NUTRITION FOR PREGNANT WOMEN AND LACTATING MOTHER

Good evening everyone...

Glad to be back again.

After such a long time I m writing an article. It fees so good.

Today I m going to talk about nutritional requirement for pregnant women and Lactating mother. As I am facing the same phase, very exciting, different and always alarming. Taking care of yourself more than anybody else so that the fetus inside me should be safe and happy.

From conception to exclusive breast feeding (first 6 months) the baby completely depends on mother’s nutritional status.  If the mother is overweight, it will decrease the blood circulation to the uterus and restrict the quantity and quality of nutrients transferred to the placenta which further provide nutrients to the fetus. On the other hand, if the mother is underweight or not gaining optimal weight during pregnancy the nutrients that are transferred to the fetus will be of inadequate in context with quality as well as quantity. There is a considerable increase in the nutritional needs of the mother. On an average the pregnant women gains about 10 - 12 kg during pregnancy. A pregnant women need to consume about 350 extra calories per day, which translates to one additional meal. The growth and development of the fetus is determine

d by the food taken by the mother. All the nutrients provided to the baby are derived from her food. In the first seven days, baby nourishes with the nutrients from the just fertilized ovum, then the amniotic fluid and later on throughout the pregnancy the baby receives nutrients via the placenta. Even after birth the baby receives all the nutrients for the first 6 months exclusively from mother’s milk. This is followed by gradual introduction of complementary foods after 6 months along with the mother’s milk. Eating healthily during pregnancy will help the baby to develop and grow normally, and will keep the mother fit as well. A healthy diet during pregnancy should contain the right balance and combination of nutrients. If the mother is consuming a balanced diet comprising of various food groups, she gets the benefit of various nutrients that are necessary and increased during the pregnancy

NUTRIENT RECOMMENDED DURING PREGNANCY

Adequate intake of a nutritious diet is reflected in optimal weight gain during pregnancy (10 to 12 kg) by the expectant woman. Their diet should be well balanced and include adequate amount of foods from all food groups, i.e. body building foods (Protein), protective foods (Vitamins and Minerals) and energy giving food (Carbohydrates). If mother takes a well balanced diet, she will have a normal course of pregnancy.

Pregnant women should choose foods rich in fiber (fibre 25 g/1000 kcal) like whole grain cereals, pulses and vegetables, to avoid constipation.

Excess intake of beverages containing caffeine like coffee and tea adversely affect foetal growth and, hence, should be avoided. In addition to satisfying these dietary requisites, a pregnant woman should undergo periodic health check-up for weight gain, blood pressure, anaemia and receive tetanus toxoid immunization.

Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency. Iron is needed for haemoglobin synthesis, mental function and body defence. Deficiency of iron leads to anaemia. Plant foods like legumes and dried fruits contain iron. Folic acid, taken throughout the pregnancy, reduces the risk of congenital malformations and increases the birth weight. Green leafy vegetables, legumes, nuts and liver are good sources of folic acid. 500 mg folic acid supplementation is advised preconceptionally and throughout Pregnancy for women with history of congenital anomalies (neural tube defects, Cleft palate). 

Calcium is essential, both during pregnancy and lactation, for proper formation of bonesØ and teeth of the offspring and for secretion of breast-milk rich in calcium and also to prevent osteoporosis in the mother.  Iodine intake ensures proper mental health of the growing foetus and infant.

The pregnant women require enough physical exercise with adequate rest for 2-3 hrs during the day. Pregnant and lactating women should not indiscriminately take any drugs without medical advice as some of them could be harmful to the foetus/baby. Smoking and tobacco chewing and consumption of alcohol must be avoided. Wrong food beliefs and taboos should be discouraged.

NUTRIENT RECOMMENDED DURING LACTATION

A balanced diet suitable for a nursing mother shall contain the same kind of food as those recommended during pregnancy, but slightly increased quantities. Twin factors of physical activity and active production of breast milk make additional demands for energy yielding foods, proteins and other nutrients. A mother's capacity to produce milk of sufficient quantity and quality to support infant growth is resilient and remarkably resistant to nutritional deprivation, however, milk production normally affects maternal body composition and nutritional status, and lactating women have increased nutrient demands.

The women who are breastfeeding her infant requires not only large quantities of body building (Proteins) foods and protective foods (Vitamins and Minerals) but also additional energy yielding foods to facilitates the synthesis and secretion of breast milk.

Intake of fluids should be increased as fluids are essential for adequate milk production. Therefore, consumption of fluids in any form like juices, butter milk, milk and milk based beverages and even plain milk should be encouraged. A mother should preferably take some fluids before breastfeeding her infant

The choice of food is wide during lactation. No food is restricted except highly spiced and strongly flavoured food, as they impart flavour to the milk which may be repulsive to the baby.

They are also given special preparation having ajwain, methi seeds, saunth, til seeds etc, which supply protein, iron, calcium and B-vitamins. These foods are called as galactogogues, i.e foods that help produce more milk.

Small and frequent meals (5-6meals in a day) are recommended. Greenleafy vegetables and fruits of all varieties should be consumed.

Since some of the medicines can be absorbed into the mother’s blood stream and may be secreted in the milk, the use of medicines during lactation should be strictly under medical supervision.

Good nutrition during lactation will not only ensure optimum milk supply for the baby and a healthy and happy infant but also help the mother maintain a good nutritional status.

Bariatric Surgery and Type 2 Diabetes

 Type 2 diabetes mellitus is a metabolic disorder characterized by insulin resistance and progressive failure of pancreatic beta cells, resulting in hyperglycemia. Obesity, is one of the potent risk factor for type 2 diabetes, contributes to its development by inducing insulin resistance and inflammation, which in turn impair glucose regulation. Bariatric surgery is a weight loss surgery, used as a last resort to treat people who are dangerously obese (carrying an abnormally excessive amount of body fat). This surgery is used to treat people with potentially life-threatening obesity that will not respond to non-surgical treatments, such as lifestyle and dietary changes or modifications. According to guidelines from the National Institutes of Health, the current indications for bariatric surgery include a BMI of 40 kg/m² or higher, or a BMI between 35 and 40 kg/m² with at least two obesity-related comorbidities. The guidelines suggest that bariatric surgery be discussed with all severely obese patients (BMI > 35 kg/m²) with type 2 diabetes who have not been able to lose weight with other weight-control approaches.

In bariatric surgery, weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). But not all bariatric procedures have the same effect on weight and diabetes.
The recent researches revealed that after bariatric surgery, patients lose more weight than with traditional weight-loss methods—up to 25% of their total body weight. Furthermore, of those with type 2 diabetes, 87% achieve at least better glucose control and need fewer antidiabetic medications, and an average of 78% achieve normal glycemic control without taking any antidiabetic medications at all.

There are three major mechanisms or theory that explains how bariatric surgery reverses diabetes. 1^st theory indicates weight loss increases insulin sensitivity. The negative energy balance and weight loss after bariatric surgery reduce insulin resistance. Consequently, the beta cells can rest because they don’t need to produce as much insulin. Usually observed after both gastric restrictive procedures and gastric bypass procedures. 2^nd theory reflects that bariatric surgery lessens insulin resistance by reducing “lipotoxicity,” a condition related to dysregulated fatty acid flux, lipid metabolites in tissues, and direct and indirect effects of hormones secreted by adipocytes. The strongest evidence for this theory comes from Bikman et al, who found that insulin sensitivity increased after Roux-en-Y surgery more than expected from weight loss alone. One year after surgery, even though they remained anthropometrically obese (BMI > 30 kg/m²), the patients had insulin sensitivity levels similar to those in a control group of lean people (BMI < 25 kg/m²).
The third theory is likely the most relevant and relates to various hormones secreted by the gut in response to food. Surgical exclusion of the duodenum in the Roux-en-Y procedure and of the duodenum and jejunum in biliopancreatic diversion result in altered relative distribution of CHO and fat absorption. The “hindgut hypothesis” raised by Cummings et al, suggests that accelerated transit of concentrated nutrients (particularly glucose) to the distal intestine results in increased production of insulinotropic and appetite-controlling substances, which account for the reversal of hyperglycemia and obesity. In contrast, the “foregut hypothesis” raised by Rubino et al, suggests that nutrient interactions in the duodenum are diabetogenic and, hence, bypassing the duodenum would reverse this defect.
Strong evidence now exists that bariatric surgery increases life expectancy and that this is largely attributable to reduction in CVD risk factors such as diabetes and cancer. Recent studies have found that the long-term death rate is 32% to 73% lower for patients undergoing bariatric surgery than in matched controls who do not undergo surgery. A decrease in the death rate related to diabetes has played an important role in these results.
REFERENCES

1. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357:753–761.
2. Bikman BT, Zheng D, Pories WJ, et al. Mechanism for improved insulin sensitivity after gastric bypass surgery. J Clin Endocrinol Metab 2008;93:4656–4663.
3. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292:1724–1737.
4. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122:248–256.
5. Consensus Development Conference Panel. NIH conference. Gastrointestinal surgery for severe obesity. Ann Intern Med 1991; 115:956–961.
6. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab 2004; 89:2608–2615.
7. DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am 2004; 88:787–835.
8. Kashyap SR, Defronzo RA. The insulin resistance syndrome: physiological considerations. Diab Vasc Dis Res 2007; 4:13–19.
9. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289:76–79.
10. Rubino F, Forgione A, Cummings DE, et al.The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006;244:741–749.
11. Sjöström L, Narbro K, Sjöström CD, et al., Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357:741–752.
12. Unger RH. Minireview: weapons of lean body mass destruction: the role of ectopic lipids in the metabolic syndrome. Endocrinology 2003;144:5159–5165.

MONK FRUIT

HI EVERYBODY…

What kind of name is this – MONK FRUIT????

When I heard this name… I was surprised too…

One of my brilliant student, Ishu Gupta asked me about this fruit. Seriously, I had no idea what this fruit was all about??? Why it’s called as monk fruit?? Where it produce?? What medicinal properties this fruit has??? Etc.. Etc… so many questions???

So, finally I did a lot of research on this monk fruit with the help of Google and pub med, and trust me, I was astonished by its properties...

Here I am…

MONK FRUIT (Siraitia grosvenorii)

Monk Fruit is also known as Luo Han Guo (luohanguo) refers to the fruit of Siraitia grosvenori, formerly called Momordica grosvenori, a member of the Curcubitaceae. Monk fruit has traditionally been grown on steep forested mountains in small family orchards. According to legend, monk fruit is named after the Buddhist monks who first cultivated it nearly 800 years ago. Ever since then it has been treasured for its health-giving powers and its unique low-calorie sweetness. Monk fruit (Luohanguo) is primarily grown in southern China, mainly in Guangxi Province, with most of the product from the mountains of Guilin. The steep mountains provide shade and they are frequently surrounded by mists that further protect against excessive sun, yet the temperature in this southern province is warm. The wild plant is rare, thus luohanguo has been cultivated in the region for many years. With the time, the plant also travelled to a few more countries in the South –East Asia but most parts of the world are still unaware of it. In fact the world came to know about this fruit barely a hundred years ago.

The outer surface of the dried Monk fruit is round and smooth, dusty yellow-brown or dusty green-brown. It is covered with fine, soft hair. The fruit is covered by a hard but thin shell. Inside is a partly dry, flexible substance containing the juice, as well as a large number of seeds. The skin, juicy part, and seeds all have a good sweet flavor. Its nature is cool, and it has no poison.

Monk fruit have some really good properties. Some of them are:-

Natural sweetener -The monk fruit act as a natural sweetener. Monk fruit extract is a high intensity, zero-calorie sweetener, and can be used in blends with sucrose, fructose and erythitol. The sweetness of this fruit is due to the presence of achemical mogrosidein its pulp. The pulp of this fruit contains around 1% mogroside making it the sweetest fruit on earth. Both the fresh and dried fruits are extracted to yield a powder that is 80% or more mogrosides. The mixed mogrosides are estimated to be about 300 times as sweet as sugar by weight, so that the 80% extracts are nearly 250 times sweeter than sugar; pure mogrosides 4 and 5 may be 400 times as sweet as sugar by weight.

Good for diabetic patients - Diabetes is a common endocrine-metabolic disease with rising incidence in recent years. It is the third most life threatening disease whose mortality is right after cancer and cardiovascular disease. Research and development of drugs against diabetes and its complications have been getting more and more attentions.

Guo-Ping Lin etal (2007) conducted a study on Effect of Siraitia grosvenorii Polysaccharide on Glucose and Lipid of Diabetic Rabbits Induced by Feeding High Fat/High Sucrose Chow. The Siraitia grosvenorii polysaccharide (SGP) from the Siraitia grosvenorii (Swingle) was isolated and purified. The therapeutic effects of SGP on diabetic rabbits induced by feeding high fat/high sucrose chow were studied. The study concluded that SGP not only ameliorates the lipid disorder, but also lowers plasma glucose levels. So SGP have obvious glucose-lowering effect on hyperglycaemic rabbits induced by feeding high fat/high sucrose chow, its mechanism may be related to amelioration of lipid metabolism and restoring the blood lipid levels of hyperglycaemic rabbits.

 TheMonk fruit helps relieve sunstroke, moistens the lungs, eliminates phlegm, stops cough, and promotes bowel movements.

These are some of the benefits of this fruit…

But I feel we need to do some more researches on medical properties of monk fruits. As in my knowledge, there is only 1 research study available in database that stated monk fruit have good effects on diabetes. If we conduct researches, keeping in mind, its sweetening properties, then I think we don’t need artificial sweeteners for diabetic patients, monk fruit will work perfectly – that my hypothesis… what u think?????

Image courtesy: scientistlive.com, 90in9.wordpress.com, blog.bariatricproductguide.com, facebook.com

Content courtesy: http://www.ncbi.nlm.nih.gov/pubmed/?cmd=HistorySearch&querykey=4

http://www.agricare.org/monk_fruit.html

T. Tsurtematsu and A. Shigenobu, “Study on the constituents from fructs of momordicae grosvenori,” Pharmaceutical Journal, vol. 103, pp. 1151–1173, 1983.

R. Kasai, R.-L. Nie, K. Nashi, et al., “Sweet cucurbitaneglucosides from fruits of Siraitia siamensis,” Agricultural and Biological Chemistry, vol. 53, no. 12, pp. 3347–3349, 1989.

L.-Q. Zhang, X.-Y. Qi, W.-J. Chen, and Y.-F. Song, “Effect of Mogroside extracts on blood glucose, blood lipid and antioxidation of hyperglycemic mice induced by Alloxan,” Chinese Pharmacological Bulletin, vol. 22, no. 2, pp. 237–240, 2006.   

1st COMPUTER GAME AMEND RECOVERY FROM STROKE

HELLO EVERYONE…

Today, I am here to share something latest and new advancement in our medical field. I am really astonished to discover that recently, scientists of Newcastle University have created a video game which helps in recovery of stroke patients.

STROKE

A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack." If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage. There are two major types of stroke: ischemic stroke and hemorrhagic stroke.

Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain.

Stroke-related impairment often restricts patients from properly participating in the activities of daily living, and impedes social interactions. Motor deficits of the hands and upper extremities are important determinants, and strongly represent one’s ability to regain independence in daily and social living. Previous reports describe that approximately 60–70% of stroke patients exhibit mild to severe hand dysfunction; and up to 20% of stroke survivors were dependent in their basic daily living activities.

There are number of researches conducted to analyze and find out the effective treatment for stroke patients to recover as soon as possible. Some of them are-

A research conducted by Hsiu-Yun Hsu etal (2012) investigated the hand movement dynamics  and to develop effective therapeutic interventions for stroke patients published in the Journal of NeuroEngineering and Rehabilitation. They used a custom-designed computerized evaluation and reeducation biofeedback (CERB) prototype to analyze hand grasp performances, and monitor the training effects on hand coordination for stroke patients with sensory disturbance and without motor deficiency. The research concluded that the CERB prototype can provide momentary and interactive information for quantitative assessing and re-educating force modulation appropriately for stroke patients with sensory deficits. Furthermore, the patients could transfer the learned strategy to improve hand function.

Another research conducted by Alma S Merians etal (2011) worked on Robotically facilitated virtual rehabilitation of arm transport integrated with finger movement in persons with hemiparesis published in the Journal of NeuroEngineering and Rehabilitation.  They worked on twelve subjects post-stroke were trained for eight days on four upper extremity gaming simulations using adaptive robots during 2-3 hour sessions. Concluded that Complex gaming simulations interfaced with adaptive robots requiring integrated control of shoulder, elbow, forearm, wrist and finger movements appear to have a substantial effect on improving hemiparetic hand function.

But recently the “circus challenge” computer game is created by the scientists of Newcastle University. These are the first action video games designed specifically to be played at home and to provide an expert therapy programme. Using wireless controllers, players try their hand at such activities as lion taming, juggling, plate spinning, high diving and flying the trapeze and by working their way through increasingly difficult levels of Circus Challenge the movements required are designed to gradually build up the strength and skills of the patient. The games gradually increase in difficulty and complexity to ensure that the stroke patient is always being challenged - but most importantly the games are designed to be fun.

Janet Eyre, Professor of Paediatric Neuroscience at Newcastle University, who also works within the Newcastle NHS Hospitals Foundation Trust, set up Limbs Alive Ltd to produce the first suite of games in association with a professional game studio. He stated that “With our video game, people get engrossed in the competition and action of the circus characters and forget that the purpose of the game is therapy.” Further he added that “Patients who have played the games find them easy to use, challenging and fun! They can be easily set up and played at home since they are designed by a professional games studio to be played on a laptop or PC. Patients forget they’re doing therapy and just enjoy the challenge of playing.”

 THIS VIDEO INSPIRES ME......

MUST WATCH....

Context courtesy:  http://www.jneuroengrehab.com/content/9/1/26/abstract

http://www.jneuroengrehab.com/content/pdf/1743-0003-9-26.pdf

http://www.jneuroengrehab.com/content/8/1/27

http://www.ncl.ac.uk/press.office/press.release/item/action-video-game-to-aid-recovery-from-stroke

Hunter SM, Crome P: Hand function and stroke. Rev Clin Gerontol 2002, 12:68–81.

Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1994,

75:394–398.

Wade DT, Langton-Hewer R, Wood VA, Skilbeck CE, Ismail HM: The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry 1983, 46:521–

524.

Duncan PW, Badke MB (Eds): Stroke Rehabilitation: The Recovery of Motor Control. Chicago: III.: Year Book Medical Publishers; 1988.

Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, Hailpern SM, Ho M, Howard V, Kissela B, et al: Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008, 117:e25–e146.

Trombly CA: Deficits of reaching in subjects with left hemiparesis: a pilot study. Am J Occup Ther 1992, 46:887–897.

Johansson BB: Current trends in stroke rehabilitation. A review with focus on brain plasticity. Acta Neurol Scand 2011, 123:147–159.

Images courtesy: everybodysgood.com, cabrr.cua.edu

EXCESS OF DIETARY SUPPLEMENTS INCREASE CANCER RISK

Hello everybody…

Today I was reading, The Hindustan Times, 20^th may 2012.

I came across, something really interesting. An article on dietary supplements…. made me explore more on this research...

Let’s us begin from scratch…

DIETARY SUPPLEMENTS

Today Nutritional supplementation is a multibillion-dollar industry, and about half of all US adults take supplements. Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include:

•  a vitamin,
• a mineral,
• an herb or other botanical,
•  an amino acid,
• a dietary substance for use by man to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands), or
•  a concentrate, metabolite, constituent or extract.

They may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet.

Few years back, it has been estimated that 30-40 percent of all cancers can be prevented by lifestyle and dietary measures alone. Intake of flax seed, especially its lignan fraction, and abundant portions of fruits and vegetables will lower cancer risk.  

Protective elements in a cancer prevention diet include selenium, folic acid, vitamin B-12, vitamin D, chlorophyll, and antioxidants such as the carotenoids (alpha-carotene, beta-carotene, lycopene, lutein, cryptoxanthin). Ascorbic acid has limited benefits orally, but could be very beneficial intravenously. Supplementary use of oral digestive enzymes and probiotics also has merit as anticancer dietary measures.

Supplement use is fueled in part by the belief that nutritional supplements can ward off chronic disease, including cancer, although several expert committees and organizations have concluded that there is little to no scientific evidence that supplements reduce cancer risk.

But recently a study conducted by Martinez ME etal 2012, published in The Journal of National Cancer Institute states that there is now evidence that high doses of some supplements increase cancer risk.

Supplements such as beta-carotene, selenium and folic acid if taken at much higher levels than their recommended daily doses, are likely to elevate the risk of developing a host of cancer stated by an article published in THE HINDUSTHAN TIMES, 20th may 2012. 

Tim Byers, MD, MPH, professor of epidemiology at the Colorado School of Public Health and associate director for prevention and control at the University of Colorado Cancer Center states that "It's not that these nutrients are toxic - they're essential and we need them, but we need them in a certain balance,"

Despite this evidence, marketing claims by the supplement industry continue to imply anticancer benefits.

My verdict

•   Excess consumption of any dietary supplements is not recommended.
• Consumer should keep this in mind that excess of anything is bad.
• Always inform your nutritionist or doctor about the supplements you are consuming.
• Stop taking dietary supplements if there are any side effects.

Contents courtesy:

http://www.ncbi.nlm.nih.gov/pubmed/?cmd=HistorySearch&querykey=2

http://www.ncbi.nlm.nih.gov/pubmed/22534785

http://medicalxpress.com/news/2012-05-dietary-supplements-cancer.html
The Hindustan Times, health scan, page : 18, 20^th may 2012.

Image courtesy: ocw.jhsph.edu, drgeo.com, inetgiant.in.