Sorry to all the people that have been contributing and really enjoying the nutrition role plays on the blog but this course has now finished.
If you do have nutrition questions or queries perhaps you would like to visit my blog on Nutrition Matters
Thursday, September 11, 2008
Thursday, August 28, 2008
Restrictive vegan diet? Yeah right!
Hi all,
I decided to analysis Di's 24hr dietary recall. I have been as accurate as I can. Had to use standard portion sizes, and exclude soya ice-cream, and rice milk, as I could not find them in Crop & Food's The Concise New Zealand Food Composition Tables 7th ED. 2006.
NUTRITIONAL ANALYSIS OF DI's 24HR DIETARY RECALL
3800 calories
142gms protein (15% of Cals) (RDA: 1st trimester 46gm (.75g/kg/per day)
2nd trimester 60gm (1.00g/kg/day)
203gms fat (48% of Cals) (RDA: 20-30% total energy intake)
352gms carbohydrates (37% of Cals) (RDA: 45-65% of total energy intake)
Iron: 51.2mgs (RDA: 27mgs)
Calcium: 1325.9mgs (RDA: 1000mgs)
Zinc: 26.8 mgs (RDA: 11mgs)
Thiamin: 2.67mg (RDA: 1.4mgs)
Niacin: 51.4mg (RDA: 18mgs)
VitB12: 1.02mcg (RDA: 2.6mcg)
Folate: 976mcg (RDA: 600mcg)
References
MOH.2006. Food and Nutrition Guidelines for healthy Pregnant and Breast feeding Women: A background paper. Wellington :MOH
Whitney, E.N. & Rolfes, S.R. Understanding Nutrition 9th Ed 2002. Wadsworth CA
Crop & Food, The Concise New Zealand Food Composition Tables 7th ED. 2006 draft 7:19:00 PM by Julia Delete
I decided to analysis Di's 24hr dietary recall. I have been as accurate as I can. Had to use standard portion sizes, and exclude soya ice-cream, and rice milk, as I could not find them in Crop & Food's The Concise New Zealand Food Composition Tables 7th ED. 2006.
NUTRITIONAL ANALYSIS OF DI's 24HR DIETARY RECALL
3800 calories
142gms protein (15% of Cals) (RDA: 1st trimester 46gm (.75g/kg/per day)
2nd trimester 60gm (1.00g/kg/day)
203gms fat (48% of Cals) (RDA: 20-30% total energy intake)
352gms carbohydrates (37% of Cals) (RDA: 45-65% of total energy intake)
Iron: 51.2mgs (RDA: 27mgs)
Calcium: 1325.9mgs (RDA: 1000mgs)
Zinc: 26.8 mgs (RDA: 11mgs)
Thiamin: 2.67mg (RDA: 1.4mgs)
Niacin: 51.4mg (RDA: 18mgs)
VitB12: 1.02mcg (RDA: 2.6mcg)
Folate: 976mcg (RDA: 600mcg)
References
MOH.2006. Food and Nutrition Guidelines for healthy Pregnant and Breast feeding Women: A background paper. Wellington :MOH
Whitney, E.N. & Rolfes, S.R. Understanding Nutrition 9th Ed 2002. Wadsworth CA
Crop & Food, The Concise New Zealand Food Composition Tables 7th ED. 2006 draft 7:19:00 PM by Julia Delete
Monday, August 25, 2008
Sunday, August 24, 2008
The B's
Hi there,
I have just being reading a previous post of mine where I say that there is no research that has a finding that tandem breastfeeding is harmful. I need to qualify that by saying providing the lactating mother's diet is adequate in provide all nutrients. I have been doing some reading and although not common, VitB12 deficiencies can occur during pregnancy and lactation.
Plant foods are not a reliable source of vitB12 for vegetarians. The B12 present in spirulina sea vegetables, tempeh, and miso has been show to be inactive B12 analog rather that the real thing. (NZDA Vegetarian Diets 2000 Positon Paper) It recommends supplementation or use of fortified food for vegetarians who avoid or limit animal foods.
Infants of vegan parents may suffer spinal cord damage and develop severe psychomotor retardation due to lack of vitB12 in the mother's diet during pregnancy. Breastfed infants of vegan mothers have been be reported to develop vitb12 deficiency and sever movement disorders. A vegan mother needs a regular source of vitB12-fortified foods or supplement that provide 2.6mcg daily.(Whitney, E.N. & Rolfes, S.R. 2002)
Whitney, E.N. & Rolfes, S.R. Understanding Nutrition 9th Ed., Wadsworth 2002
I have just being reading a previous post of mine where I say that there is no research that has a finding that tandem breastfeeding is harmful. I need to qualify that by saying providing the lactating mother's diet is adequate in provide all nutrients. I have been doing some reading and although not common, VitB12 deficiencies can occur during pregnancy and lactation.
Plant foods are not a reliable source of vitB12 for vegetarians. The B12 present in spirulina sea vegetables, tempeh, and miso has been show to be inactive B12 analog rather that the real thing. (NZDA Vegetarian Diets 2000 Positon Paper) It recommends supplementation or use of fortified food for vegetarians who avoid or limit animal foods.
Infants of vegan parents may suffer spinal cord damage and develop severe psychomotor retardation due to lack of vitB12 in the mother's diet during pregnancy. Breastfed infants of vegan mothers have been be reported to develop vitb12 deficiency and sever movement disorders. A vegan mother needs a regular source of vitB12-fortified foods or supplement that provide 2.6mcg daily.(Whitney, E.N. & Rolfes, S.R. 2002)
Whitney, E.N. & Rolfes, S.R. Understanding Nutrition 9th Ed., Wadsworth 2002
Saturday, August 23, 2008
Rosalind's Visit
Dave here,
Had a good visit from Rosalind. She's good. Even got me and Di doing a 24 hour dietary recall!
I like a very through person like that. Makes me feel confident in her care.
She is a bit worried about Di having anemia, and has prescribed iron supplements. Given us some good ideas about food choices, not that we needed them really, as Di and I like to think that we are informed Vegans. Di keeps talking about not eating eating some kind of nuts, as the baby may develop some kind of reaction to them. She's afraid because she eats so healthy, the baby may develop allergies. Not to sure what that's all about.
Had a good visit from Rosalind. She's good. Even got me and Di doing a 24 hour dietary recall!
I like a very through person like that. Makes me feel confident in her care.
She is a bit worried about Di having anemia, and has prescribed iron supplements. Given us some good ideas about food choices, not that we needed them really, as Di and I like to think that we are informed Vegans. Di keeps talking about not eating eating some kind of nuts, as the baby may develop some kind of reaction to them. She's afraid because she eats so healthy, the baby may develop allergies. Not to sure what that's all about.
our appointment
What a delightful couple.
Di and Dave are so excited about the pregnancy, and I feel very special in sharing in this occasion with them.
We did talk about Di continuing to breastfeed Peter, however, I am not too overly concerned at the moment. We still have a bit of time left, after all, Peter may well wean himself.
My main concern for this appointment is her first antennal blood results.
(haemaglobin 110g/L and Ferritin 9ug/L)
To start with, it appears to me Di has iron deficiency. Our appointment went for at least an hour, as I was explaining to Di and Dave what these terms mean in regard for a healthy pregnancy. I am concerned that she is a vegatarian, however, she has been doing a lot of research herself on the internet, looking at ministry of health sites etc, to gain a better understanding. I think we can become great partners in care together. Communication seems to be going well. I have sourced some literature to help with my treatment plan.
According to Pairman et al (2006), a ferritin level less than 12-15ug/L “indicates empty stores of iron and iron deficiency.” (Harram et al 2001, cited in Pairman et al 2006).
Di’s Haemaglobin is also lowish being 110g/L, however it can be difficult to determine whether this is associated with the relatively normal process in pregnancy of haemodilution, or, anaemia. According to Pairman et al (2006), this result would most likely be anaemia. Pairmain et al (2006) continues by stating that serum ferritin is the blood test of choice in determining iron stores in the body, particularly in the first trimester. As Di is right on the cusp of moving in to the second trimester, I could expect her serum ferritin to drop even more, as according to Pairman et al (2006), haemodilution occurs independent of changes in iron stores. A ferritin level of 15-30ug/L shows that iron stores are too small to cope with the requirements of pregnancy. (Pairman et al 2006).
We began our appointment quite casually. Di and Dave knew what we were to discuss, and appeared relaxed and comfortable. I actually had a few hours to spare, so I could relax too.
We talked about how important the mineral “iron” is to the body, particularly during pregnancy. I explained that iron is an important mineral that is available to the body from food, in two forms. Haem, being a structure of haemaglobin, and, non-haem iron.
Haem iron is present in meat, poultry and fish. Non –haem is also present in meat, fish and poultry, but is also the only form found in plant foods.
Since she is a vegetarian, I would like to recommend her including foods in each meal of non-haem and haem foods. Ideally, I would like to suggest including fish twice a week together with a selection of non-haem foods. She also does not consume dairy products, however according to the NZ dietetic Association, soy is a good form of calcium as well as cooked legumes, nuts and seeds, almond butter spread for her morning toast, green leafy veggies, dried figs and even calcium fortified orange juice. I have given her lists of recipe ideas for each main meal of the week, and encouraged her to include foods rich in vitamin C to assist in iron absorption in the gut.
Fortunately, Di does not drink too much tea and coffee. I have advised her to consume a cuppa at least 3 hours apart from her meals as the tannins in tea particularly, reduces iron absorption up to 40%.
ABOUT ANAEMIA
During our appointment, I also explained that significant anaemia can pose a real threat to the overall well being of the mother and baby. The physiological changes that commonly occur in pregnancy may either expose an underlying anaemia, or it may continue to develop during the pregnancy. (coggins 2001, cited in Pairman et al 2006). “Haemoglobin levels are used as a primary measure of anaemia, as approximately 70% of iron in the body is haemoglobin”. (Jordan 2002, pg 268, cited in Pairman et al 2006, pg 353).
Another thing is, when diagnosing anaemia, it’s important to differentiate between other types of anaemia, such as folate, b12, sickle cell, thalassaemia and autoimmune anaemia. Pairman et al (2006) recommends correct diagnosis to avoid unnecessary treatment regimes that may actually cause more harm than good. Iron overload can occur in women with haemochromatosis, or inneffectice erythropoiesis, such as sickle cell disease and thalassaemias.
However, from her latest antennal screen, I feel we need to treat iron deficiency anaemia. She does take 800mcgs of folate per day, and has done for the past 3 months. There are no indications of family history with any above mentioned conditions.
My recommendations include diet variation as described, and also an iron supplementation of approximately 105mg of iron daily throughout pregnancy. Mainly as her ferritin is only 9ug/L. Best to be taken before food, to help reduce side effects of tummy upsets. I would recommend Ferrogradumet, which contains 105mg of elemental iron. I have also written out blood slips for a repeat screen in another 4 weeks.
By the end of our appointment, I could tell Di and Dave were a little overwhelmed with our topic, however I think I have inspired them to be creative in their meal preparations, making them interesting, healthy and cost effective for their lifestyle. Hopefully Peter will enjoy it too.
I am a fairly new midwife, so I tend to source my books and current literature to support my practice. I think we’re on track so far. Di and Dave both know to call me at any time if any more questions arise.
I shall catch up with them both within 4 weeks.
These references were great.
Pairman S, Pincombe J, Thorogood C, Tracy S, (2006), Midwifery preparation for practice, Elsevier, Australia
Vegetarian Diets – American Dietetic Association, Journal of the NZ Dietetic Association, Vol 54, No 2.
Di and Dave are so excited about the pregnancy, and I feel very special in sharing in this occasion with them.
We did talk about Di continuing to breastfeed Peter, however, I am not too overly concerned at the moment. We still have a bit of time left, after all, Peter may well wean himself.
My main concern for this appointment is her first antennal blood results.
(haemaglobin 110g/L and Ferritin 9ug/L)
To start with, it appears to me Di has iron deficiency. Our appointment went for at least an hour, as I was explaining to Di and Dave what these terms mean in regard for a healthy pregnancy. I am concerned that she is a vegatarian, however, she has been doing a lot of research herself on the internet, looking at ministry of health sites etc, to gain a better understanding. I think we can become great partners in care together. Communication seems to be going well. I have sourced some literature to help with my treatment plan.
According to Pairman et al (2006), a ferritin level less than 12-15ug/L “indicates empty stores of iron and iron deficiency.” (Harram et al 2001, cited in Pairman et al 2006).
Di’s Haemaglobin is also lowish being 110g/L, however it can be difficult to determine whether this is associated with the relatively normal process in pregnancy of haemodilution, or, anaemia. According to Pairman et al (2006), this result would most likely be anaemia. Pairmain et al (2006) continues by stating that serum ferritin is the blood test of choice in determining iron stores in the body, particularly in the first trimester. As Di is right on the cusp of moving in to the second trimester, I could expect her serum ferritin to drop even more, as according to Pairman et al (2006), haemodilution occurs independent of changes in iron stores. A ferritin level of 15-30ug/L shows that iron stores are too small to cope with the requirements of pregnancy. (Pairman et al 2006).
We began our appointment quite casually. Di and Dave knew what we were to discuss, and appeared relaxed and comfortable. I actually had a few hours to spare, so I could relax too.
We talked about how important the mineral “iron” is to the body, particularly during pregnancy. I explained that iron is an important mineral that is available to the body from food, in two forms. Haem, being a structure of haemaglobin, and, non-haem iron.
Haem iron is present in meat, poultry and fish. Non –haem is also present in meat, fish and poultry, but is also the only form found in plant foods.
Since she is a vegetarian, I would like to recommend her including foods in each meal of non-haem and haem foods. Ideally, I would like to suggest including fish twice a week together with a selection of non-haem foods. She also does not consume dairy products, however according to the NZ dietetic Association, soy is a good form of calcium as well as cooked legumes, nuts and seeds, almond butter spread for her morning toast, green leafy veggies, dried figs and even calcium fortified orange juice. I have given her lists of recipe ideas for each main meal of the week, and encouraged her to include foods rich in vitamin C to assist in iron absorption in the gut.
Fortunately, Di does not drink too much tea and coffee. I have advised her to consume a cuppa at least 3 hours apart from her meals as the tannins in tea particularly, reduces iron absorption up to 40%.
ABOUT ANAEMIA
During our appointment, I also explained that significant anaemia can pose a real threat to the overall well being of the mother and baby. The physiological changes that commonly occur in pregnancy may either expose an underlying anaemia, or it may continue to develop during the pregnancy. (coggins 2001, cited in Pairman et al 2006). “Haemoglobin levels are used as a primary measure of anaemia, as approximately 70% of iron in the body is haemoglobin”. (Jordan 2002, pg 268, cited in Pairman et al 2006, pg 353).
Another thing is, when diagnosing anaemia, it’s important to differentiate between other types of anaemia, such as folate, b12, sickle cell, thalassaemia and autoimmune anaemia. Pairman et al (2006) recommends correct diagnosis to avoid unnecessary treatment regimes that may actually cause more harm than good. Iron overload can occur in women with haemochromatosis, or inneffectice erythropoiesis, such as sickle cell disease and thalassaemias.
However, from her latest antennal screen, I feel we need to treat iron deficiency anaemia. She does take 800mcgs of folate per day, and has done for the past 3 months. There are no indications of family history with any above mentioned conditions.
My recommendations include diet variation as described, and also an iron supplementation of approximately 105mg of iron daily throughout pregnancy. Mainly as her ferritin is only 9ug/L. Best to be taken before food, to help reduce side effects of tummy upsets. I would recommend Ferrogradumet, which contains 105mg of elemental iron. I have also written out blood slips for a repeat screen in another 4 weeks.
By the end of our appointment, I could tell Di and Dave were a little overwhelmed with our topic, however I think I have inspired them to be creative in their meal preparations, making them interesting, healthy and cost effective for their lifestyle. Hopefully Peter will enjoy it too.
I am a fairly new midwife, so I tend to source my books and current literature to support my practice. I think we’re on track so far. Di and Dave both know to call me at any time if any more questions arise.
I shall catch up with them both within 4 weeks.
These references were great.
Pairman S, Pincombe J, Thorogood C, Tracy S, (2006), Midwifery preparation for practice, Elsevier, Australia
Vegetarian Diets – American Dietetic Association, Journal of the NZ Dietetic Association, Vol 54, No 2.
Friday, August 22, 2008
Eat well to feel well
Julia being Julia
I can understand why Dave is concerned. Especially if Di experienced the maternal fatigue of early pregnancy due to hormonal influences. Not easy with a busy toddler to care for as well.
My advice to Dave is just to let nature take its course. There is no current research that says that tandem breastfeeding is harmful to mother, child and newborn. The need for physical nourishment is minimal for a child older than one year, when the newborn arrives. It is more for the security and psychologic benefits. (Lawrence 1999) Abrupt weaning with the arrival of a new baby who replaces Peter's place at the breast would not be good timing!
Di, because she is a vegan, and still breastfeeding Peter will have increased nutritional needs. A vegetarian or vegan diet can meet the increased demand for energy and protein during pregnancy, but there may be problems in trying to achieve the recommended intake of some vitamins and minerals, especially for vegans, due to dietary restrictions.
MOH Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women , 2006, pg117, gives some good practical advice for the vegetarian and vegan pregnant and breastfeeding women. It includes eating a variety of foods across the four major food groups. Iron status should be closely monitored, with medications used if required. Adequate sources of calcium from alternative food sources should be consumed if diet does not contain milk products. Vitamin B12 supplements are more likely to be required. Include more omega-3 LCPUFA rich foods such as green leafy vegetables, nuts and seeds. The MOH advises that if there is a family history of allergic disease peanuts and peanut products should be avoided in pregnancy and breastfeeding.
Lawrence, R.A. Breastfeeding A guide for the Medical Profession 5th Ed 1999 Mosby
I can understand why Dave is concerned. Especially if Di experienced the maternal fatigue of early pregnancy due to hormonal influences. Not easy with a busy toddler to care for as well.
My advice to Dave is just to let nature take its course. There is no current research that says that tandem breastfeeding is harmful to mother, child and newborn. The need for physical nourishment is minimal for a child older than one year, when the newborn arrives. It is more for the security and psychologic benefits. (Lawrence 1999) Abrupt weaning with the arrival of a new baby who replaces Peter's place at the breast would not be good timing!
Di, because she is a vegan, and still breastfeeding Peter will have increased nutritional needs. A vegetarian or vegan diet can meet the increased demand for energy and protein during pregnancy, but there may be problems in trying to achieve the recommended intake of some vitamins and minerals, especially for vegans, due to dietary restrictions.
MOH Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women , 2006, pg117, gives some good practical advice for the vegetarian and vegan pregnant and breastfeeding women. It includes eating a variety of foods across the four major food groups. Iron status should be closely monitored, with medications used if required. Adequate sources of calcium from alternative food sources should be consumed if diet does not contain milk products. Vitamin B12 supplements are more likely to be required. Include more omega-3 LCPUFA rich foods such as green leafy vegetables, nuts and seeds. The MOH advises that if there is a family history of allergic disease peanuts and peanut products should be avoided in pregnancy and breastfeeding.
Lawrence, R.A. Breastfeeding A guide for the Medical Profession 5th Ed 1999 Mosby
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