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Vitamin K deficiency and osteopenia in disuse-affected limbs of vitamin D-deficient elderly stroke patients administering medications 7th edition discount topamax 100 mg on-line. Dietary folate intake medicine yoga purchase topamax 200mg line, alcohol, and risk of breast cancer in a prospective study of postmenopausal women. Serum ascorbic acid and other correlates of self-reported cataract among older Americans. Influence of thiamin supplementation on the health and general well-being of an elderly Irish population with marginal thiamin deficiency. Increasing vegetable and fruit intake: randomized intervention and monitoring in an at-risk population. Antioxidants and reduced functional capacity in the elderly: findings from the nun study. Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the nun study. Progress in geriatrics: screening the older population for cobalamin (vitamin B12) deficiency. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Homocysteine metabolism and risk of myocardial infarction: relation with vitamins B6, B12, and folate. Physiologic importance of extra-hepatic vitamin Kdependent carboxylation reactions. Low dietary folate intake is associated with an excess incidence of acute coronary events: the Kuopio Ischemic Heart Disease Risk Factor Study. Dietary intake, dietary patterns, and changes with age: an epidemiological perspective. Microvascular disease and dementia in the elderly: are they related to hyperhomocysteinemia? Arsenic also plays a role in the modulation of kidney arginase activity, alkaline phosphatase activity, and plasma levels of triglycerides, uric acid, and urea. Based on animal studies, the human arsenic requirement appears to be between 12 and 25 µg daily. The role of arsenic in human malnutrition has been extrapolated from animal studies. In postmenopausal women on a low-magnesium diet, boron supplementation (3 mg/day) reduced the urinary excretion of calcium, magnesium, and phosphorus. These studies have led to the perhaps premature claim that boron supplementation may play a role in the prevention of calcium loss and bone demineralization in postmenopausal women. Hyperglycemia, which responds to chromium replacement, has been reported to occur in patients on total parenteral nutrition. One well-controlled study of 16 patients 65 years of age and older found that chromium in combination with nicotinic acid caused a 15% decrease in the integrated glucose area in response to a glucose load. Tissue and serum chromium levels decline with age20­22 and may do so more dramatically in Western societies that eat refined foods and are somewhat deficient in chromium. In a study of institutionalized older individuals, the average chromium content of food offered (not eaten) was 52 µg/day. It acts as a catalyst in multiple enzymatic reactions, including the superoxidase dismutase reaction, the cross-linking of collagen, the lipyloxidase enzyme, the electron transport chain through cytochromic oxidase, coagulation factor V, and the conversion of dopamine to norepinephrine. Copper deficiency is associated with hypercholesterolemia, perhaps through an increased rate of cholesterol release from the liver. However, the evidence that copper deficiency is associated with atherosclerosis is extremely weak. A recent study did demonstrate higher serum copper levels in persons who had a myocardial infarction than in age-matched controls. Symptoms of congenital copper deficiency (Menkes syndrome) include arterial disease, abnormal hair, osteoporosis, cerebellar atoxia, and other brain damage. Symptoms in two patients on total parenteral nutrition with severe copper deficiency responded to copper supplementation. Although older subjects ingest significantly lower amounts of copper than younger subjects, they appear to have no problem in maintaining metabolic balance. The potential pathophysiologic role of copper deficiency in atherosclerosis and the hyperglycemia of aging warrants further study.

Venulet concluded that smoking is involved in the pathogenesis of certain widespread disorders such as scurvy treatment of gout generic topamax 100 mg overnight delivery, gastric ulcer medicine 75 order topamax 100 mg overnight delivery, and cardiovascular disease. Apart from difficulties arising from ascorbic acid depletion, smoking lowers the general bodily resistance to disease. He showed that in heavy smokers, ascorbic acid is destroyed and no longer excreted in the urine. He described the many functions of ascorbic acid in the body including its role in detoxicating poisons. In his concluding paragraph he states, "The salvation of the smoker may be in this vitamin. They advised all smokers to consume an abundance of vitamin C to prevent development of a deficiency. He gave 1 gram of ascorbic acid a day to packand-a-half cigarette smokers and found the increases in blood ascorbic acid never attained the peak levels shown by nonsmokers. Rupniewska (5), in 1965, also reported a decreased store of ascorbic acid in aged smokers. Calder, Curtis and Fore (5), in 1963, indicated that tobacco smoke destroyed vitamin C in solution. They also demonstrated a statistically significant difference in blood plasma ascorbic acid and leukocyte ascorbic acid contents of cigarette smokers and non-smokers. A 1968 study by Brook and Grimshaw (5) demonstrated that blood plasma and leukocyte ascorbic acid levels are significantly lower in men than in women. In nonsmokers, the plasma levels declined with age while the leukocyte levels did not. Cigarette smoking was found to significantly lower both the blood plasma and the leukocyte ascorbic acid concentrations. Heavy smoking had the same effect on the blood plasma ascorbic acid as increasing the chronological age by 40 years. Pelletier (5), in tests on five smokers and five nonsmokers, as reported in 1968, demonstrated that the ascorbic acid levels of the blood and blood plasmas of smokers were about 40 percent that of nonsmokers. On giving his subjects 2 grams of ascorbic acid a day he found that after continued administration the 166 blood ascorbic acid levels stabilized at approximately the same value for both groups. However, the urinary excretion of ascorbic acid by the smokers never reached the levels excreted by the nonsmokers, which indicated a continuing greater utilization of the ascorbic acid by the smokers. He also make tests on guinea pigs which were fed nicotine for one month in amounts comparable to those consumed by heavy smokers. There was a drop in the blood and tissue ascorbic acid, as compared to guinea pigs fed the same diet without the nicotine, amounting to 49 percent in the adrenal gland, 50 percent in the kidneys, 47 percent in the heart, and 34 percent in the liver. From all this research work, it should be evident that habitual smokers, unless they take steps to correct the condition, are likely to be in a chronic, subclinical scorbutic state. In this situation, the classical signs of scurvy may not be manifest, but the body is in a state of biochemical scurvy. With this depletion, there is lowered resistance to disease and the biochemical detoxication processes are impaired. For the numerous hard-core smokers who cannot kick the habit, cigarette manufacturers could institute a program of research to determine if the longterm daily use of ascorbic acid will provide some protection against cancers, emphysema, coronaries, and other diseases which afflict smokers. Research conducted at Tulane University by Schlegel and coworkers (6), and mentioned previously, prompted Schlegel to recommend the daily use of 1. In the forty years since the discovery of ascorbic acid, there have been so many papers published on the beneficial relationship of ascorbic acid to wound healing, on the improved strength of the scar tissue, and on the faster healing of bone fractures, that it is just impossible to fully review this vast volume of work within a brief chapter. However, the interested reader can refer to the papers presented at the Scientific Conference on vitamin C, held by the New York Academy of Sciences in 1960 (1). The papers by Abt and Schuching, Robertson, Gould, Crandon, Fullmer, and Lee are of particular interest in this connection. The utilization of ascorbic acid in wound healing is now so well documented that there are many surgeons who routinely provide their patients with 1 or 2 grams of ascorbic acid a day, postoperatively, to aid in their healing and recovery.

Optimum dietary protein-to-energy ratios for channel catfish fingerlings symptoms 1 week before period generic topamax 200 mg visa, Ictalurus punctatus medicine jar paul mccartney buy topamax 200 mg free shipping. Protein and energy requirements of fingerling channel catfish for maintenance and growth. Comparison of satiate feeding and restricted feeding of channel catfish with various concentrations of dietary protein in production ponds. Effects of dietary energy: Protein ratio on growth charcteristics and body composition of hybrid striped bass, Moroni chrysops Ч M. Studies on the sparing effect of lipids on dietary protein in rainbow trout (Salmo gairdneri). Apparent digestibility protein and energy coefficients of feed ingredients for channel catfish. Studies on the essential amino acids and scoliosis caused by tryptophan deficiency of chum salmon fry. Oral administration of serotonin against spinal deformity of chum salmon fry induced by tryptophan deficiency. Isoleucine, leucine, valine and phenylalanine requirements of chinook salmon and interrelations between isoleucine and leucine for growth. Methionine intake in rainbow trout (Oncorhynchus mykiss), relationship to cataract formation and the metabolism of methionine. Use of simultaneous curve fitting and a four-parameter logistic model to evaluate the nutritional value of protein sources at growth rates of rats from maintenance to maximum gain. Use of a four-parameter logistic model to evaluate the quality of the protein from three insect species when fed to rats. Use of a four parameter logistic equation to evaluate the response of growing rats to ten levels of each indispensable amino acid. Optimum dietary protein to energy ratio for channel catfish fingerlings, Ictalurus punctatus. Investigations into the requirements of the tilapia (Sarotherodon mossambicus) for dietary methionine, lysine and arginine in semisynthetic diets. The effects of varying dietary protein level on the growth, Copyright © National Academy of Sciences. Nutritional requirements of the puffer fish: Purified test diet and the optimum protein level. Application of a biochemical method for the estimation of amino acid needs in fish. Requirements for sulfur containing amino acids and utilization of D-methionine by rainbow trout. Effects of dietary tryptophan levels on growth, feed/gain carcass composition and liver glutamate dehydrogenase activity in rainbow trout (Salmo gairdneri). Requirements for sulfur amino acids and utilization of D-methionine by rainbow trout (Oncorhynchus mykiss). Studies on mineral and protein utilization by Atlantic salmon (Salmo salar) grown in sea water. A preliminary study on the protein requirements of (Chanos chanos) (Forskal) fry in a controlled environment. Leucine-induced amino acid antagonism in rats: Muscle valine metabolism and growth impairment. Growth response of Tilapia zillii fingerlings fed isocaloric diets with variable protein levels. Interactive effects of dietary protein and lipid on growth and protein utilization of age-0 striped bass. Portal absorption and hepatic uptake of amino acids in rainbow trout forcefed complete diets containing casein or crystalline amino acids. Interactions of dietary levels of protein and energy on channel catfish (Ictalurus punctatus). Factors affecting dietary requirement and deficiency signs of L-tryptophan in rainbow trout. Total aromatic amino acid requirement, phenylalanine requirement and tyrosine replacement value for fingerling channel catfish.

With needle electrodes treatment vs cure buy cheap topamax 100 mg, it is usually possible to pick up the activity of single muscle fibers symptoms 7 days after ovulation buy discount topamax 200mg. It has been shown by electromyography that little if any spontaneous activity occurs in the skeletal muscles of normal individuals at rest. With minimal voluntary activity a few motor units discharge, and with increasing voluntary effort, more and more are brought into play to monitor the recruitment of motor units. Gradation of muscle response is therefore in part a function of the number of motor units activated. In addition, the frequency of discharge in the individual nerve fibers plays a role, the tension developed during a tetanic contraction being greater than that during individual twitches. Finally, the motor units fire asynchronously, that is, out of phase with one another. This asynchronous firing causes the individual muscle fiber responses to merge into a smooth contraction of the whole muscle. This figure is about the same as that obtained in a variety of experimental animals and seems to be constant for mammalian species. Because many of the muscles in humans have a relatively large cross-sectional area, the tension they can develop is quite large. Where the end of one muscle fiber abuts on another, the membranes of both fibers parallel each other through an extensive series of folds. These areas, which always occur at Z lines, are called intercalated disks (Figure 5­15). They provide a strong union between fibers, maintaining cell-to-cell cohesion, so that the pull of one contractile cell can be transmitted along its axis to the next. Along the sides of the muscle fibers next to the disks, the cell membranes of adjacent fibers fuse for considerable distances, forming gap junctions. These junctions provide low-resistance bridges for the spread of excitation from one fiber to another. They permit cardiac muscle to function as if it were a syncytium, even though no protoplasmic bridges are present between cells. The T system in cardiac muscle is located at the Z lines rather than at the A­I junction, where it is located in mammalian skeletal muscle. An even more striking example is the gluteus maximus, which can exert a tension of 1200 kg. The total tension that could be developed if all muscles in the body of an adult man pulled together is approximately 22,000 kg (nearly 25 tons). For example, the attachments of the muscles in the body are such that many of them are normally at or near their resting length when they start to contract. In muscles that extend over more than one joint, movement at one joint may compensate for movement at another in such a way that relatively little shortening of the muscle occurs during contraction. Nearly isometric contractions of this type permit development of maximal tension per contraction. The hamstring muscles extend from the pelvis over the hip joint and the knee joint to the tibia and fibula. If the thigh is flexed on the pelvis at the same time, the lengthening of the hamstrings across the hip joint tends to compensate for the shortening across the knee joint. In the course of various activities, the body moves in a way that takes advantage of this. Such factors as momentum and balance are integrated into body movement in ways that make possible maximal motion with minimal muscular exertion. One net effect is that the stress put on tendons and bones is rarely over 50% of their failure strength, protecting them from damage. In walking, each limb passes rhythmically through a support or stance phase when the foot is on the ground and a swing phase when the foot is off the ground. The support phases of the two legs overlap, so that two periods of double support occur during each cycle. There is a brief burst of activity in the leg flexors at the start of each step, and then the leg is swung forward with little more active muscular contraction. Therefore, the muscles are active for only a fraction of each step, and walking for long periods causes relatively little fatigue. A young adult walking at a comfortable pace moves at a velocity of about 80 m/min and generates a power output of 150 to 175 W per step.

It occurs in the human diet predominantly in tomatoes and processed tomato products symptoms 5 days before missed period discount topamax 200mg online. It is a potent antioxidant and the most significant free radical scavenger in the carotenoid family natural pet medicine 100mg topamax with mastercard. There is no known deficiency state for carotenoids themselves and no Recommended Daily Intake. All of the carotenoids are antioxidants, and approximately 50 are considered vitamins because they have pro-vitamin A activity. Vitamin A refers to preformed retinol and the carotenoids that are converted to retinol. Preformed vitamin A is found only in animal products, including organ meats, fish, egg yolks, and fortified milk. This requires conversion in the kidney to the metabolically active form, calcitriol. Vitamin D is not a true vitamin, since humans are able to synthesize it with adequate sunlight exposure. By photoconversion, 7-dehydrocholesterol becomes previtamin D3, which is metabolized in the liver to 25-hydroxyvitamin D3, the major circulating form of vitamin D. In the kidney, this is converted to two metabolites, the more active one being 1,25-dihydroxyvitamin D3. Gamma-Tocopherol is the predominant form of vitamin E in the human diet, yet most studies have focused on alpha-tocopherol, which is the type found in most over-the-counter supplements. One reason for this is that alpha-tocopherol is biologically more active than gamma-tocopherol. Vitamin E deficiency is rare and is seen primarily in special situations resulting in fat malabsorption, including cystic fibrosis, chronic cholestatic liver disease, abetalipoproteinemia, and short bowel syndrome. The mouth can also be affected by thiamine deficiency, increasing the sensitivity of the teeth, cheeks, and gums, as well as fissures in the lips. Thiamine deficiency is rare but often occurs in alcoholics, because alcohol interferes with the absorption of thiamine through the intestines. Historically, this disease was often associated with the very poor and was also a major cause of mental illness. The mouth is also affected by pellagra, which can cause the inside of the cheeks and tongue to become red and painful. Due to the abundance of pyridoxine in many foods, a deficiency is rare except in alcoholics. A pyridoxine deficiency causes dermatitis, glossitis, peripheral neuropathy, incoordination, confusion, and insomnia. Folic acid is essential to virtually all biochemical reactions that use a one-carbon transfer and is produced by bacteria in the stomach and intestines. A deficiency of folic acid causes anemia, poor growth, and glossitis-all of which are similar to symtoms suffered by those with B12 deficiency. Folic acid is present in nearly all natural foods but can be damaged during 112 Geriatric Nutrition cooking. Deficiencies are found mainly in alcoholics and persons who are unable to absorb food due to topical sprue or gluten enteropathy. Vitamin B12 cannot be absorbed by the body until it is combined with a stomach mucoprotein called intrinsic factor. Once the B12 becomes bound to the intrinsic factor, it is able to pass into the small intestine to be absorbed and used by the body. Over 40% of patients older than 80 years have gastric atrophy that may or may not be related to Helicobacter pylori infection. Other factors that contribute to food-cobalamin malabsorption in elderly people include antacids, including H2-receptor antagonists and proton pump inhibitors, surgery or gastric reconstruction. Pernicious anemia is an autoimmune disease characterized by the destruction of the gastric mucosa, especially fundal mucosa, by a primarily cell-mediated process. Gastric secretions are neutral to slightly acidic even in the presence of gastrin (which normally increases acidity) and contain little or no intrinsic factor.

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