Nausea and Vomiting during Pregnancy... Why?

Congratulations to my friend Nadine who is expecting her first baby- she's so excited and I'm very happy for her!

According to Dr. Atul Gawande, in his book ‘Complications: A surgeon’s notes on an imperfect science’, 60-85% of pregnant women experience pregnancy sickness. 5 out of every 1000 women will experience such severe nausea and vomiting to actually lose weight.

You’d think that throwing up while pregnant is evolutionary counterproductive since a growing embryo needs nourishment but Gawande presents the work of evolutionary biologist Margie Profet who claims it’s actually a good thing. She points out that many foods have natural toxins that are safe for healthy humans since we've developed elaborate detoxifying systems. However, embryos don’t have these systems in place. According to Profet, pregnancy sickness is a way to minimize the embryo’s exposure to toxins since women sufferers tend to prefer bland foods that don’t easily spoil and they stay away from foods high in natural toxins, like certain bitter foods and animal products that aren’t fresh.

The embryo is most sensitive to toxins in the early stages of development when it’s developing its organs, explaining why pregnancy sickness occurs mostly during the first trimester. At this stage, the embryo is small and its caloric needs are easily met by the mom’s fat stores.

Although obviously very uncomfortable for the mother, the good news is that women with moderate to severe pregnancy sickness have lower rates of miscarriages than women with mild nausea or none at all.

20% of women will experience nausea and vomiting after the first trimester, some may even suffer for the whole length of their pregnancy. In these severe cases, the risk of dehydration and electrolyte imbalance is very real and these women will require IV fluids and careful monitoring.

Some studies have shown that ginger might be an effective natural treatment for nausea and vomiting. Other possibly helpful tips include eating smaller meals more frequently, avoiding drinking fluids with meals, avoiding spicy foods and fried foods, cooking in the microwave to produce less odours, eating plain crackers or dry cereal before getting out of bed in the morning. Medication is sometimes prescribed as well.
It's often recommended that you take your prenatal supplement later in the day if you suffer from morning sickness.

Formula Kills Babies

I’m sure you've heard this story already but two babies are dead and 1253 more are sick (340 are still hospitalized) in China as a result of contaminated baby formula that was found to contain melamine, the same chemical that killed cats and dogs when it was found in pet food last year. Melamine is a chemical additive commonly used to make plastics and fertilizer. It’s high in nitrogen and when products are tested for protein, they actually just test for nitrogen. As such, this cheap additive has been used to make it appear like a product is high in protein. Melamine and one of its by-products block kidney function and, as a result, the poor babies have been suffering from kidney stones.

The contaminated milk powder has been traced to a major Chinese dairy, Sanlu Group Co. The group recalled its products last week although the Chinese media reported that some parents were complaining of problems since March. So far, over 10 000 tons of milk powder has been seized or recalled. Yesterday, Chinese authorities announced that they’ve arrested two men suspected to be responsible for the contamination.

Although Canada and the States don’t import formula from China, it’s possible that it has found its way here illegally. As a result, The Food and Drug Administration, Health Canada and the Canadian Food Inspection Agency have warned consumers to avoid baby formula from China- read the label!

Remember, if possible, breastfeeding is best....

The Omnivore's Dilemma

The Omnivore’s Dilemma: A Natural History of Four Meals by Michael Pollan is one of my most recent reads and it’s an eye-opening book. Pollan is a journalist and in this book, investigates the origins of 4 different meals, through their various foods chains.

There’s the industrial meal- Pollan follows corn from a field in Iowa and a steer from a Concentrated Animal Feeding Operation (CAFO) to his McDonald’s meal eaten in his car.
The ‘Big Organic’ meal- the author follows ‘Rosie’ the chicken from an organic industrial farm to Whole Foods and asks “could a factory farm be considered organic?” along the way. He also eats organic asparagus grown in Argentina and examines the ethical and environmental implications of doing so.
His third meal is grown locally through sustainable agriculture on a ‘beyond organic’ farm and is a real education not only on the value of eating locally, of “opting out of a globalized industrial agriculture” and of how our food choices profoundly impact our environment, but on the symbiotic relationship between man, animal and the land.
The last meal is one the author forages himself- hunting and gathering all the ingredients and includes an enlightening discourse on the ethics of eating meat.

Reading this book has been the catalyst for me to change the way I eat and, as such, has been life-changing. I recommend you read it and guarantee that it will revolutionize the way you think about the food you eat.

If you don’t have time to read the book, Pollan gave a great talk at UC Davis in 2006 that covers all the main points of The Omnivore’s Dilemma. It’s about an hour, but worth it.

Slow Food

The Slow Food movement started in Italy in 1989 as a protest against the opening of a McDonald’s in Rome. The movement’s founder, Carlo Petrini, sought to fight industrial ‘fast food’ eating and remind consumers not only of the joys of eating, but of where their food comes from. Slow Food, now an international association with over 85 000 members in 132 countries, proposes responsibility on the part of the consumer- something they’ve termed ‘ecogastronomy’.

The movement is committed to safeguarding local and traditional foods and methods of preparation, to educating about the risks of fast food, factory farming, agribusiness and monoculture, to promoting ‘taste education’, to lobbying against use of pesticides, to teaching students and prisoners gardening skills, to developing political programs to preserve family farms and to encouraging ethical buying practices in the marketplace.

Just recently, Slow Food USA hosted the inaugural Slow Food Nation in San Francisco. Founded by Alice Water, one of the most influential American chefs and one of the earliest champions of the organic and local food movements, it was the largest celebration of American Food in history, with about 60 000 people in attendance.

Does High Fructose Corn Syrup make us fat?

Have you seen the new commercials put out by the Corn Refiners Association? They’re meant to convince us that the much talked about High Fructose Corn Syrup (HFCS) is no worse for us than table sugar or honey. For a while now, HFCS has been targeted as the cause of the obesity epidemic. That’s because the rise of obesity parallels the increased use of HFCS by food manufacturers, both of which started in the 1980s. By 1984, Coca-Cola had completely replaced sugar with HFCS. Corn sweeteners are made from corn, and corn is a subsidized crop and is therefore cheaper than sugar to use, explaining the huge increase in its use. In 2005, about 77 lbs of corn sweeteners were produced per capita in the US, compared to 35lbs in 1980.

Does HFCS make us fat?

According to most experts, including the Centre for Science in the Public Interest, and probably to the delight of the Corn Refiners Association, HFCS itself is not responsible for making people fat. Although far from natural, as the Corn people would like you to think, HFCS does start out as simple cornstarch- basically made up of chains of glucose molecules. Enzymes from cultured molds are then added to the cornstarch to break down the long glucose chains. To increase the sweetness, enzymes from various species of a bacteria are added to convert some of that glucose to fructose. HFCS is usually either 45% or 55% fructose. Table sugar, or sucrose, also contains glucose and fructose, in equal proportions. As such, it can be deducted that the physiological impact of both these sweeteners are similar.

However, a recent study published in the July issue of the Journal of Nutrition found that study participants given a drink containing more fructose than glucose (50% each and 75% fructose/25% glucose) converted sugar into body fat at a significantly higher rate than those given a drink of just glucose. These findings are interesting but it would be misleading to use these results to imply that fructose is responsible for increasing body fat. First of all, the study only had 6 young and healthy subjects. More importantly, however, we’ve known that we metabolize fructose somewhat differently than glucose but, even the lead researcher of this most recent study has said, we also know that fructose is not responsible for weight gain and dieters should not eliminate fruit, which have a high fructose concentration, from their diet. Excess caloric consumption results in weight gain. Incidentally, Americans are consuming an additional 200 calories per day compared to what they were eating 30 years ago.

Want to lose weight? Reduce caloric intake and that involves reducing all sugar intake- including HFCS.

Sources:

“Limiting Fructose May Boost Weight Loss, Researcher Reports”. http://www.sciencedaily.com/releases/2008/07/080724064824.htm

“Food Additives”. http://www.cspinet.org/reports/chemcuisine.htm

“Corn Refiners Ad Campaign Called Deceptive”. http://www.cspinet.org/new/200806231.html

Pollan M. The Omnivore’s Dilemma: A Natural History of Four Meals. Penguin Books 2006.

Willett W. Eat, Drink, and Be Healthy. Free Press 2001.

Nestle M. What to Eat. North Point Press 2006.

Schwarcz J. That's the Way the Cookie Crumbles. ECW Press 2002.

Meat Eating and Global Warming- Food for Thought.

The BBC reported today that Rajendra Pachauri, chairman of the UN Intergovernmental Panel on Climate Change (IPCC) is set to speak tomorrow evening in London about the environmental impact of meat eating. The UN Food and Agriculture Organization estimates that direct greenhouse gas emissions from meat production account for about 18% of the world’s total emission. As such, meat production puts more greenhouse gases into the atmosphere than transport (which accounts for 13% of the world’s greenhouse emissions).

The figure represents the emissions released from all part of the meat production cycle: clearing of forested land, making fertilizer, transport and use of farm vehicles and methane emissions from the cattle and sheep.

Dr. Pachauri stated “...I want to highlight the fact that among options for mitigating climate change, changing diets is something one should consider.”

According to The Consumer’s Guide to Effective Environmental Choices, about 800 million acres, or 40% of US land area, is used for raising livestock. 60 million acres of land is additionally used to grow grain to feed the livestock. This land use evidently reduces the land available to support natural wildlife. In fact, household meat consumption alone is responsible for about a quarter of threats to natural ecosystems and wildlife.

A typical cow raised for slaughter will convert 32 lbs of grain into 4 lbs of weight. That’s a lot of grain, considering a typical steer weighs 1100lbs at the time of slaughter. In fact, 60% of the corn that’s grown in the US goes to feeding livestock. This grain requires a lot of synthetic fertilizer- over 100lbs per acre. Some of this fertilizer (ammonium nitrate) evaporates into the air where it’s transformed into nitrous oxide, an important greenhouse gas. A lot of it runs off into our waterways, potentially harming our health and poisoning the marine ecosystem. Nitrogen stimulates algae growth creating a hypoxic ‘zone’ that is as big as New Jersey in some areas, killing all the wildlife.

According to Michael Pollan, author of The Omnivore’s Dilemma, petroleum is the most important ingredient in the production of modern meat. The food chain responsible for raising the meat that ends up on your plate is fossil fuel driven. According to Pollan, a typical steer will have consumed the equivalent of 35 gallons of oil in his lifetime. Bon Appétit!

Other environmental impacts of meat consumption include a drain on water resources- 18% of total drinkable water use is attributable to livestock raising. Animal waste is a huge problem- about 2 billion tons of manure is produced a year. Not only is this manure responsible for emitting an estimated 150 trillion quarts of methane gas into the air yearly (methane being the second most significant contributor to the greenhouse effect behind carbon dioxide), but it’s also responsible for about 16% of common water quality problems and its runoff into our waterways is a serious threat to that ecosystem.

Dr. Pachauri recommend that meat eaters aim to give up meat for at least one day a week, and continue decreasing from there, to minimize their carbon footprint. Moreover, a 2003 Swedish study found that organic beef, raised on grass rather than grain, emits 40 per cent less greenhouse gases and consumes 85 per cent less energy. Moreover, choosing locally raised beef reduces the amount of transport involved. These represent better environmental choices. Researchers are doing their part by genetically engineering strains of cattle that will produce less methane gas.

Sources:

“Shun Meats, says UN climate chief”. http://news.bbc.co.uk/2/hi/science/nature/7600005.stm

“Meat is Murder on the Environment”. http://environment.newscientist.com/article/mg19526134.500-meat-is-murder-on-the-environment.html

“Eat Less Red Meat to Help the Environment, UN Climate Experts Says.” http://www.telegraph.co.uk/news/uknews/2699173/Eat-less-red-meat-to-help-the-environment-UN-climate-expert-says.html

Brower M, Leon W. The Consumer’s Guide to Effective Environmental Choices: Practical advice from the union of concerned scientists”. NY: Three Rivers Press. 1999. http://www.amazon.com/Consumers-Guide-Effective-Environmental-Choices/dp/060980281X

Pollan Michael. The Omnivore’s Dilemma: A natural history of four meals. Penguin Books. 2006. http://www.michaelpollan.com/omnivore.php

http://images.google.ca/imgres?imgurl=http://www.motherjones.com/blue_marble_blog/ee_foodmiles.jpg&imgrefurl=http://www.motherjones.com/blue_marble_blog/archives/2008/04/8023_food_miles_your.html&h=440&w=250&sz=22&hl=en&start=43&um=1&usg=__5ygtn6-ScJTQQwKNdfasaZkpZjc=&tbnid=pQPDopuKh2Z7TM:&tbnh=127&tbnw=72&prev=/images%3Fq%3Dgreenhouse%2Bgas%2Bfood%26start%3D40%26ndsp%3D20%26um%3D1%26hl%3Den%26client%3Dfirefox-a%26rls%3Dorg.mozilla:en-US:official%26sa%3DN

Garlic-in-Oil... Potentially Dangerous

Storing garlic, either whole, chopped or minced, in oil is a common form of preserving it since it conserves the garlic taste really well. However, did you know that if you don’t properly store your garlic-oil mixture, you can get very sick?

Clostridium Botulinum is a bacteria that causes botulism- a potentially fatal condition- and it’s actually quite widespread in nature. If the bacteria is exposed to oxygen, the spores can’t grow and can’t produce the toxins that will cause botulism. However, when you take garlic, that contains the bacteria, and cover it in oil, there’s no oxygen present. This is the perfect environment for the spores to grow and produce toxins. There is no change in smell, taste or appearance of the garlic to indicate the presence of toxins, making it all the more dangerous.

When you consume garlic with toxins, you can get botulism. Symptoms include dizziness, blurred or double vision, difficulty in breathing, swallowing and speaking , paralysis and even death.

To avoid getting poisoned, use your garlic-in-oil preparation right away and throw away leftovers. If you want to store it, refrigerate right away- don’t leave it at room temperature- and use within a week. After a week, throw it away. You can freeze your garlic-in oil preparation (the oil prevents the mixture from freezing completely) but it’s recommended you use it right away once you take it out, put it back in the freezer or, again, refrigerate right away and use within a week.

Commercial garlic-in-oil preparations are free from toxins when the product has been preserved. To make sure it has been preserved, check the ingredient list and look for salt or acid. Prior to adopting these preservation techniques, there were 2 botulism outbreaks reported in the late 1980s linked to these products. Remember to still follow the storage directions on the product.

Sources:

Garlic in Oil. http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/garlic-ail-eng.php

Household Solutions 40. http://www.dabbler.ca/household-solutions/household-solutions-40-20080623/

Can creatine help you build muscle?

Usually, when it comes to ergogenic supplements, most health professionals will dissuade athletes from taking them citing lack of research, questionable safety, unwanted side effects. For this reason, it surprised me to read about creatine. Turns out that creatine is one of the best researched ergogenic aids on the market, was called by one well-known sport dietitian as "the most important natural fuel-enhancing supplement yet to be discovered for strength trainers" and can produce significant improvement in sports requiring high levels of power and strength.

What is creatine?

Creatine is a compound naturally found in meat and fish. We also synthesize it in our liver and kidney from amino acids. 95% of creatine is stored in our muscles where it becomes creatine phosphate, the primary fuel for short, high-intensity bursts of activity lasting 1-10 seconds like weight lifting, sprinting, ice hockey etc.
Just like endurance athletes carb-load to increase muscle glycogen stores, creatine-loading can increase muscle creatine stores. Creatine won't build muscle directly but will allow you to increase the duration and intensity of your workout, resulting in muscle gain.

How much?

We get about 1-2 g creatine from food daily (vegetarians get less) but supposedly that's not enough to improve strength training performance. Creatine supplements usually come in the form of powder under the name creatine monohydrate. Studies show that taking four to five 5 gram (1 tsp) doses a day for 5 days- or 0.3g/kg body weight per day- will result in rapid loading. From there, 2 grams (1/2 tsp) a day will keep muscles saturated. A more gentle loading regimen is 2 grams a day for 28 days. Taking more than 40grams daily may cause possible liver and kidney damage. .

Creatine stays in the muscles for 4-5 weeks after a loading phase without extra supplementation. Coordinate creatine supplementation with your training schedule, starting just before you begin a high intensity training session.

20-30% of people don't respond to creatine-loading. Interestingly, creatine works best in combination with a liquid carbohydrate supplement and this may help non-responders to get creatine into their muscles. Ingesting 75-100 grams carbohydrates can boost the amount of creatine loaded in muscles by up to 60%.
75 grams carbohydrate = 3 cups orange juice or 5 cups gatorade.

Side Effects

Creatine is non-toxic and so far there is no evidence to suggest that it's unsafe when taken by healthy adults in the recommended doses for a short term period of ~8 weeks (safety of prolonged use has not been determined yet). Nonetheless, the American College of Sports Medicine recommends that all athletes check with their doctor before taking creatine.

Creatine supplementation is not advised for people with pre-existing kidney disease. There's also no research done on the effect of creatine supplementation on growing kids under the age of 18.

Weight gain of 2-5 lbs is commonly seen in creatine users and is partly due to water weight but evidence now shows that much of the weight gain is a result of increased muscle mass. Anecdotal reports suggest that creatine may cause cramping, nausea, GI problems and higher rates of muscle tearing. The cramping may be the result of dehydration therefore it's recommended that athletes supplementing with creatine drink more water than usual.

As with any supplement, quality of the product is poorly controlled- what you buy is not necessarily what you get.

Creatine and Endurance

Creatine supplementation has been shown to have no effect on VO2max or to improve endurance. However, some researchers believe that creatine supplementation can indirectly improve endurance performance by lifting the lactate threshhold, allowing a more intensive interval-type training. Moreover, increasing muscle mass can potentially help certain endurance athletes like swimmer and rowers... but may hinder others that don't want extra muscle mass, like marathoners and long-distance cyclists.

Is it Legal?

Yes. Creatine actually became public when it was reported that Linford Christie, 100m gold-medal winner, used creatine during the 1992 Barcelona Olympics. Sally Gunnell, 400m hurdle gold-medalist and many British rowers used creatine in preparation for the Barcelona games as well. However, there is concern for cross-contamination since athletes taking creatine have tested positive for banned prohormone products.
The NCAA does not condone the use of creatine.

Sources

Kleiner SM, Greenwood-Robinson M. Power Eating: Build muscle, boost energy, cut fat, 2nd ed. Human Kinetics. 2001.

Ryan, M. Sports Nutrition for Endurance Athletes, 2nd ed. VeloPress 2007.

Girard-Eberle S. Endurance Sports Nutrition. Human Kinetics 2000.

Clark N. Sports Nutrition Guidebook, 3rd ed. Human Kinetics 2003.

Creatine supplements. http://en.wikipedia.org/wiki/Creatine_supplements

Ramadan Mubarak!

Today was the first day that an estimated 1-1.5 billion Muslims around the world started a month long fast- it’s the first day of Ramadan, the holy month of Islam (in North America, Ramadan will start tomorrow, Sept 2nd). It is the duty of all healthy adult Muslims to abstain from eating, drinking, smoking, sexual activity and even gossiping during sunlight hours for the next 29-30 days- the Koran exempts the sick, the elderly, children below the age of puberty and pregnant women from this duty. The purpose of Ramadan is both physical and spiritual; through fasting and prayer, Muslims practice self-discipline and sacrifice that allows them not only be able to sympathise with the less fortunate, but to cleanse their souls and be relieved of past sins.

During Ramadan, most people will consume two meals a day: the Iftar or the meal at sunset that breaks the fast and the Suhur or the pre-dawn meal. Perhaps a little surprising is that, according to most studies, 50-60% of people who fast will maintain their weight during this month. The rest will either gain weight, as a result of compensatory eating during non-fasting hours, or lose weight- this is more common in overweight individuals.

In order to keep weight stable during Ramadan, it is recommended to avoid the common practice of eating foods rich in saturated fats and simple carbohydrates during non-fasting hours. Instead, the diet during Ramadan shouldn’t differ much from a normal healthy balanced diet rich in complex carbohydrates, vegetables, fruit, protein and healthy fats. It’s also recommended to eat the morning meal as late as possible to keep the time between meals as short as possible.

Dehydration is a very real risk, especially in this hot weather. It’s recommended to take in more fluids during non-fasting hours and to avoid strenuous exercise during fasting hours. Instead, exercise 2 hours after the iftar.

An estimated 40-50 million people with diabetes are expected to fast during Ramadan even though they would be exempt from fasting given that their medical condition may place them at high risk for complications. There is limited information on the consequences of fasting during Ramadan on people with diabetes- most of the findings are based on the 2001 population-based Epidemiology of Diabetes and Ramadan (EPIDIAR) study that looked at 12 243 people with diabetes from 13 Islamic countries. Basically, the study found that risks associated with fasting include low blood sugar, high blood sugar, diabetic ketoacidosis and dehydration.

People with diabetes should obtain a medical assessment 1-2 months prior to Ramadan and obtain proper education on symptoms of hypoglycemia and hyperglycemia, blood glucose monitoring, physical activity, meal planning and how to manage complications. They should also monitor their blood glucose frequently and break the fast if blood glucose falls below 3.9 mmol/L or goes above 16.7 mmol/L or if they become sick.

To avoid high blood sugar after their sunset meal, people with diabetes should spread out their meal, distributing calories over 2-3 smaller meals during the non-fasting interval. They should also exercise 2 hours after the sunset meal rather than during the day. Insulin and medication regimens most probably need to be changed and should be discussed with either their doctor or diabetes educator.

This said, people with Type 1 Diabetes should be advised not to take part in Ramadan since they are at high risk of developing complications, as are people with diabetes that cannot or are unwilling to monitor their blood glucose multiple times during the day. Nonetheless, fasting is a religious decision that is made by individuals, hopefully after receiving appropriate advise from their medical team as well as from their imams (religious leaders).

Ramadan Mubarak!

Sources:

Muslims prepare for start of Ramadan. http://www.cbc.ca/world/story/2008/08/31/ramadan.html?ref=rss

The Trials of Ramadan Fasting. http://news.bbc.co.uk/2/hi/uk_news/magazine/6989742.stm

Ramadan. http://en.wikipedia.org/wiki/Ramadan

Recommendations for Management of Diabetes During Ramadan. http://care.diabetesjournals.org/cgi/reprint/28/9/2305.pdf