Woman's WorldVolume 17, No. 3, Summer 2009
Woman's WorldBy Jean Talbert, M.D.
Pregnant women are often advised to avoid certain foods to protect the health of their babies. As a result, these diets can become so restrictive that they no longer have adequate nutrition themselves. And good nutrition before and during pregnancy is a crucial component of a healthy pregnancy.
A well-balanced diet with appropriate weight gain can also decrease the risk of many pregnancy complications. What should pregnant women be eating or avoiding? Studies on pregnant women are limited but the risks and benefits of several nutrients are fairly well understood.
Folic acid, one of the B vitamins, is recognized as an essential nutrient pre-conception and during pregnancy. The risk of neural tube defects, such as spina bifida, is significantly reduced with adequate folic acid supplementation prior to conception and through the first trimester. Many cereals and breads are now fortified with folic acid, but it can also be found naturally in green leafy vegetables, citrus fruit, whole grains and beans. The current recommended intake for average risk women is 400 mcg per day, which is contained in most over-the-counter vitamins and all prenatal vitamins.
Calcium is important for bone health of both the mother and the fetus. Good calcium intakes have also been associated with higher birth weights and lower risk of preterm delivery. A calcium intake of 1000-1300 mg per day is currently recommended and supplements are advised if necessary.
Iron deficiency is not uncommon during pregnancy. A mild iron deficiency prior to pregnancy only becomes worse as the fetus depletes the mother’s iron stores. The CDC recommends 27 mg of iron per day for all pregnant women. This can be obtained through diet or vitamin supplements. Foods rich in iron include meat, dark green leafy vegetables, dried fruit, beans, nuts and blackstrap molasses. Iron absorption is improved if consumed with foods rich in vitamin C. Higher doses of iron are often advised during the third trimester.
Omega 3 fatty acids, the three types of which are EPA, DHA and ALA. Recent studies suggest that all three are important for the normal development of the fetal eyes and brain. They may also lower the risk of pre-eclampsia, preterm labor and post-partum depression. Many experts recommend approximately 300 mg per day of these omega 3 fatty acids. EPA and DHA are found primarily in oily fish. ALA is found in vegetable oils, seeds, leafy green vegetables, soy, walnuts or fortified foods such as eggs and orange juice. Some prenatal vitamins are now packaged with an additional capsule of flax seed or fish oil. Although shark, swordfish, king mackerel and tile fish are good dietary sources of omega 3 fatty acids, they should be avoided during pregnancy due to possible mercury contamination. Fish oil supplements derived from fish liver should also be avoided due to possible high vitamin A levels.
Vitamin A in excess levels has been associated with miscarriage and birth defects of the central nervous system, heart or face. Intake should not exceed 10,000 units per day. Vitamin A supplements in the form of beta-carotene or from foods such as leafy green vegetables, carrots, eggs, dairy products do not present any risk.
Fish may be a good source of omega 3 fatty acids, but excess consumption can introduce other risks, including high levels of mercury and should be completely avoided during pregnancy since mercury may cause central nervous system damage in fetuses. Otherwise, fish is a healthy food and pregnant women are advised to eat up to 12 oz of seafood such as salmon, pollack, catfish or shellfish per week or up to 6 oz of tuna per week. Canned light tuna is safer than albacore tuna or tuna steaks. The safety of local fresh water fish varies tremendously. Information can be obtained from the Environmental Protection Agency (www.epa.gov/waterscience/fish/states.htm or 1-888-SAFEFOOD). In addition, pregnant women should eat only cooked fish or frozen sushi grade raw fish to avoid infections with parasites or bacteria.
Peanut allergies have recently become more prevalent. But studies to date have shown no benefit of avoidance diets in the prevention of childhood allergies as some have claimed.
Artificial sweeteners have not been seen to increase the risk of birth defects. Nonetheless, pregnant women would probably benefit from natural food choices.
Foodborne infections present a particular risk to the fetus. For safety, follow these precautions:
Women of reproductive age should all be counseled regarding a healthy diet prior to conception. Visit www.mypyramid.gov to create an individualized diet plan for before and during pregnancy.
(Dr. Talbert is a board certified OB/GYN specialist practicing with Cape Obstetrics, Midwifery & Gynecology in Falmouth and Sandwich, 508-457-0088.)
Menu Calorie Counts End Guesswork,
But That’s Just The First StepBy Debra Gibbons, R.D.
Years ago nutrition labeling for calories, fats, cholesterol, fiber and vitamins was mandated on packaged foods. Then trans fats were added to the nutrition label because, along with saturated fat and cholesterol, they may increase the “bad” cholesterol.
Some restaurants already are offering limited nutrition facts for some menu items and now the larger restaurant chains are under the gun to provide more complete information on all items.
Now legislation has been proposed on both the state and federal level (See Representative Cleon Turner’s article on Page __.) requiring restaurant chains to prominently display the calories of all their menu selections on the menu or a menu board. Along with prices, you will see specific calorie contents as you order.
The more frequently you dine out the more useful this information will be.
To assess the calories of a meal accurately, however, you must know your daily calorie requirements.
How many calories do you need a day to maintain your weight? If you have no concept of those needs you can’t make choices based on calorie content. There is a simplified way to approximate your daily requirements:
Multiply your weight by 10 calories if you are obese or inactive or a chronic dieter; by 13 calories for persons over 55, active women and sedentary men; 15 calories for active men and very active women; and 20 calories for very active men.
(Example: a 180-pound obese woman needs 1800 calories daily to maintain that weight; cutting back 500 calories a day would facilitate a 1-pound per week weight loss.)
Fish and salads usually seem like healthy choices but a Caesar salad with grilled shrimp provides 980 calories. A tuna salad sandwich on honey wheat bread sounds like a good idea, but it contains 720 calories. It is not surprising that a big fish sandwich has 640 calories. Add a small order of French fries for a total of 870 and for some people that is about half of their calorie needs for the entire day in only two foods. A nice appetizer of Aussie Cheese fries starts your meal with a whopping 2900 calories. (Sharing with three other people still comes to 725 calories apiece.)
On the positive side, you often can modify your choices to fit your own needs. Example: Venetian Apricot chicken for lunch has only 280 calories compared to the Lasagna Classico at 860.
Adding up the calories will help you decide what is best for you since descriptions can be misleading. And what may be a good choice at one restaurant may not be at another.
Knowing the calorie content of menu selections may persuade you to take a second look at what you’re ordering. And then you can truly sit back and just enjoy.
(Ms. Gibbons, a Registered Dietician and Certified Diabetes Educator, provides outpatient nutrition medical therapy at Cape Cod Hospital.)
By Denise M. Dever
Those over the age of 60 are more likely to ignore those “use by” dates—and risk more from this practice—than younger people, according to new research by the Food Standards Agency. That’s because eating food beyond its “use by” date increases the risk of food poisoning from the listeria food bug, which can be life-threatening for this age group.
Food poisoning is a very real concern at any age. There are more than 250 known food-borne diseases, according to the U.S. Centers for Disease Control and Prevention. And each year, these diseases kill more than 5,000 people and make about 76 million people sick, sending 325,000 to the hospital. Fortunately, most cases of food sickness are mild and last only a day or two.
According to the agency, the number of cases of people taken ill with listeria rose 20 percent in 2007 and has more than doubled since 2000, with the increase occurring predominantly among people over 60.
Research shows that less than half of this age group recognizes “use by” dates as an important indicator of whether food is safe.
Bacteria cause most cases of food-related illness such as E. coli infection, salmonella, and botulism. The refrigerator can be a breeding ground for some of these, so proper storage of food is as important as adherance to “use by” dates in keeping healthy.
(Ms. Dever is President and Co-Owner of Home Instead Senior Care providing non-medical home care for seniors, 508-778-8613 or www.homeinstead.com.)
By Representative Cleon H. Turner
In an age of unprecedented obesity rates, rising healthcare costs, and a new trend of health conscious consumers, one is hard pressed to find anyone not in the restaurant business opposed to menu labeling.
According to the Massachusetts Health Policy Forum, in 2005 more than 56 percent of Massachusetts adults were overweight, a 40 percent increase from rates reported in 1990. Overall, nearly 21 percent of Massachusetts adults are obese.
Being overweight and obese is associated with significant social and economic costs and consequences primarily because of their effect on health and healthcare costs. The causes of obesity are complex: people are eating out more; portion sizes are larger; high calorie/high fat foods are widely available and less expensive; unhealthy foods and beverages are aggressively marketed; generally people exercise less; and nutritional education is largely ineffective.
House Bill 3715, An Act Relative to Menu Labeling in Restaurants is an effort to require restaurants to label their menus with specific nutrition information. The bill calls for the advertisement of calorie information of food items prior to their sale, be it in a brochure, a table tent, a label next to a menu item, or a separate caloric index. If a menu item is intended for more than one individual, the menu must indicate the number of diners to be served and the calorie content for each person served. Minimum and maximum calorie counts must be listed if the dish is a combination of two other items.
Nutritional and calorie content information will be required once per menu item if portion size, recipe amounts and preparation techniques are consistent. Menus and menu boards may include a disclaimer that indicates that variations may occur in nutritional contents across servings.
Beginning July 1, 2010, food facilities would have to provide complete nutritional information at the point of sale until calories are posted either on menus or menu boards. If passed, this legislation would require nutrition information to be posted on interior menu boards and menus by January 1, 2012.
This bill would apply to chains and franchises with nine or more locations and creates one statewide standard: as the law stands now, municipalities can each establish their own labeling laws.
Meanwhile, a federal menu labeling bill called the Labeling Education and Nutrition Act (LEAN Act) has been introduced that would require chains with more than 20 units to post calorie counts for all menu items.
The language in the LEAN Act is almost identical to that in House Bill 3715 and its effects will be quite similar on a nationwide scale. The problems presented by poor nutrition and obesity are in no way unique to Massachusetts. These are problems on a national scale and require a national solution.
(Representative Turner, D-Dennis, is a member of the Legislature’s Joint Public Health Committee.)