hands to palpate. - Murphy's Sign (Gallbladder) - Palpate with knees bent and explain breathing - Ragland's Postural Hypotension - Explain the test procedure. Ask if the client ever gets dizzy when they stand quickly and instruct the client to grasp your arm and be ready to steady them if they become dizzy. - Paradoxical Pupillary - Remember to ask the client to fix their eyes on a spot in the distance. - Oral pH - Never touch the end of the strip going into the client's mouth with your hand. - Lowenburg's Test - Ask if the client has any vascular problems with their legs. - Iodine Skin Test - Ask if the client has sensitivities to iodine or history of medical diagnosis of Hashimoto's Thyroiditis, Grave's or other thyroid condition. - Zinc Test - Briefly explain the test before you put the zinc in their mouth. Agree on how they will communicate what they taste.