18. LIFE STAGES Flashcards
This module covers: • The dietary requirements for different population groups. • How to support clients through lactation and infant weaning. • Nutrition through childhood and adolescence. • Factors affecting food choices for the ageing population. • Healthy ageing and longevity.
Outline the benefits of breast milk for infants
- 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.
Outline the benefits of breast milk for mothers
- 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.
What is the macronutrient composition of breast milk?
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.
(Rolfes et al. 2006)
Breast Milk: Immune Protection
what is colostrum?
During the first two or three days after delivery, the breasts produce COLOSTRUM, a pre-milk substance containing mostly with:
1) serum with
2) antibodies (Secretory IgA) and
3) white blood cells.
Breast Milk: Immune Protection
Functions of COLOSTRUM?
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.
Breast Milk: Immune Protection
How many species of bacterial microbiota is contained in Breastmilk and colostrum?
700
Breast Milk: Immune Protection
Whats the impact on breastmilk if mother is overweight?
Considerably less diversity of species than normal-weight mothers
Breast Milk: Immune Protection
What impact on breastmilk if caesarean birth?
LESS diversity in breastmilk microflora than in vaginal birth mothers (-> stress?)
Birth/breastmilk play role of early bacterial colonisation in the GIT
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: Immune Protection
What is high in Colostrum?
Secretory IgA
Vitamin A
Zinc
also provides bifidus factors which favour growth of friendly bacterium LACTOBACILLUS BIFIDUS in GIT which prevents harmful bacteria gaining a foothold.
Breast Milk: Immune Protection
What’s the name of iron-binding protein in breastmilk which prevents bacteria from accessing iron?
LACTOFERRIN
It also aids iron absorption and kills some bacteria directly.
Breast Milk - Immune Protection
Name the protein in breastmilk which fights off the virus that causes infant diarrhoea (rotavirus)?
LACTADHERIN
Several other growth factors and enzymes stimulate
the development of t
Breast Milk: Immune Protection
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.
What condition is mentioned where breastmilk offers protection?
Cardiovascular disease
(possible links to oxytocin release which causes vasodilation) breast-fed infants have lower blood cholesterol as adults.
Even the most advanced formulas cannot imitate the unique nutrient component of breast milk
Breast Milk: Minerals
The calcium content of breast milk is
ideal for what?
infant bone growth
Breast Milk: Minerals
Zinc has also high bioavailability, thanks to the presence of what?
Zinc-binding protein
Breast Milk - Minerals
Breast milk is low in sodium, which is
a benefit for what?
Immature Kidneys
Breast milk - minerals
Breast milk contains relatively small
amounts of iron, but the iron has a high
bioavailability. Historically, how did this fact help baby get more iron?
by delaying cord clamping
Lifestages pg 10
Breast milk - iron
when is Iron transferred to the baby across the placenta ?
in the third trimester.
Breast milk - iron
Pre-term babies have less iron per kg than full term, true or false?
true
Breast milk IRON
Iron stores are used up in infancy as blood volume increases with body size
true or false?
True
Breast milk - iron
How much of baby’s blood is outside its body at birth?
1/3
Life stage pg 11
breast milk - iron
what happens by delaying umbilical cord clamping?
By delaying umbilical cord clamping until it stops
pulsating, babies can get 30% more iron-rich blood,
oxygen, erythrocytes, leukocytes and stem cells.
Leave the navel to air dry and let the stump fall of on its own
Lifestages pg 11
Breastmilk - the perfect baby food
What period is recommended to exclusively breastfeed?
6 month
and continue up to 2 years or more
Human breast milk compliments and boosts the immune system as long as it
Breastfeeding also provides feelings of love,
comfort and protection and can contribute
to a toddler’s feeling of self-esteem
Breast Milk: The Perfect Baby Food
Breastfeeding mothers also benefit from
being near their child. The physical contact
increases oxytocin, what does it support?
which supports bonding,
and also has mild anti-inflammatory effects.
Establishing Successful Lactation
Guidance to support your clients:
- 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.
Key Postpartum Nutrients
Key Postpartum Nutrients include:
Protein, what is it needed for?
Protein
* Needed to replenish reserve.
* Needed for breast milk production
to support growth: extra 11g / day.
Beans, lentils, quinoa,
fish, organic eggs.
Key Postpartum Nutrients
What’s iron needed for as a key postpartum nutrient?
Iron
* ↑blood volume (anaemia is common
in pregnancy).
* ↓iron = fatigue, altered cognition.
Almonds, kale, spinach
poultry, sunflower/
pumpkin seeds, algaes.
Key postpartum nutrient
What’s zinc needed for as a key postpartum nutrient?
Zinc * Involved in production of ovarian
hormones; has a high trace of
mineral concentration in the brain.
* ↓ zinc can contribute to PPD.
Pumpkin seeds, whole
grains, sprouts, egg
yolks, oysters, organic
liver, seafood
Key postpartum nutrients
What’s B vitamins needed for as a key postpartum nutrient?
B Vitamins
* ATP production (B1, B2, B3, B5)
* B2 PPD protection.
* Folate depleted with lactation.
* B12 cofactor for DNA
production, myelination (nervous
system development). Can be
depleted by nitrous oxide in labour.
Lentils, leafy greens,
whole grains, organic
eggs, seeds and nuts,
liver, avocado,
banana, asparagus,
beans, legumes,
mushrooms, peanuts.
Life stages pg 52
Key Postpartum nutrients
What’s EPA/DHA needed for as a key postpartum nutrient?
EPA/DHA
* Essential for neural and eye
development of foetus.
* ↑ need postpartum, mother at risk of
losing DHA from brain tissue as
passed to foetus / breastfed infant.
Flaxseeds, hemp
seeds, chia seeds, oily
fish (salmon, mackerel
etc) anchovies,
sardines, herring).
Lifestages pg 15
key postpartum nutrient
What’s MAGNESIUM needed for as a key postpartum nutrient?
Magnesium
* Mg needed to convert ADP to ATP
(essential for energy postpartum).
* Absorbed by foetus in pregnancy &
lactation.
* ↓ levels can contribute to PPD.
Dark leafy
greens;
pumpkin
seeds,
almonds,
molasses.
key postpartum nutrients
What’s MAGNESIUM needed for as a key postpartum nutrient?
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).
Broccoli,
blackcurrant,
peppers,
pineapple,
strawberries,
oranges.
Lifestages pg 16
key postpartum nutrients
What’s Vitamin D needed for as a key postpartum nutrient?
Vitamin D
* Diet and lifestyle changes in pregnancy
(e.g. lack of dietary intake and avoiding sun
exposure / excess sunscreen) can
predispose women to low vitamin D levels.
* Vitamin D has a role in commensal
bacterial colonisation.
* Reduces risk of PPD. (Abedi et al., 2018)
Sunlight,
mushrooms,
egg yolk,
wild-caught
oily fish,
sunflower
seeds.
key postpartumnutrients
What are probotiotic foods needed for as a key postpartum nutrient?
Probiotic Foods
* Babies receive beneficial bacteria from the
mother (from birth and breastfeeding).
It is especially important if born by
caesarean or if given antibiotics during /
after labour.
Yoghurt,
kefir, miso,
kombucha,
sauerkraut.
Lifestages pg 17
Nutrition During Lactation
Energy requirements during lactation are high. So what can you recall from pg 23?
- Daily nutrient requirements during lactation
are higher than during pregnancy. - Breastfeeding benefits are dependent
on mother’s nutritional status. - Inadequate maternal nutrition may
leave the mother depleted. - Severe energy restriction may
hinder milk production. - The postpartum period is not the time to go
on a weight loss diet to lose the baby weight! - 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. - Every woman is different and will require different nutrition
according to her constitution refer back to Energetics lecture. - 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.
- Avoid salted, sweetened foods, sugary drinks, cow’s dairy
products and microwaved foods.
Nutrition During Lactation
**Avoid caffeine and other stimulants:
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.
* Coffee consumption should be eliminated.
* Chocolate, soft drinks and tea also
contain caffeine, so it is recommended
to avoid these.
Avoid alcohol as it 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. - Alcohol consumption also interferes with
the ability to look after your baby
Nutrition During Lactation
Eliminate smoking — it reduces milk
volume, so smokers may produce too little
milk to meet their infant’s
energy needs
- The milk contains nicotine which
alters its smell and flavour. - Infants of breastfeeding mothers
who smoke gain less weight. - They are also at higher risk of
sudden infant death syndrome.
- 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.
Nutrition During Lactation
- Feed on demand. Your baby tells you when it is
hungry — follow baby’s needs. Each baby is different. - If milk supply is low, try galactagogues fenugreek or
fennel seed tea; 2–3 cups/day, and stay hydrated. - Milk supply increases with the demands of the baby.
The best way to increase milk supply is to feed more. -
Stress can lower breast milk production.
If stressed, drink chamomile or lemon balm tea. - Additional fluid is usually not needed for breast-fed babies.
- In hot weather, or when the baby has a temperature or diarrhoea,
filtered water can be added. Never give juice or sugary drinks.
When breast milk does not agree with the baby:
* Babies can develop GI symptoms towards any
foods in mother’s diet. Investigate and eliminate!
* Infants who develop food allergy symptoms
may be more comfortable if the mother’s diet
excludes the most common offenders:
cow’s milk, eggs, fish, peanuts, tree nuts.
* Go for a leisurely walk in natural surroundings;
this will also help your baby.
* Include a daily relaxation practice (e.g. mother and baby yoga or
baby massage with sesame / almond oil, according to constitution).
Lifestages pg 31
Tradition postpartum care
Many cultures practise postnatal techniques to
nourish, nurture and revitalise the mother after
childbirth as well as to help her with additional
demands of breastfeeding and caring for a newborn.
- China: one month confinement — nourishing warm foods,
no visitors, no leaving the house, rest and feeding the baby. - Korea: 21 days — mother sleeps, eats and nurses the baby at
this time. Large amounts of hot tea and seaweed soup is given. - India: mother is kept warm for 10–40 days by a fire, she is
fed warming rich foods containing almonds and pistachios. - Nepal: new mother spends first 11 days with baby in darkened
room, nourishing foods include ghee and caraway soup.
Lifestage pg 18
Korean Seaweed Birthday Soup
Serves 6–8. Traditional Korean postpartum soup, eaten by
children on their birthdays. Seaweed — rich in calcium and
iron, promotes lactation and calms the nervous system. recipe to follow->
- In a medium pot, sauté ½ chopped onion in 2 tablespoons
sesame oil until lightly browned. Add 1 chopped garlic clove,
115g of organic beef sirloin OR 1 cup of dried anchovies
(omit if vegetarian). Stir and cook until browned. - Add 2 litres of broth of your choice, 30g of dried
seaweed (dulse / wakame or kelp) which has
been rinsed and 6 shiitake mushrooms.
Reduce heat and simmer for 40 minutes. - Eat warm and store leftovers in fridge for up to three days.
Lifestages pg 20
Brown Rice Congee
Serves 4–6.
A food of rebirth — replenishes Spleen Qi.
Requires minimal effort to digest, is gentle and nourishing, recipe to follow->
- In a medium pot, bring 390g of soaked brown rice with 1 litre
of water to a boil over a high heat. You may also use organic
vegetable or chicken broth to make it more flavourful. - Reduce heat to a simmer and cook until the
grains soften and open. Stir often and keep
checking and adding water if it’s been absorbed. - Serve hot with toppings such as black sesame
seed paste / picked vegetables / boiled egg / adzuki beans. - Store leftovers in the fridge for up to five days or portion freeze.
Name TWO allergenic foods to consider when weaning.
- eggs
- fish
- wheat
- cow’s milk
- peanuts
- tree nuts.
Lifestages pg 31
Describe TWO reasons each for Vitamin C and Magnesium being important nutrients for a client who is 1 month postpartum.
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.
What are TWO effects of alcohol on breast milk?
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.
How does a natural birth and breast milk benefit the infant?
- 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?).
Outline how breast milk can confer immune protection to the infant.
- 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.
Which minerals are present in breast milk and how does it benefit the infant?
- 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.
What are the benefits of delayed cord clamping?
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
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?
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.
What guidance can you provide your client to help them establish successful lactation?
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.
Why is ensuring adequate protein especially important post-partum. List FOUR good sources for the new mother to include in her diet.
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.
Which nutrients can reduce the risk of PPD (post-partum depression)?
List three good sources for each.
- 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.
How can a mother help to positively influence the infant’s gut microbiome despite a cesearean birth and/or antibiotics during birth?
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.
What is the energetic quality of the foods you would recommend to mothers during the postpartum period?
Nourishing warm foods that replenishes Spleen Qi and requires minimal effort to digest, is gentle and nourishing.
How is pregnancy considered energetically and which foods should be avoided? Which foods are to be recommended instead?
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).
Your client has given birth two weeks ago and is approaching you for weight loss advice. How would you approach this?
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.
What general guidlines would you provide for nutrition during lactation?
- 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
What should be limited / eliminated from the diet and lifestyle during lactation?
- 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.
What are ‘galactagogues’ and how can they be used to aid lactation?
Galactagogues such as fenugreek or fennel seed enhance lactation and can be consumed as tea (2–3 cups/day).
Outline FOUR of the many issues with infant formula.
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.
At what age are solid foods to be introduced and what are some signs that the infant might be ready for weaning?
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.
What are the advantages of ‘Baby-lead weaning’?
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.
Which foods should not be introduced whilst weaning?
- 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)
What is the issue with disposable nappies and what is the alternative?
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.
List five ways in which parents can encourage good eating habits in children
- 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!
Type 2 diabetes in children is on the rise, fuelled by the obesity epidemic. Outline four approaches to prevent / manage childhood obesity.
- 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.
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?
- 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.
Why could adolescence be an age of nutritional vulnerability?
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.
List three factors that can affect food choices in adolescence
- 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.
Why could protein quality potentially be an issue adolescence and which individuals might be at risk of protein insufficiency?
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).
What general recommendations could you make for teenagers in terms of macronutrient intake.
- 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.
Discuss why there is increased requirement during adolescence of:
a) Iron
b) Calcium
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).
List the contributing factors for childhood obesity.
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).
Pregnancy: Energetics
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).
What should they avoid?
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).
Pregnancy: Energetics
Focussing on more drying foods:
* 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).
is the newborn baby damp?
YES, The newborn baby is also damp (childhood
is the moist life stage). An infant needs
breastmilk, warmth, comfort and sleep.
Ageing
Ageing is a normal biological process which involves some
physiological changes and decline. what do they include?
- Lowered hormone levels, e.g. sex hormones, growth hormone.
- Immunity: dysregulation of innate and adaptive immune function.
- Loss of skin integrity due to ↓production of lipids, ↓desquamation.
- Decreased bone density and muscle mass.
- Heart valves and arteries stiffen (= less flexible).
- Decrease in renal function (GFR declines).
- Reduced chest wall compliance and alveolar recoil.
- Neurological function declines (with neuron atrophy).
- GIT: affected by ↓stomach acid, dysphagia and ↓taste sensation
Lifestages pg 62
Ageing
It is important to distinguish between the normal changes
of ageing versus changes due to disease. give a few examples?
- E.g. atherosclerosis is becoming more common in teenagers.
- Ageing is normal, accelerated ageing is not.
- Ageing can be accelerated by:
- Lifestyle, poor diet and ↓physical exercise.
- Stress and not having a goal in life.
- The socioeconomics status.
- Diseases and medications.
- Genes contribute about 30% and lifestyle factors 70% to ageing.
- Biological age can differ from one’s chronological age.
Ageing
Telomeres = the specific DNA-protein structures found at both
ends of each chromosome. As a normal cellular process, a
small portion of telomeric DNA is lost with each cell division. what do you know about telemeres?
- When telomere length reaches a critical limit, the cell
undergoes senescence and / or apoptosis. Telomere
length can, therefore, serve as a biological clock to
determine the lifespan of a cell and an organism. - Certain lifestyle factors such as smoking and poor diet
can increase the pace of telomere shortening. - Studies show that shorter telomeres are a risk factor for cancer
ENERGETICS of Ageing
Mature years are dominated by dryness. Give a few examples of appearance and foods to increase?
- I.e. wrinkles, joint stiffness, decreasing physical strength.
- Increase: soups, stews and smoothies, sweet and high water
content fruit and veg, root vegetables, nut milks, ‘mucilaginous’
okra, chia and linseeds, liquorice, most herbal teas.
Lifestage pg 65
ENERGETICS OF Ageing
Old age is dominated by coldness
Can you give examples of appearance and foods to increase?
- I.e. digestive power weakens, circulation reduces,
we feel colder, declining mobility, exhaustion and withdrawal. - Increase: warm, cooked and mildly spiced food and drinks that
increase body temperature, digestive power and circulation
(Refer back to your Energetics lecture)
Ageing - Sarcopenia
Body composition changes with age in what way?
- Fat mass and visceral fat increases.
- Lean muscle mass decreases
Ageing - Sarcopenia
Sarcopenia: what is it?
- The age-related **loss of muscle mass, strength
and function **which can significantly impact an
older adult’s quality of life by decreasing mobility,
increasing the risk of falls and fractures, lowering
metabolic rates and increasing the risk of death. - Accelerates with decreased physical activity.
Weight-bearing exercises slow its pace
(whilst also supporting bone mineral density).
Ageing - Sarcopenia
What are Contributing factors to sarcopenia ?
-
Sedentary lifestyle, lack of exercise,
prolonged bed rest: muscle disuse causes
a large decline in muscle size and strength. - Body composition changes with age.
- Poor nutritional status (reduced protein and energy intake).
-
Hormonal changes (low testosterone,
oestrogen, growth hormone, as well as insulin
resistance have anabolic effects on muscle). - Inflammation (↑interleukin-6 and CRP).
- Chronic diseases (e.g. cancer, heart failure).
Ageing - Energy Requirements
In the elderly there are two factors
that can affect energy balance, can you identify them?
- Age-related loss of lean muscle
mass affects body composition
and basic metabolic rate is
lowered as physical activity declines. - Increase in fat mass increases the risk of
cardiovascular disease, diabetes and obesity,
which influences energy balance.
* Co-morbidities and infection may increase energy
requirements, immobility may reduce them.
Lifestages pg 68
Ageing - Malnutrition
Malnutrition is caused by many factors, such as what?
- Reduced intake of food: changes in taste and smell
(sometimes due to medications, cigarette smoking
or Alzheimer’s), alterations in gastric hormones
regulating appetite and motility, depression
and bereavement, as well as social isolation. - Cachexia (side effect for cancer or COPD).
- Stroke / dementia can lead to dysphagia
(difficulty eating / swallowing). Dysphagia
may also lead to aspiration pneumonia (a leading
cause of death amongst nursing home residents).
Ageing - Malnutrition
What can Poor oral health be associated with?
- A poor nutritional status (e.g. high refined sugars, low antioxidant).
- Dentures (problems chewing); amalgams (risk of dental infections).
- Xerostomia: causing difficulty chewing and swallowing, whilst also
impacting the oral microbiome and reducing salivary IgA.
This increases the risk of oral thrush, which can reduce taste.
Lifestages pg 70
Ageing - Malnutrition
The consequences of malnutrition are extensive, can you name TWO?
- Loss of muscle mass and strength.
- Loss of mucosal integrity malabsorption.
- Impaired immune function.
- Psychological impact: apathy / depression.
Ageing - Malnutrition
Factors affecting food choices in elderly?
-
Physiological: decreased visual acuity, joint problems,
hand tremors, hearing problems, anorexia, dementia. -
Social / psychological: reluctance to go shopping,
isolation, depression, fear, bereavement. - Economical: isolation, low income.
- Reduced appetite: could be due to
increased levels of cholecystokinin with
ageing, resulting in increased satiation
after meals and delayed gastric emptying.
These can make acquiring, preparing and eating food more difficult.
Ageing - Gastrointestinal
Changes that occur in the GI tract with age?
- Parietal cell intrinsic factor production declines with age.
- Achlorhydria (reduced stomach acid) can lead to:
-
Poor digestion, absorption and biliary excretion
B12
(low HCl also impairs bile flow and pancreatic function). - VitaminPoor digestion, absorption and biliary excretion
B12 deficiency (HCl and intrinsic factor are needed). - SIBO and other intestinal bacterial infections.
- Iron deficiency (due to impaired absorption).
- Gastric motility and gastric emptying can also be impaired.
- To support these clients: avoid drinking with meals, chew well / eat
fewer solid foods, eat bitter greens, supplement where appropriate.
Ageing - Cardiovascular
Cardiovascular diseases are not ‘diseases of ageing’
as such; they are often diseases of unhealthy choices. Can you name a few?
- Decreased arterial wall compliance, thickening
/ stiffening of arteries: ↑ systolic blood pressure. - Decreased maximum heart rate.
-
Increased left ventricular muscle mass (also due
to hypertension): can be a predictor for cardiovascular disease. - Focus client’s dietary intake on whole foods, rich in antioxidants.
Increase bitter foods and heart nourishing foods / herbs such as
garlic and rosemary. Encourage regular aerobic exercise.
Ageing - Renal
Renal function decreases with age, can you describe what happens?
Significant changes in structure and function
of the kidney occur, including:
* Kidney cortex volume decreases.
* Number of renal cysts increase with age.
* Nephrosclerosis increases with age, with a
decline in nephron numbers and the GFR.
Decreased renal function may lead to:
* Problems with urinary excretion and difficulties
regulating sodium concentration in the body.
Poor glomerular filtration is reflected by a low GFR on a blood test
Ageing - Neurological
Neurological function declines and cognitive
impairment and dementia increase with age.
- Cognition, steadiness, coordination, gait,
sensations and daily living tasks. - Depression in older people is often undiagnosed as symptoms
can be confused with other medical illnesses. Loneliness, losses,
not having a goal and purpose of life are the foundation of
depression and need to dealt with by the Naturopathic Nutritionist. - Deficiency of B vitamins (folate, B12, B6) have been linked to
cognitive impairment, and can contribute to raised homocysteine
a risk factor in the pathogenesis for Alzheimer’s.
Ageing Immune System
Ageing is associated with dysregulation of both
innate and adaptive immune functions, including:
- A progressive decline in T-lymphocyte function.
- A decline in cell mediated immunity.
- This increases the risk and severity of infections
and cancer incidences amongst the elderly. - Poor nutritional status further exacerbates impaired
immune function. Key considerations are: - Protein energy malnutrition = reduced lymphocyte
proliferation increased risk of infection. - Micronutrient deficiencies (A, C, E, Zn, Se, Fe) that ↓ immunity.
- Optimise the intake of these nutrients to support immunity.
Ageing: Skeletal
Various skeletal changes occur with ageing?
- Bones: Bone Mineral Density (BMD) gradually declines with
increasing age and is a risk factor for osteoporosis (and fractures).
BMD decline is accelerated in women following the reduction
of oestrogen associated with the menopause. - Cartilage: Decreases its water content, changes
to the extracellular matrix structure with collagen
fibres cross-linking (making the cartilage stiffer),
and a reduced delivery of nutrients to cartilage.
Intervertebral discs lose their height limiting movement. - Regular weight-bearing exercise can support bone density and
cartilage health. Also optimise vitamin C status to support cartilage
Ageing: NAD+
NAD+ is an essential co-factor in all living cells that is involved in fundamental biological processes. What happens in depletion?
- NAD+ depletion is associated with the hallmarks of ageing and
may underlie a wide range of age-related diseases, such
as metabolic disorders, cancer and neurodegenerative diseases. - You can increase NAD+ levels by:
- Exercising regularly.
- Getting adequate sleep.
- Fasting / periodic calorie restriction.
- Eating a nourishing diet which includes avocados, green leafy
vegetables, fish, nuts, cremini mushrooms, fermented foods.
NAD+ = Coenzyme
Nicotinamide Adenine Ageing: NAD+ Dinucleotide
Ageing: Melatonin
Melatonin is a hormone secreted by the pineal gland
that regulates the circadian rhythm. It also
- Serves as a potent antioxidant, a
chemotoxicity reducing agent,
and an anti-ageing substance. - Modulates immune defence (e.g. NK cells).
- Acts as a tumour surveillance agent.
- Optimise melatonin levels by: increasing natural sunlight
exposure, having a regular bedtime in a dark room, avoiding
artificial light at night and stimulants (e.g. caffeine), eating
Montmorency cherries and B6-rich foods for melatonin synthesis.
Nutrition for Healthy Ageing
The elderly often have diets lower in calories, fat, fibre and
certain nutrients.
Encourage clients to consume nutrient dense diets.
* Protein: a higher protein intake (1g / kg body
weight) can increase bone mineral density
and preserve muscle mass. However, high
protein diets can pose stress on the kidneys
and increase urinary calcium excretion.
* Carbohydrates: 50–70% of calories should come from
vegetables, fruits, whole grains, legumes; these will provide
micronutrients as well as fibre to counteract constipation.
Nutrition for Healthy Ageing
Lipids:
* Important for cognitive functions, skin and joint health especially.
* Include polyunsaturated and monounsaturated fats.
* Include omega 3 fatty acids for neurological cognition
and joint health: oily fish, chia, flax and hemp seeds.
* Reduce saturated fats (trans-fats atherosclerosis).
what foods help?
Cooked foods are easier to chew and digest than raw foods:
* Focus on soups, stews, well-cooked grains and
legumes, small amounts of stewed fruits (high in sugar).
* Ensure adequate hydration by including liquid foods / herbal teas
Nutrition for Healthy Ageing
How does B12 help?
Vitamin
B12
* Older adults at risk of
deficiency from achlorhydria.
* Important for cognition.
Egg yolks, salmon,
sardines.
Nutrition for Healthy Ageing
How does Vitamin D help?
Vitamin D
* Low levels in elderly due to
poor skin synthesis, reduced
kidney conversion and less
sun exposure (housebound).
Sunlight,
mushrooms, egg
yolk, wild-caught oily
fish, fish liver oils.
Nutrition for Healthy Ageing
How does vitamin E help?
Vitamin E * An antioxidant that protects
against free radical damage,
which is linked to accelerated
ageing, neurodegenerative
diseases and atherosclerosis.
Almonds, egg yolk,
hazelnuts,
sunflowers, wheat
germ.
Nutrition for Healthy Ageing
How does FOLATE help?
Folate
* Important for lowering
homocysteine levels, a risk
marker for Alzheimer’s,
atherosclerosis, Parkinson’s.
Green leafy vegetables,
barley, beans, lentils,
sprouts, yeast, organic
liver.
Nutrition for Healthy Ageing
How does calcium help?
Calcium * Decreased absorption in the
elderly.
Sesame seeds, almonds,
broccoli, green leafy veg,
sardines, molasses.
Nutrition for Healthy Ageing
How does Potassium help?
Potassium * Positive effect on blood
pressure.
* Inverse association of
potassium and stroke mortality.
Nuts (esp. pistachios), all
vegetables, avocado,
banana, dates, parsley,
potato, sunflower seeds.
Nutrition for Healthy Ageing
How does CoQ10 help ?
CoQ10 * An antioxidant that protects cells
from oxidative damage.
* Body production declines with age
and with statin use (very common
in the elderly).
* CoQ10 also supports the immune
system and facilitates ATP
production.
* Useful for cardiovascular problems
such as coronary artery disease,
hypertension, angina,
atherosclerosis.
Spinach, cauliflower,
broccoli, avocado,
parsley, oranges,
strawberries, apples,
grapefruit,
sesame seeds,
pistachios, walnuts,
sweet potato, organ
meats, oily fish, egg
yolk.
Lifestage pg84
Nutrition for Longevit
According to longevity biologist, Valter Longo what does he recommend?
- Eat a diet high in plant foods with some fish (two or three meals
a week). After age 65–70, if you start losing muscle
mass, add more fish and introduce some animal
foods such as eggs, sheep / goats milk yogurt. - Eat at the table of your ancestors: consume a
variety of foods to ensure adequate nutrient intake;
choose ones that were common on the table of
your grandparents and great-grandparents. - **Restrict your eating to 11–12 hours a day **or less and consume
two or three meals a day at most (e.g. breakfast and one other).
Healthy ageing herbal teas
Can you name 3 teas and say how they help?
Nettle leaf:
* A diuretic — relieves fluid retention,
blood purifier — flushes out toxins, skin
cleanser, nutritive, assists blood glucose
balance, anti-inflammatory (arthritis).
Dandelion root:
* Enhances digestion (bitterness stimulates
release of digestive juices to improve breakdown
and absorption of nutrients), supports liver
detoxification, a gentle laxative, mild diuretic
(assists with fluid retention). Promotes peristalsis.
Peppermint:
* Soothes digestion — relieves griping
pain, flatulence and nausea.
* Is antimicrobial internally and topically.
* Relieves pain and itching topically.
Chamomile:
* Relieves pain, flatulence and spasm
in the digestive tract. It is calming to
the nervous system, relieving stress
and promotes a restful sleep.
* Topically helps with wound healing.
Lifestages pg 87
