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The article, “The Impact of Pregnancy Nutrition on Offspring Obesity” by Jami Josefson, MD, focuses on possible factors for childhood obesity as linked to maternal nutrition during gestation. Obesity in pregnancy is cited as a culprit in immediate and long-term battles with obesity for… both mother and child. The problem is hard to quell as more middle class preschoolers are being added to the ranks of obese youth in the United States. The problem arises as the risk of adulthood obesity is doubled when children are classified as obese at this young an age. The factors the author attributes to this trend in childhood obesity include; maternal obesity, excessive gestational weight gain, and birth weight and neonatal body composition. Maternal obesity and excessive weight gain during pregnancy are both well-documented factors contributing to not only maternal obesity postpartum, but also as a risk fact for the child. The Gestational Diabetes Mellitus (GDM), also correlated with maternal obesity and excessive weight gain, poses a threat as a higher obesity factor for the offspring. Interestingly though, even if a woman does not quite meet the criterion to be considered having GDM, if insulin resistance /impaired glucose tolerance is present in an obese pregnant mother, some infants have displayed “some features of infants of diabetic mothers, such as increased body fat at birth.” Also mentioned, were altered lipid and inflammatory pathways of the mother, as these also contribute to fetal fat deposition.

The latter factor, birth weight and neonatal body composition, seems to be the more tell-tale of signs for childhood, adolescent and adult onset obesity. According to studies, “babies born large at birth are more likely to become obese”. However, “most obese children had a normal birth weight”. Babies born to mothers who are obese or who have developed GDM are more prone to being obese later on in life not only because of their insulin status, as previously thought, but because of the level of adiposity. This higher level of adiposity combined with a higher insulin status, studies have shown, “usually persisted into adolescence”. It would seem that newborn adiposity “is a potential indicator of obesity risk”.

There is an upside to this discovery, however. Obese mothers who lose weight prior to becoming pregnant greatly reduce their risk of having a child who is predisposed to being obese. The author suggests lifestyle changes, exercise, weight loss before conception, behavior modification counseling, and individualized weight grain recommendations as starting points to help curtail what is becoming an epidemic in the United States.

This article was quite interesting in that the author brought in the idea of fetal/infant adiposity as being a stronger indicator of childhood obesity. Other studies have merely said that obesity and/or GDM status in pregnancy is a high risk factor for these children, not actually mentioning why it is that childhood obesity is the result. I believe that if more studies were done to further this research, we may have yet another weapon in the fight against childhood obesity.  I really appreciate the fact that he mentioned behavior modification as a pathway to help mothers who are obese or overweight. I’ve been pregnant and, while it is easy to modify your lifestyle to make sure that there is the best possible environment to grow your child, food habits are the hardest to modify. (Quitting smoking when I found out I was pregnant was easier than cutting out foods I loved (i.e. Sushi).)

Josefson J. The Impact of Pregnancy Nutrition on Offspring Obesity. J Am Diet Assoc. 2011;111:50-52.

Why You Should See a Registered Dietitian

For my public speaking class, we were asked to write a persuasive speech. After years of reading nutrition books and articles online, talking to people who are both knowledgeable and not-so-much, and being told conflicting things, and then after taking courses in nutrition, I felt that this was a good topic for a persuasive speech.

I turned it into a Power Point and plan to update it and add to it over time (so feel free to provide constructive criticism and suggestions!). If you are interested in it, you can left-click and download it on the right side of the blog under “Now Tweeting”. Of course, the slides are straightforward and I do hope to put more into it- I was just on a tight schedule with finals.

Yours in health,

Julie Wallace

UG Dietetics Student

The bacteria that cause Foodborne Illnesses.

Adapted from a very short paper on how microbiology influences my chosen degree. I will update this when time permits.

The CDC’s webpage on Food Safety states, “While the food supply in the United States is one of the safest in the world, each year about 76 million illnesses occur, more than 300,000 persons are hospitalized, and 5,000 die from foodborne illness (Centers for Disease Control and Prevention, 2010)”.

There are a variety of bacteria that can affect food safety and cause people to become very sick:

  • Campylobacter jejuni, Escherichia coli, Listeria monocytogenes, and Salmonella can survive in raw or undercooked meat and poultry. Symptoms of consuming these bacteria can include abdominal pain, diarrhea, nausea, and vomiting.
  • Listeria monocytogenes, Salmonella, Shigella, Staphylococcus aureus, and Campylobacter jejuni can be found in raw, unpasteurized milk and dairy products and may cause nausea, vomiting, abdominal cramps, diarrhea, and fever.
  • Salmonella enteriditis can be found in raw or undercooked eggs and can cause the same symptoms as the above mentioned bacteria. 

  • Vibrio vulnificus and V. parhaemolyticus can be found in raw or undercooked shellfish and can cause chills, fever and may cause people to collapse.
  • Clostridium botulinum may be found in improperly canned goods and smoked or salted fish. This is a reason why many are told to be cautious with dented canned goods purchased at the store. Symptoms of consuming this bacteria include double vision, inability to swallow, difficulty speaking, and inability to breathe, dyspnea,- a very dangerous symptom that requires immediate medical assistance!
  • E. coli, L. monocytogenes, Salmonella, Shigella, Yersinia entercolitica, viruses and parasites can be found on fresh produce or produce which has been minimally processed. Symptoms include diarrhea, nausea and vomiting.

There are many other types of bacteria which can cause serious foodborne illnesses and symptoms other than those I have listed.

As a nutrition professional, it is important to counsel clients/patients, food-industries and their related agencies, health-related agencies, and the general public on the dangers of foodborne illnesses caused by bacteria, viruses, and parasites. It’s also important to advise them on how to prevent such illnesses. It’s important to remind others to

  • Wash their hands
  • Sanitize food preparation surfaces
  • Keep meats and poultry separate from produce
  • Scrubbing the outside of produce with dish soap or another appropriate cleaning agent will help protect against the consumption of bacteria and even pesticides – just make sure you rinse thoroughly so you do not consume soap residue.
  • Properly throw out cracked eggs
  • Avoid purchasing and using dented cans from the grocery store.
  • If someone in the household is sick, they should avoid cooking so they do not infect others.
  • Properly cook food, especially meat and poultry, so that it is heated both on the outside and entirely on the inside to destroy dangerous bacteria before consumption.
  • Once food is prepared, it should only be kept at appropriate temperatures or placed inside the refrigerator for a certain length of time to prevent foodborne illnesses.
  • Boil drinking water for at least 1 minute when needed, as in cases of sewer damage
  • Water filters are available at inexpensive prices at stores for added protection by consumer preference.

Lastly, when counseling clients on nutrition, I would provide them with food safety guidelines sheets, symptoms of foodborne illnesses that indicate when they should seek medical care and if they should report information to a health agency, as well as provide them with information on food safety contamination risks when travelling like the one below:

The USDA has now created a Fact Sheet on Food Safety Guidelines which can be found here: Food Safety and Security: What Consumers Need to Know – details on the guidelines above, such as proper heating and holding temperatures can be located within this Fact Sheet as well.

My questions to you are:

  1. What food safety measures do you take to prevent foodborne illness?
  2. What tips can you offer that aren’t provided here?
  3. Have you ever contracted a foodborne illness? If so, how did you know and what treatment did you seek?

Works Cited

Centers for Disease Control and Prevention. (2010, September 23). Food Safety. Retrieved November 14, 2010, from Centers for Disease Control and Prevention: http://www.cdc.gov/foodsafety/

Escott-Stump, S. (2008). Foodborne Illness. In S. Escott-Stump, Nutrition & Diagnosis-related Care (pp. 126-131). Baltimore, MD: Lippincott Williams & Wilkins, a Wolters Kluwer business.

USDA. (2008, November 20). Food Safety and Security: What Consumers. Retrieved November 14, 2010, from USDA Food Safety and Inspection Service: http://www.fsis.usda.gov/Fact_Sheets/Food_Safety_Security_Consumers/index.asp

Copper Tones

No- we aren’t talking about this Copper ‘Tone’! But we will discuss how copper colors the skin, hair, and eyes and how it ‘tones’ our skin below!

Introduction

(contributed by Ashley Patterson and Julie Conant)

There are abundant amounts of information about the top vitamins and minerals such as Vitamin C, Vitamin B12, folic acid, and potassium that most of us health conscious people come across each day. But what about the trace minerals? For instance, copper, the third least profuse mineral in the body. Sure it is only in the body in small amounts, but plays a crucial role in many biochemical functions. With this post, the goal is to inform the readers of just how important this minute trace mineral, copper, really is!

Copper is an essential micronutrient and trace element found in the blood. According to Krause’s Food & Nutrition Therapy, “highest concentrations are found in the liver, brain, heart, and kidney while the muscle itself has little copper, skeletal muscle contains almost 40% of all copper in the body” (Mahan & Escott-Stump, 2008). It has many different and important functions which we will discuss below. We will also cover dietary recommendations, good sources of dietary copper, and the dangers of both copper toxicity and deficiency.

Atomic Structure of Copper

provided by Ashley Patterson

Atomic Structure of Copper (Cu) contributed by Ashley Patterson

Chemical Formula: Cu

Atomic Number: 29 (Protons: 29, Electrons 29, Neutrons: 35)

Molecular Mass: 63.55 grams

Biochemical/Metabolic Functions

(contributed by Julie Conant)

  1. Energy Production: cytochrome c oxidase (-ase = enzyme) is used to produce ATP (think of this as your body’s fuel source) in the mitochondria
  2. Connective Tissue Formation: lysyl oxidase (another enzyme, folks) is used to link collagen and elastin. Ladies, especially, should know how important collagen and elastin is to keep our skin looking firm and youthful. Copper helps to keep the skin tone, in a sense. This enzyme may also help in preventing osteoporosis but much further research needs to be done.
  3. Iron Metabolism: ferroxidase I and ferroxidase II (remember Fe for Iron like you see on the supplement bottles as ferrous something or other?) is oxidized to ferrous iron which is transported to form red blood cells.
  4. Central Nervous System:
  • Neurotransmitter synthesis and metabolism: used to convert dopamine to norepinephrine. Monoamine oxidase (MAO) is used in metabolizing norepinephrine, epinephrine, and dopamine. MAO also degrades serotonin.
  • Formation and maintenance of myelin sheath: Remember cytochrome c oxidase we mentioned a minute ago? It’s used in the synthesis of myelin sheath (that’s the important insulating material that wraps around the axon so that electrical messages can be sent efficiently).
  1. Melanin Formation: required for melanin, a pigment that colors the hair, skin, and eyes. As the name of this post suggests, copper has tones and colors parts of the body.
  2. Antioxidant functions:
  • Superoxide dismutase: Ah, another important enzyme. SOD converts free radicals eventually to water to be excreted from the body.
  • Ceruloplasmin: binds with free copper ions (nomads that are hanging around causing oxidative damage). It also oxidizes ferrous iron to keep free ferrous iron ions from roaming around the body also causing free radical havoc. It also appears to help transport iron to bone marrow to make red blood cells.
  1. Regulation of gene expression: copper levels in the body may affect how proteins on specific genes are expressed. An important aspect of this ability is that it may affect proteins that regulate the storage of copper in cells.
  2. Nutrient interactions:
  • Iron:needs copper for efficient metabolism and red blood cell formation.
  • Zinc: may cause copper deficiency by binding and trapping copper in intestinal cells so they cannot be absorbed.
  • Fructose: animal studies may suggest that fructose can deplete copper in the body but human studies don’t seem to indicate the same result. In other words, a high fructose diet doesn’t appear to cause copper deficiency in humans or pigs (in rats, on the other hand, it might).
  • Vitamin C: some studies have shown that Vitamin C may decrease ceruloplasmin oxidase but they didn’t show any deficiency in copper itself, interestingly enough.

Dietary Reference Intakes

(contributed by Julie Conant)

Recommended Daily Allowance (ug/d) Upper Limit (ug/d)
Infants
0 – 6 months 200 No Data
7 – 12 months 220 No Data
Children
1 -3 years 340 1,000
4 – 8 years 440 3,000
Males
9 – 13 years 700 5,000
14 – 18 years 890 8,000
19 – 30 years 900 10,000
31- 50 years 900 10,000
50 – 70 years 900 10,000
>70 years 900 10,000
Females
9 – 13 years 700 5,000
14 – 18 years 890 8,000
19 – 30 years 900 10,000
31- 50 years 900 10,000
50 – 70 years 900 10,000
>70 years 900 10,000
Pregnancy
14 – 18 years 1,000 8,000
19 – 30 years 1,000 10,000
31 – 50 years 1,000 10,000
Lactation
14 – 18 years 1,300 8,000
19 – 30 years 1,300 10,000
31 – 50 years 1,300 10,000

Table adapted from information from: http://www.iom.edu/Global/News%20Announcements/~/media/48FAAA2FD9E74D95BBDA2236E7387B49.ashx

Dietary Sources

(contributed by Julie Conant)

Food Serving Copper (mcg)
Liver, kidneys, heart (beef), cooked 1 ounce 4,049
Oysters, cooked 1 medium oyster 670
Clams, cooked 3 ounces 585
Crab meat, cooked 3 ounces 624
Cashews 1 ounce 629
Sunflower seeds 1 ounce 519
Hazelnuts 1 ounce 496
Almonds 1 ounce 332
Peanut butter (chunky) 2 tablespoons 185
Lentils, cooked 1 cup 497
Mushrooms, raw 1 cup (sliced) 344
Shredded wheat cereal 2 biscuits 167
Chocolate (semisweet) 1 ounce 198
Hot cocoa mix 1 ounce (1 packet) 93

Table provided from: http://lpi.oregonstate.edu/infocenter/minerals/copper/

One Major Biochemical Reaction

(contributed by Ashley Patterson)

Antioxidant Functions of Copper

Cells are susceptible to a number of free radicals per day. Copper is a crucial antioxidant to prevent damage. Superoxide dismutase (SOD) is an enzyme that contains copper. There are three types of this enzyme including SOD1 (cytoplasm), SOD2 (mitochondria), and SOD3 (extracellular). This enzyme’s function is to extinguish superoxide, which is produced from daily metabolic activity, in all cells that are exposed to oxygen. Superoxide is converted to hydrogen peroxide which can then be reduced to water. The destruction of superoxide inhibits harm to blood vessels and the central nervous system. SOD may play a huge role in the treatment of inflammatory bowel disease by reducing inflammation.  Copper also plays a role as an antioxidant to ward off damage to DNA and premature aging. SOD is added to some cosmetic products to decrease damage to the skin from free radicals. Research indicates that injections of SOD may be effective in treating osteoarthritis, rheumatoid arthritis, and interstitial cystitis.

Diseases/Disorders caused by a Deficiency of Copper

  1. Toxicity-related Disorders (contributed by Ashley Patterson)

  • Wilson’s Disease is a genetic disorder in which the body cannot remove copper from the body causing it to build up mainly in the liver, brain, and kidneys. One sign of Wilson’s disease is a brown ring around the iris where copper pigments have deposited around the eye. The reason for over accumulation is the lack of the production by the liver of a key protein, ceruloplasmin, which transports copper through the body. Results of Wilson’s disease can be fatal if left untreated causing liver cirrhosis or neurological disorders. Treatment includes lifelong avoidance of foods high in copper as well as administering a copper chelating agent to remove it from the body through urinary excretion.
  • Miscellaneous information about higher levels of copper:

May cause cardiovascular abnormalities and/or damage and increase atherosclerosis and cardiovascular disease but further research needs to be done.

Excessive intakes through leaching of pipes or copper cookware may lead to abdominal pains, cramps, nausea, vomiting, diarrhea, and liver damage.

Copper toxicity when paired with a zinc deficiency may lead to head aches, joint pain, autism, schizophrenia, hypertension, fatigue, and hyperactivity but further research is required to prove these relationships.

  1. Deficiency-related Issues (contributed by Julie Conant)
  • Menkes disease: a genetic disorder which causes dangerously low levels of copper. Infants born with this disorder have low numbers of white blood cells (neutrophils) to fight off infections. When those with Menkes are given copper supplementation, their immune responses generally improve.
  • Miscellaneous information about copper deficiency:

Relatively rare

Might be caused by consuming too much zinc over a prolonged period of time

Impairs iron metabolism and may cause ‘copper-deficiency anemia’

Appears as anemia that doesn’t respond to iron therapy but does respond to copper therapy

May result from low levels of neutrophils, a type of white blood cell (this deficiency is known as neutropenia)

High-risk individuals for copper deficiencies include:

  • Low-birth weight infants and young children born with copper deficiency
  • Infants and children fed formula from only cow’s milk (which is low in copper)
  • Infants and adults with osteoporosis
  • Premature infants
  • Those who are malnourished for a variety of reasons:
  1. Long bouts of diarrhea
  2. Malabsorption syndromes: Celiac sprue, Crohn’s, Short Bowel Syndrome
  3. Those with heavily restricted diets or are receiving IV nutrition such as Total Parenteral Nutrition (TPN)
  4. Those with cystic fibrosis

(Contributed by Ashley Patterson and Julie Conant) Answers will be provided later in a new post after you have been given time to figure it out on your own!

  1. Copper is the _____ least abundant mineral in the body.
  2. Can zinc cause copper deficiency?
  3. How many forms of the enzyme Superoxide dismutase (SOD) are present in the body?
  4. Should infants who consume formula from only cow’s milk be concerned about copper toxicity or deficiency?
  5. What type of symptoms can the use of copper cookware produce?
  6. True or False: Hot cocoa, Shredded Wheat Cereal, and Peanut butter are sources of copper?
  7. What condition lead to excess build up of copper in the brain, kidneys, and the liver?
  8. Does copper help my skin get a lovely ‘copper’ tone?
  9. What is superoxide converted to before it is reduced to water?
  10. Does copper help to alleviate Depression?

Works Cited

Cowan, R, Gaw, A, Murphy, M, Shepherd, F, & Stewart, M. (2008). Clinical biochemistry. Philadelphia: Elsevier Health Sciences.

Institute of Medicine of the National Academies. (2001). Dietary Reference Intakes: Elements. Retrieved October 16, 2010, from Institute of Medicine of the National Academies:http://www.iom.edu/Global/News%20Announcements/~/media/48FAAA2FD9E74D95BBDA2236E7387B49.ashx

Libonati, C. (2010, July 28). Understanding copper deficiency in celiac disease. Retrieved fromhttp://glutenfreeworks.com/blog/2010/07/28/understanding-copper-deficiency-in-celiac-disease/

Mahan, L. K., & Escott-Stump, S. (2008). Krause’s Food & Nutrition Therapy. St. Louis, MO: SAUNDERS Elsevier.

Sutton, M. L., Vusirikala, M. M., & Chen, M. P. (191 – 199 2009). Hematogone Hyperplasica in Copper Deficiency. American Journal of Clinical Pathology, 191 – 199.

The Linus Pauling Institute Micronutrient Information Center. (2007, July). Linus Pauling Institute Micronutrient Research for Optimum Health: Copper. Retrieved October 15, 2010, from Oregon State University: http://lpi.oregonstate.edu/infocenter/minerals/copper/

Answers to the Quiz

  1. 3rd
  2. Zinc over long periods of time by cause copper deficiency by binding with the copper and not allowing it to be absorbed.
  3. 3: SOD1, SOD2, and SOD3
  4. Yes. Infants and children who consume formulas made only from cow’s milk are at a higher risk for copper deficiency because cow’s milk is low in copper.
  5. Abdominal pains, cramps, nausea, vomiting, diarrhea, and liver damage
  6. True! Please refer to the table above for sources of copper.
  7. Hydrogen Peroxide
  8. Well yes and no. Copper, maybe, but it really depends on your personal skin tone. Copper does help form melanin, a pigment that colors your skin, hair, and eyes.
  9. Answer
  10. Copper may because it is used to convert dopamine to norepinephrine. Monoamine oxidase (MAO) is used in metabolizing norepinephrine, epinephrine, and dopamine. MAO also degrades serotonin (remember hearing about MAO inhibitors when seeing commercials for antidepressants?).

Just for fun!Video Clip from HOUSE on Wilson’s Disease:



Feeding Your Toddler a Balanced Diet

As a first time mom, there has been many and will be many new adventures throughout motherhood and with every new challenge I learn what works best for both me and my child.  The new chapter that I’ve embarked on is feeding my toddler balanced healthy meals.  Being a dietetic student, I feel compelled to make certain that my son’s meals are nutritious.  It wouldn’t be the best choice just to feed him all the pre-packaged food that is supplied by many national brands, by simply allowing the brands to plan for me.  In moderation, most things are good but to depend solely on a national retail brand to supply my son his so-called balance diet is just not right in my eyes.  Consequently, I have challenged myself to feed my son freshly prepared nutritious meals.  And my husband doesn’t mind my strong ambitions towards this since he also gets to eat these home cooked meals.

My passion for cooking was just turned up another notch, as I have been inspired, so I began to research along with learning in my classes what a balance diet consists of.  Specifically, I searched the area of infants and toddlers.  My discussion will be supported by material that I have found searching various registered dietitians’ articles.

The question is what you should feed your toddler (12-23 month), what guidelines should be used when planning and preparing a meal.  Below is an example, supplied by Brenda Davis, R.D. and Vesanto Melina, M.S., R.D., of the recommended, if you will,  “food guide” for early toddlers specifically on a vegetarian based diet.

Calcium

Calcium-Rich Foods
20-24 oz. (600-720 ml) of breast milk, commercial soy formula, or full-fat fortified soymilk(or a combination)
This will allow for three 6-8 oz. (180 – 240 ml) servings of milk.

Breads and Cereals

Cereals
4-6 oz. iron-fortified infant cereal (can be mixed with porridge, cold cereals, pancakes, muffins, etc.)
PLUS
1-2 toddler-size servings of other breads and cereals per day:
½ slice of bread
1/4 cup (60 ml) rice, quinoa, enriched pasta, or other cooked grain
½ cup (120 ml) cold cereal

Vegetables
2-3 toddler-size servings per day:
½ cup (120 ml) salad or other raw vegetable pieces
¼ cup (60 ml) cooked vegetables
1/3 cup (80 ml) vegetable juice

Fruits
2-3 toddler-size servings per day:
½-1 fresh fruit
¼ cup (60 ml) cooked fruit
¼ cup (60 ml) fruit juice

Beans and Bean Alternates
2 toddler-size servings per day:
¼ cup (60 ml) cooked legumes
2 oz. (55 g) tofu
½ – 1 oz. (14-28 g) veggie “meat”
(i.e. 1 deli slice; 2 Tbsp. veggie ground round
1½ Tbsp. nut or seed butter

Vitamin B12Vitamin B12
Aim for 1 mcg B12 in fortified foods

Vitamin D
Get sufficient sunlight, or at least 5 mcg vitamin D from fortified foods or supplements

Essential Fatty Acids
Aim for 1.1 g of omega-3 fatty acids/day

For conversion’s sake, as most aren’t mathematicians, 1 mcg = 0.001 mg. As you see it’s a small amount but essential to the dietary needs of any toddler.  Most of these like the B12 and Vitamin D can be supplemented in a vitamin form or as mentioned fortified in foods.

One thing I would like to add about the calcium intake is that almond milk is also a great substitute to soy milk, as my toddler didn’t take well to soy milk.  The almond like soy has been fortified with the calcium in most cases store-bought almond milk has 45% of the DV (daily value) in one serving 240 ml.  Almond milk does have 30% of your daily calcium naturally so only a small portion is fortified as with soy milk it has 80 mg of calcium from one serving of soy milk not making it a rich source of calcium it its natural state.

The challenges to getting your toddler to eat healthy may not be easy but persistence will conquer all. Yes most time children will frown upon green vegetables, but what worked in my case is adding flavor.  I have found that adding flavor to any green or what would be considered a bland vegetables to your child creates interests to their tiny little taste buds. Mild spices like cumin or lightly seasoned with garlic may improve the chances a toddler eating vegetables. In a future post, I will become more detailed in the area of menus and possible recipes,offering what worked for our family and pass it along in hopes that it helps with whatever situation anyone have going on.

Other great tips are:

* Offer your toddler three meals and two snacks a day

* Allow your toddler to respond to their own internal cues for hunger and fullness.

* Don’t push food on a child who’s not hungry

* Don’t allow your toddler to eat on demand all day long, overeating is not acceptable

* Keep a regular schedule of meals/snacks, a routine will be made and good eating habits are developed

In addition to the vegetarian version there is also a more basic toddler food guide which includes meat sources. Here are the links:

http://www.mypyramid.gov/downloads/PreschoolerMiniPoster.pdf or http://www.pediatricsoffranklin.com/12_18montholds.aspx both are credible websites.

Thanks,

Until next time……Happy eating

Elexius B. Skerrit

Bibliography:

http://www.buzzle.com/articles

http://www.keepkidshealthy.com

http://www.nutrispeak.com/

Foods to ADD or subtract?

I’m talking about ADD and ADHD, of course. This is a controversial ‘disorder’ and I will be upfront and say that I am not here to discuss the controversy. I am simply here to provide information related to the symptoms of this disorder while remaining professional, using current research information, and remaining within the scope of nutrition. I am not here to discusses that are out of my scope of knowledge but accept that people will still have questions about a disease or the medications for a particular condition. Remaining within the focus of nutrition, I want to provide answers, topics to think about or ask your healthcare provider, or tools to make you a more informed health consumer.

Attention-deficit disorder (ADD) is a mental condition with the following characteristics: distractability, forgetfulness, the appearance of not listening, and not finishing tasks. It can have a hyperactive component, such as in ADHD, with characteristics of impulsivity, fidgeting, squirming, inability to remain seated, excessive movement such as running, restlessness, impatience, and excessive talking (Escott-Stump, 2008).

If you or your child has been diagnosed with ADD or ADHD, you may have some questions regarding treatment options. While medications or therapy are options that many choose, diet may also play a role in treating ADD/ADHD. Even if you don’t choose diet as the primary approach, it can still play a large role due to side effects of many medications used to treat this disorder.

Why does diet play a large role when it comes to these types of medications? Some medications used to treat ADHD can decrease calcium absorption. Various medications can increase or decrease various nutrient levels in the body. Those who take medications for ADHD should avoid caffeine and St. John’s Wort. These medications may cause weight loss and even anorexia (Pronsky & Crowe, 2010). To avoid the weight loss or anorexia, which can be especially profound in children, many take ‘drug holidays’ in which the medication is not taken on weekends or days when the child does not have to attend school or the adult does not have to work. Another way to help combat the weight loss is to consume a calorie-dense breakfast before consuming the medication.

On a side note, I recently watched an episode of Dr. G: Medical Examiner which was tragic and reminds us of the importance of checking our drug information and double checking with pharmacists. One prescription used to treat ADHD, Methylphenidate, resided next to another drug beginning with Meth- and even looked the same in appearance. The child was given the incorrect prescription and died- while this is probably a rare occurrence, it doesn’t hurt to double check on your prescriptions.

According to Alan C. Logan, a drop in blood glucose (blood sugar) may appear as ADHD. He also states that both adults and children with ADHD are under increased oxidative stress and could benefit from an antioxidant-rich diet. He also states that fatty acids, especially omega-3 fatty acids from fish oil and GLA from borage and evening primrose, have shown to assist in behavior and learning. Lastly, he states that artificial ingredients, primarily food dyes, and preservatives, particularly sodium benzoate, are linked to children with hyperactivity (Logan, 2008).

This provides another reason to consider purchasing organic when possible. Here is a link to the top and lowest scoring produce regarding pesticide content. A quick way to spot if your produce is organic, also, is by the first digit on the sticker: 9 = organic.

Alternatively, an article in the Journal of Family Practice claims that dietary changes do not appear to improve symptoms of ADHD and that “studies investigating the link between diet and ADHD is limited by small sample sizes, subjective outcome measures, and non-standardized intervention protocols” (Ballard, Hall, & Kauffman, 2010).

According to the Harvard Mental Health Letter, “the jury is still out” (Harvard Health Publications, 2009). And when the information doesn’t add up the same each time, I am inclined to agree. With all of that said, diet can still be an inexpensive way to alleviate symptoms of the disorder itself or side effects of medications. Some health practitioners may recommend an ‘elimination diet’. That type of diet may sound scary but don’t worry! Eliminating just a certain type of food every week or so instead of all of them at once is less stressful. With elimination diets, it’s important to refrain from the food type in question for at least 7 days and to re-introduce it into the diet slowly and watch for any reactions.

If you’re a frugal person, like most of us are, especially in this economy, purchasing organic food doesn’t have to wreck your budget either. Using the list provided above, you can just avoid the top fruits and vegetables with pesticides instead of purchasing 100% organic. Consider purchasing in-season and from local farmers who use organic or minimal pesticide use- cutting out the middle man may potentially save on costs, you support local economy, and learn where your food is coming from. Another tip: scrub (don’t just rinse or gently wash) your produce from the store with dish soap- it’s an inexpensive way to clean your produce instead of purchasing more expensive products that promise to do the same thing.

In health,

Julie Wallace

UG Dietetics Student, SI Tutor for Core Nutrition Courses at Life University, and a student member of the American Dietetic Association.

*The information provided herein is provided by classroom knowledge and the sources cited. It is not intended to be medical advice. You should consult your health practitioner who understands your personal and unique health status before trying any advice, products, etc.

Works Cited

Ballard, W., Hall, M. N., & Kauffman, L. (2010). Q/ Do dietary interventions improve ADHD symptoms in children? Journal of Family Practice , 234-235.

Escott-Stump, S. (2008). Attention-deficit Disorders. In S. Escott-Stump, Nutrition & Diagnosis-related Care (pp. 141-142; 207). Baltimore, MD: Lippincott Williams & Wilkins, a Wolters Kluwer business.

Harvard Health Publications. (2009). Diet and attention deficit hyperactivity disorder. Harvard Mental Health Letter , 4-5.

Logan, A. C. (2008). Does Diet Affect ADHD? : Strong Evidence Suggests It Does. Alive: Canadian Journal of Health & Nutrition , 87-88.

Pronsky, Z. M., & Crowe, S. J. (2010). FOOD-MEDICATION INTERACTIONS 16th ed. Birchrunville, PA: FOOD-MEDICATION INTERACTIONS.

Proton pump inhibitors (PPI) which decrease acid production in the stomach are the main type of medications prescribed for treatment of GERD. Research suggests that use of this type of medicine may reduce the absorption of certain minerals and vitamins. In a study conducted in the United Kingdom, 44% of patients using PPIs had an increased risk of hip fractures because of calcium malabsorption. Calcium is inadequately absorbed in the body due to decreased acid in the stomach, which is termed achlorhydria. There is a strong correlation with the incidence of hip fractures related to the amount of dosage and strength of the dosage of the PPI. The longer and higher the dose of PPI taken by the patient with GERD, the more their risk for hip fractures increases. Vitamin B12 is also affected by taking PPI medication. It may also not be absorbed properly when under the care of acid suppressing medicine. Long-term use of PPI medication decreases the levels of Vitamin B12, a protein bound vitamin, absorbed by the body. Gastric Acid is needed for the intrinsic factor to be present and absorb the extrinsic factor (Vitamin B12); therefore, low levels of gastric acid greatly impair the absorption of Vitamin B12.

GERD is a condition that may have more serious complications if left untreated. It can increases the risk of Barrett’s esophagus and esophageal or stomach cancers in patients, particularly when it is left uncared for. The esophageal lining is damaged by the repetitive contact of acid that escapes from the stomach which can cause ulcers and bleeding. Narrowing also occurs due to scar tissue build up.  Irregular restoration of the esophagus from damages made by acid leads to a condition termed as Barrett’s esophagus. The condition is characterized by an abnormal shape and color from new adaptive cells that could lead to cancer. Research indicates adenocarcinoma of the esophagus and gastric cardia are the fastest rising cancers within the US. GERD can also lead to the decay of teeth through the regurgitation of acid into the throat and mouth. Asthma can develop due to lung damage caused by breathing in acid into the lungs.

Some research suggests that the reason for increased gastric acid secretion back into the esophagus is because of low stomach acid instead of high stomach acid along with a weak esophageal sphincter (muscle that opens with swallowing to allow food to pass to the stomach). Digestion cannot take place properly without enough acid; therefore, food and acid regurgitate into the esophagus. The research is still underway but is showing increasing evidence because of the fact that stomach acid decreases with age. If the research is found to be true then acid reducing medications may be making symptoms worse.

With seeing the risks of taking and not taking the medications prescribed for GERD, patients are left in quite a predicament. Should they not take a medicine that blocks their absorption of certain nutrients and may worsen their condition or should they take it to ward off the incidence of cancer? With research the hope is that answers will soon be available. For now tips are available to help fight GERD with or without medication:

  • Eat smaller meals and snacks instead of 2 or 3 large meals to alleviate pressure
  • Chew gum after meals
  • Avoid refined flours, sugar, and trans fats
  • Avoid overly spiced foods
  • Keep a food journal to track symptoms
  • Do not lie down for 2 to 3 hours after a meal
  • Elevate the head of the bed with blocks about 2 or 3 inches
  • Do not use extra pillows as this bends the esophagus creating more pressure
  • Quit Smoking if you smoke
  • Avoid tight fitting clothing
  • Lose weight if overweight
  • Remove stress from your
  • An alternative medicine approach is to drink 2 tsp of apple cider vinegar to aid in digestion

Bibliography:

1)      Acid stomach or not enough stomach acid?. (2006, September 1). Retrieved from http://www.prohealth.com/library/showarticle.cfm?libid=12108

2)      Ahnen D, Laine L, McClain C, Solcias E, Walsh J, (2000).Review Artical: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther. 14, 651-668.

3)      Buttner P, Daniell K, Harrison S, Nowak M, Raasch B, Speare R, (2006).Effectiveness of lifestyle measures in the treatment of gastroesophageal reflux disease- a case series. Therapeutics and Clinical Risk Management. 2(3), 329-334.

4)      Epstein S, Lewis J, Metz D, Yang Y, (2006).Long-term Proton Pump Inhibitor Therepy and Risk of Hip Fracture. Journal of the American Medical Association (JAMA). 296(24), 2947-2953.

5)      Fight Heartburn First with Lifestyle and Diet Changes, (2007). Tufts University Health & Nutrition Letter. 25(1), 4-5.

6)      Galmiche J, Letessier E, Scarpignato C, (1998).Fortnightly review: Treatment of gastroesophageal reflux disease in adults. British Medical Journal. 316(7146), 1720-1723.

7)      Gastroesophageal reflux: More than just heartburn (2004). Harvard Women’s Health Watch. 12(3), 4-6.

8)      Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD), (2007). Retrieved May 19, 2009, from National Digestive Diseases Information Clearinghouse Web site: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm

9)      Heartburn: What you eat does make a difference. Retrieved May 19, 2009, from American Dietetic Association Web site: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_4527_ENU_HTML.htm

10)  Lowery, L. (2010, September 20). Digestive disorders linked to low healthy stomach acid. Retrieved from http://www.betterhealthresearch.com/health-articles/digestive-disorders-linked-to-low-healthy-stomach-acid/

11)  Wassef, F (2004).Ask Our Experts. Alive: Canadian Journal of Health & Nutrition. 266, 22-23.

12)  Welbery, C (2007).Proton Pump Inhibitor Association with Hip Fractures. American Family Physician. 76(3), 432-433.

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