18. LIFE STAGES

Question 1

Outline the benefits of breast milk for infants

Answer 1

• Provides vitamins, minerals, carbohydrates, proteins and fats in the right proportions for healthy baby development.
• Contains bifidobacteria and prebiotic oligosaccharides to help colonise the digestive tract and build the immune system.
• Breastfeeding ensures best possible health, developmental and psychosocial outcomes.
• Reduces the risk of conditions such as eczema, asthma and food allergies.

Question 2

Outline the benefits of breast milk for mothers

Answer 2

• Breast milk is cheap and convenient.
• Delays the return of regular ovulation, lengthening birth intervals (prolactin inhibits GnRH release).
• Conserves iron stores (↑ energy & cognition).
• Studies show protection against breast and ovarian cancer (↓ oestrogen & ovulation).
• Aids post-birth weight loss due to increased energy expenditure.
• Supports the mother-baby relationship (oxytocin release).
• Assists in a swifter recovery from symptoms of postpartum depression (PPD). Homeopathy is recommended for PPD.

Question 3

What is the macronutrient composition of breast milk?

Answer 3

The macronutrient composition of breast milk is as follows:
- 88% Water
- 6-7% Carbohydrate: Lactose; easily digested by infants and enhances calcium absorption.
- 3-5% Lipids: Linoleic and linolenic acid as well as arachidonic (AA) acid and DHA.
- Less than 1% Protein: Mostly alpha-lactalbumin and whey.
- Enzymes: Specific for digestion of proteins, fats and carbohydrates. Certain enzymes also serve as transport for other nutrients such as zinc, selenium and magnesium.

Question 4

What is colostrum and what function does it have?

Answer 4

Colostrum is a pre-milk substance containing mostly serum with antibodies (Secretory IgA) and white blood cells, produced during the first two or three days after delivery. Its functions:
- Protects the infant from infections against which the mother has developed immunity.
- Contains maternal antibodies to inactivate pathogenic bacteria within the infant’s digestive tract. This is partly the reason why breast-fed infants have fewer intestinal infections than formula-fed infants.
- Has a laxative effect to expel wastes that accumulated in the digestive tract during foetal development.

Question 5

Name TWO allergenic foods to consider when weaning.

Answer 5

• eggs
• fish
• wheat
• cow’s milk
• peanuts
• tree nuts.

Question 6

Describe TWO reasons each for Vitamin C and Magnesium being important nutrients for a client who is 1 month postpartum.

Answer 6

Vitamin C
- Co-factor for collagen synthesis (aids in wound healing postpartum).
- Increases absorption of non-haem iron
- Depleted in times of stress (adrenals).
- Synthesis of thyroxine and adrenal steroid hormones (postpartum thyroiditis).

Magnesium
- Mg needed to convert ADP to ATP (essential for energy postpartum).
- Absorbed by foetus in pregnancy & lactation.
- ↓ levels can contribute to PPD.

Question 7

What are TWO effects of alcohol on breast milk?

Answer 7

Alcohol easily enters breast milk and significantly diminishes the amount of breast milk consumed by the infant.
- It changes the taste of the breast milk.
- Even low doses of alcohol are not metabolised efficiently by the infant which suppresses feeding and causes sleepiness.
- Alcohol interferes with lactation by inhibiting the hormone oxytocin.

Question 8

How does a natural birth and breast milk benefit the infant?

Answer 8

• Birth and breast milk play a role in early bacterial colonisation of the GIT (and other areas) of the infant.
• Various research confirms that an infant’s bacterial profile is directly related to that of its mother; the role of ‘friendly’ (or commensal) bacteria includes digestive support and immune modulation.
• Breast milk and colostrum may contain more
  than 700 species of bacterial microbiota.
• A 2012 study found that milk from overweight mothers has considerably less diversity of species than normal-weight mothers.
• Caesarean birth mothers also showed less diversity in their breast milk microflora than in vaginal birth mothers (→stress?).

Question 9

Outline how breast milk can confer immune protection to the infant.

Answer 9

• Colostrum is high in secretory IgA, vitamin A and zinc, and also provides bifidus factors, which favour the growth of the ‘friendly bacterium’ lactobacillus bifidus in an infant’s GIT so that other, harmful bacteria cannot gain a foothold there.
• An iron-binding protein in breast milk, lactoferrin, prevents bacteria from accessing the iron they can use to grow. It also
  aids iron absorption and kills some bacteria directly.
• The protein lactadherin in breast milk fights off the virus that causes most infant diarrhoea (rotavirus).
• Several other growth factors and enzymes stimulate the development of the digestive tract and protect against infections.
• Breastfeeding prevents or delays the occurrence of atopic dermatitis, cow milk allergy and wheezing in early childhood when compared to formula-fed infants, according to research.
• Breast milk can offer protection against the development of cardiovascular disease compared with formula-fed infants (possible links to oxytocin release which causes vasodilation); breast-fed infants have lower blood cholesterol as adults.

Question 10

Which minerals are present in breast milk and how does it benefit the infant?

Answer 10

• The calcium content of breast milk is
  ideal for infant bone growth.
• Zinc has also high bioavailability, thanks
  to the presence of zinc-binding protein.
• Breast milk is low in sodium, which is
  a benefit for immature kidneys.
• Breast milk contains relatively small amounts of iron, but the iron has a high bioavailability. Historically, babies got more iron by delaying cord clamping.

Question 11

What are the benefits of delayed cord clamping?

Answer 11

At birth, one third of a baby’s blood is outside its body.
By delaying umbilical cord clamping until it stops
pulsating, babies can get 30% more iron-rich blood, oxygen, erythrocytes, leukocytes and stem cells.

Also possibly reduces the need for Vitamin K injection

Question 12

Your client is a new mother and wants to know how long to breastfeed for and why. Apart from the positive physical impacts such as on the infant’s immune system, what other benefits can you inform her about?

Answer 12

It is recommended to breastfeed exclusively for six
months and continue up to two years or more.

Breastfeeding also provides feelings of love, comfort and protection and can contribute to a toddler’s feeling of self-esteem.

Breastfeeding mothers also benefit from being near their child. The physical contact increases oxytocin, which supports bonding, and also has mild anti-inflammatory effects.

Question 13

What guidance can you provide your client to help them establish successful lactation?

Answer 13

Establishing Successful Lactation:
* Consider hiring a doula or lactation consultant straight after birth to help start your breastfeeding journey and address any issues.
* Familiarise yourself with local breastfeeding support (‘milk spots’) in your area.
* Spend the first week postpartum at home with your baby with plenty of skin-to-skin contact.
* Feed on demand (especially at night).
* Consider pumping one feed in order for the mother to get some rest between feeds.

Question 14

Why is ensuring adequate protein especially important post-partum. List FOUR good sources for the new mother to include in her diet.

Answer 14

Protein is needed to replenish the mother’s energy reserves.
It is needed for breast milk production to support growth: extra 11g / day.
Good sources: Beans, lentils, quinoa, fish, organic eggs.

Question 15

Which nutrients can reduce the risk of PPD (post-partum depression)?
List three good sources for each.

Answer 15

• Zinc - Pumpkin seeds, whole grains, sprouts, egg yolks, oysters, organic liver, seafood.
• Magnesium - Dark leafy greens; pumpkin seeds, almonds, molasses.
• Vitamin D - Sunlight, mushrooms, egg yolk, wild-caught oily fish, sunflower seeds.

Question 16

How can a mother help to positively influence the infant’s gut microbiome despite a cesearean birth and/or antibiotics during birth?

Answer 16

By consuming probiotic foods such as yoghurt, kefir, miso, kombucha or sauerkraut, the mother can help to expose the infant to beneficial bacteria through the breast milk.

Question 17

What is the energetic quality of the foods you would recommend to mothers during the postpartum period?

Answer 17

Nourishing warm foods that replenishes Spleen Qi and requires minimal effort to digest, is gentle and nourishing.

Question 18

How is pregnancy considered energetically and which foods should be avoided? Which foods are to be recommended instead?

Answer 18

Although everyone’s constitution is different, pregnancy is generally considered a time of moisture (consider the amniotic fluid).
During pregnancy, women can feel more hungry, emotional, lethargic, and congested (all signs of excess moisture).

Avoid:
- Damp-forming food (i.e. dairy, refined sugars, processed foods).
- Excess fluids, cold green smoothies, mucilaginous foods (e.g. okra).
- Sweet and high water content fruits (e.g. melons, ripe bananas).

Consume:
- Whole grains, legumes and generally lighter, drier, crunchier foods.
- Warmth also helps to counteract moisture so foods and drinks taken warm and small amounts of culinary herbs and spices will be balancing (not high amounts during pregnancy and breast feeding).

Question 19

Your client has given birth two weeks ago and is approaching you for weight loss advice. How would you approach this?

Answer 19

Since energy requirements during lactation are high, the postpartum period is not the time to go on a weight loss diet to lose the baby weight! This can be attempted later and breastfeeding should enhance weight loss until such time.
- Daily nutrient requirements during lactation are higher than during pregnancy and inadequate maternal nutrition may leave the mother depleted.
- Breastfeeding benefits are dependent on mother’s nutritional status and severe energy restriction may hinder milk production.

Question 20

What general guidlines would you provide for nutrition during lactation?

Answer 20

• Do not skip meals: especially breakfast. Erratic eating triggers the body’s stress response which can affect milk production.
• Eat to satisfaction: oxytocin triggers the milk ejection reflex and also more enzymatic activity in the intestines (→ better digestion). Chew food well.
• Drink to thirst: no over/under drinking. Filtered water is best. Constant thirst can be a symptom of EFA deficiency. Over-drinking may affect milk supply.
• Avoid cold foods and drinks: especially if experiencing low milk supply or if prone to mastitis.
• Focus on whole, fresh, organic produce.
• Well-cooked and energetically neutral foods: e.g. round grain rice, potato, sweet potato, are easily digested by both mother and child.
• Include probiotic foods (e.g. sauerkraut, kimchi, kefir) and prebiotic foods (e.g. asparagus, Jerusalem artichoke, dandelion greens, onions, garlic (may cause gas in baby) to support the microflora.
• Include sources of EPA / DHA: flaxseeds, hemp, oily fish, algae.

Always tailor advice to your client’s constitution

Question 21

What should be limited / eliminated from the diet and lifestyle during lactation?

Answer 21

• Salted, sweetened foods, sugary drinks, cow’s dairy products and microwaved foods.
• Caffeine and other stimulants (chocolate, soft drinks and tea): Caffeine enters breast milk to make the infant irritable and wakeful. Large doses of caffeine interfere with the bioavailability of iron from breast milk and impair the infant’s iron status.
• Avoid alcohol as it easily enters breast milk and significantly diminishes the amount of breast milk consumed by the infant.
• Eliminate smoking: it reduces milk volume, so smokers may produce too little milk to meet their infant’s energy needs.
• Medicinal drugs: Some medicines are contraindicated with breastfeeding — always check with your GP. Contraindicated: anti-cancer drugs, lithium, oral retinoids, amiodarone, codeine, decongestants, aspirin.
• Illicit drugs: Are always harmful and can cause irritability, tremors, hallucinations and even death in infants. It can also impact the mother’s ability to care for her baby.

Question 22

What are ‘galactagogues’ and how can they be used to aid lactation?

Answer 22

Galactagogues such as fenugreek or fennel seed enhance lactation and can be consumed as tea (2–3 cups/day).

Question 23

Outline FOUR of the many issues with infant formula.

Answer 23

Modern-day infant formula is the ultimate refined food, composed of highly processed ingredients such as sugar, non-fat dried milk, vegetable oils and a list of synthetic nutrients.
* Infant formula lacks many key substances for development and growth and contains no antibodies for immune protection.
* Primarily composed of sugar or lactose, dried skim milk and refined vegetable oil which can include GM components.
* Organic formula is made of basically the same ingredients but they are not genetically modified.
* Soy-based formula is made of soy protein, sugar and refined oils.
* Rocket fuel, phthalates, melamine and high levels of heavy metals have been found in infant formula.
* Additives to infant formula, such as iron, DHA, AA and lab-made folic acid are problematic.
* Heat damages the protein in formulas forming advanced glycation end products (a bio-marker implicated in ageing and the development of many degenerative diseases), as well as compromising the nutritional value.

Question 24

At what age are solid foods to be introduced and what are some signs that the infant might be ready for weaning?

Answer 24

Current guidelines recommend not introducing solids until six months of age. At this point the gastrointestinal tract and immune system have matured to a level where new foods are more likely to be tolerated.
Weaning too early (four months) or too late (> 12 months) may increase the risk of allergies. Breastfeeding whilst weaning (six–12 months) can protect the baby from allergenic foods via antibodies in breastmilk.

The baby needs to show signs of being ready: sitting upright, taking an interest in the parents’ food, putting food in their mouth.

Question 25

What are the advantages of ‘Baby-lead weaning’?

Answer 25

Baby-lead weaning:
* Lets babies feed themselves finger foods right from the start.
* Supports the development of hand-eye co-ordination, chewing skills and dexterity.
* Offers babies an opportunity to explore the taste, texture, aroma and colour of a variety of foods.
* Encourages self-regulation
* Less time-consuming than preparing puréed foods.
* Baby is part of the dining experience, although that may encourage the baby to eat foods they are not ready to digest.

Question 26

Which foods should not be introduced whilst weaning?

Answer 26

• Concentrated sweets, baby food desserts have no place in an infant’s diet
• Products containing sugar alcohols can cause diarrhoea, e.g. glycerol, sorbitol, mannitol, xylitol used as sweeteners as well as in chewing gum.
• Canned vegetables — contain too much sodium, sugar or preservatives, and are nutritionally inferior to fresh / frozen produce.
• Honey should never be fed to infants because of the risk of botulism (a rare but serious bacterial infection).
• Soya products — they are hard to digest and contain compounds with oestrogen-like compounds (‘isoflavones’).
• Cow’s milk — apart from the side-effects linked to excess protein intake, cow’s milk consumption before 12 months can cause:
  1. Iron deficiency anaemia (impairs iron absorption).
  1. Deficiency of linoleic acid (low in cow’s milk).
  1. Gastrointestinal blood loss (can cause occult blood in infants).
  1. Type 1 diabetes (in genetically predisposed infants)

Question 27

What is the issue with disposable nappies and what is the alternative?

Answer 27

Disposable nappies:
Most disposable nappies contain a range of chemicals including dioxins, sodium polyacrylate, tributyl-tin, plastics, dyes and fragrances. These can irritate the skin.

What’s the alternative?
* Use natural cloth nappies, wash in fragrance-free, low-chemical detergent.
* Dry in the sun — it reduces bacterial growth.
* Allow ‘free time’ without a nappy, which may also assist potty training.
* Use calendula cream for any skin irritation.

Question 28

List five ways in which parents can encourage good eating habits in children

Answer 28

• Lead by example by eating well yourself.
• Make mealtimes pleasant: turn off the TV and include the child in conversations (encouraging mindful eating of each meal).
• Encourage children to chew food well.
• Cook together and grow a garden with your child.
• Put food out in serving bowls and let your child help him / herself.
• Do not entice or manipulate your child to eat. It entices reluctance and reciprocal control. Don’t bribe with sugary desserts!

Question 29

Type 2 diabetes in children is on the rise, fuelled by the obesity epidemic. Outline four approaches to prevent / manage childhood obesity.

Answer 29

• Prepare foods at home using organic whole foods.
• Eat away from TV to ensure mindfulness.
• Be aware of age-related portions.
• Encourage structured mealtimes versus snacking.
• Discourage inactivity; encourage regular exercise in a way your child would enjoy, e.g. team sports can improve compliance and build relationships.
• Promote adequate sleep.

Question 30

List two things to focus on in order to avoid Iron deficiency anaemia in children. What are some of the signs and symptoms to look out for?

Answer 30

• Avoid processed foods (ready meals, sugary snacks, soft drinks, crisps).
• Cow’s milk inhibits the absorption of iron.
• Optimising digestion and gut health: probiotic and prebiotic rich foods, chewing food well.
• Deficiency symptoms / signs include: fatigue, listlessness, irritability, loss of appetite, apathy, impaired learning, slow growth rates, pallor, tachycardia, spooning of nails.

Question 31

Why could adolescence be an age of nutritional vulnerability?

Answer 31

Teenagers make many more choices for themselves than they did as children:
- They make their own food decisions.
- They may be influenced by their peers.
- Alcohol consumption may begin here.
- They may diet to meet extreme ideals of slimness or athletic ability.

Question 32

List three factors that can affect food choices in adolescence

Answer 32

• Physiological: Increased appetite due to growth spurts; decreased appetite in case of illicit drug or alcohol use.
• Social: Strong influence of peers, preoccupation with body size and body image; media and advertising.
• Economical: More independent and increased money spending; living in food-insecure, temporary housing; fast and convenience foods.

Question 33

Why could protein quality potentially be an issue adolescence and which individuals might be at risk of protein insufficiency?

Answer 33

Protein quality is often an issue, with teenagers opting for processed meats and dairy products.
Protein insufficiency can occur in teens, e.g. in those on weight-loss diets or on inappropriately planned diets (i.e. junk food).

Question 34

What general recommendations could you make for teenagers in terms of macronutrient intake.

Answer 34

• Protein: Ensure good quality protein intake and sufficient levels to support increased body mass and growth.
• Carbohydrates: Limit refined carbohydrates which could lead to conditions such as acne. Focus on nutrient-dense foods such as whole grains, sourdough breads, sprouts, fresh fruits and vegetables to support GIT health.
• Fats: Fat intakes should not exceed 30–35% of total caloric intake and EFAs are important for the production of sex hormones (e.g. testosterone, oestrogen, progesterone) which is crucial during this time. They are also needed for skin, hair and nail health (consider teenage acne).
  Include healthy fats contained in nuts and seeds, oily fish, avocado, olives and olive oils.

Question 35

Discuss why there is increased requirement during adolescence of:
a) Iron
b) Calcium

Answer 35

a) Iron
- Iron requirements increase in adolescence for both males and females as their blood volume increases with growth.
- Iron needs increase for females as they start to menstruate, and for males as their lean body mass develops.
- For females, iron needs remains high (heavy menstruation and pregnancy) until late adulthood / menopause. Menstruation makes women more susceptible to iron deficiency.
- Include non-haem iron foods such as almonds, apricots, avocado, sunflower, pumpkin seeds as well as vitamin C-rich foods to aid absorption (broccoli, citrus fruits, peppers, rosehips, strawberries, sweet potatoes etc.)

b) Calcium:
- Adolescence is a crucial time for bone development and the requirement for calcium reaches its peak during these years.
- Low calcium diets and physical inactivity compromise the development of peak bone mass (the best protection against osteoporosis). Encourage daily exercise and avoidance of fizzy drinks, caffeine, alcohol, fast food.
- Include bone supportive nutrients such as vitamin D and magnesium rich foods (almonds, barley, leafy greens, legumes).

Question 36

List the contributing factors for childhood obesity.

Answer 36

Childhood obesity is associated with:
- Eating highly processed and hyperpalatable foods (sugary cereal, ready meals, soft drinks, crisps, high fat and calorie fast food).
- Reduced energy expenditure, less time spent outside, TV watching, mindless eating.
- Bigger food portions, both at home and in restaurants.
- Gut dysbiosis (e.g. antibiotic use in childhood, not being breast-fed).