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study guide will be posted on moodle
she says it will be more specific than the last one
some Q's from first part of course
she is apologizing a second time; she didn't realize we haven't taken endocrinology
exam will be multiple guess

NUTRITION THROUGH THE AGES
this lecture taken mostly from Krause
dosages are mostly government RDA numbers (not naturopathic)

IN PREPARATION FOR CONCEPTION
it strikes me that fertility is part of the definition of vitality
our lives are such that they decrease both, more young people are infertile these days

female fertility
coffee: more than 4 cups of coffee per day may decrease fertility
alcohol-->hyperprolactinemia (in women)-->menses dysfx-->decr fertility
vitex: chaste tree dose 30 mins after dosing (Aus science) (incr LH)
progesterone: micronized static dose may not be enough, supp more days 12-26 and incr gradually
(prometrium used in infertility clinics)
reduce inflammation via diet, elimination
B6: to tx PMS In infertile female, dose 100-800mcg x6mo
if underweight, gain, if overweight, exercise

male fertility
B12: 1000-6000 mcg/d to treat low sperm count, motility and low serum LH
(take B12 early in the day or it will disturb sleep)
if smoker: vitamin C 200-1000 mg/day
zinc sulfate: 220-440mg/day effective after 4 months (or 1/4 cup pumpkin seeds/day)
L-arginine 4 grams/day for mile oligospermia

pre-conception detox
indications: repeated miscarriage, infertility
detox protocol x 4mo
don't try to conceive until fresh ova/sperm have matured: ova 116 days, sperm 74 days
some sources:
diet cleanup: fresh whole foods, no junk, no alcohol, no caffeine
Angela Hywood ND www.tonicaustralia.com.au
Dr Francesca Naish The Natural Way to Better Babies www.fertility.com.au
http://www.foresight-preconception.org.uk

PRENATAL
supp esp if: substance abuse hx, teen, short time btw preg, hx of low birth wt babies, twins+
weight: gain, normal to gain *25-35 pounds, underwt gain 28-40, overwt gain 15-25
supp vitamins during 1st month-->43% decr in heart defects, doesn't help in month 2
folate (600mcg) for DNA synthesis (new research shows too much-->infant asthma risk)
prenatal multi esp if nutrit hx not great
macronutrient needs during preg:
prot 71g (28gmore), carbs 135-175g, fiber 28g,
lipids 13g/day omega 6, 1.4g/day omega 3
sardines and herring-->as 1/3 of total protein-->smart babies
B6: RDA 1.9mg/day, 25mg tid for severe nausea, needed for AA synthesis (tryptophan metab)
also if N/V eat sm freq meals, prot, carbs, may need hospitalization
vit C: 80-85mg/day, low levels assoc w/ preeclalmpsia and PROM
vit A: 2800 IU prob in food, do not take more, over 10,000 IU->incr neural tube defect risk
vit A: avoid analogs (accutane for acne-->use clindamycin instead)
vit D: 200IU/day, current UL 2000IU, crosses placenta, if def-->decr Ca+
iron: *30mg/day, or if def give 60-120mg/day ferrous but back to 30 when anemia resolves
Fe: divide doses, btw meals w/ milk, tea, coffee, but w/ cit C
maternal anemia is CHT below 32%, HGB below 1g/dl
Ca+: 3 servings/day of dairy OR sardines
zinc: 11mg/day (don't go as high as 30mg/day)
sodium: do not restrict even if there's edema, rather balance with K and Mg
gentle diuretic OK: parsley tea
Mg: 360-400mg/day, reduces pre-eclampsia and IUGR
iodine: 220mg/day, too little-->cretinism
fluids: 6-8 glasses/day
alcohol: none
caffeine: limit to 2 cups, during 1st trimester may incr risk of spontaneous abortion
avoid: heavy metals, Ca+ from dolomite, methyl mercury from carnivorous fish
avoid: PCBs from fatty fish, salmon, lake trout, carp
constip: fluids, fiber, dried fruits

LACTATING MOTHER
benefits of breast feeding to mom:
lactation amenorrhea, wt loss, cancer preventative
wt loss 1lb/wk OK
hydration: 2-3 quarts/day, more in hot weather
prot: additional 25grams/day
carbs (Krause table 7-3)
fatty acids: omega 6 13g/day, omega 3 1.3g/day
iodine and other thyroid support
B vits
RDA: about *400 calories/day needed to supply infant needs
calcium: take it, breast feeding causes 3-7% bone loss in mother

INFANCY
breast milk vs formula
breast best for baby
-->more kcal, bioavailable nutrients, grows faster in 1st year
-->less D and OM, less allergies, more immune to common pathogens, contains SIgA
-->contains lactoferrin which binds iron and deprives bact to inhibit their growth
-->more taurine and cysteine
-->has bile activated lipases not present in formula
-->peroxides and vit C inactivates bact cell membranes, also lysozyme
-->maternal probiotics: lactobacillus bifidus, bifidobact sp incr in lactic rich GI
water soluble vits in milk reflect maternal intake (keep going with prenatal)
similar amounts of lipids in both
(I thought breast has more short and med chain fatty acids??)
human milk oligosaccharides readily fermented in infant colon-->bifidobact pop
-->lower fecal pH and incr fecal lactate concentrations
formula has higher protein content than breast milk
formula has far more casein-->could cause autism, more diabetes?
soy: for veg families, galactosemia or pimary lactase def, allergy to cow milk

adding solids
when mother's supply can't keep up with hunger
veggies first to encourage vegetable acceptance
avoid skin/rinds, things that stick to roof of mouth (grapes, hot dogs, peanut butter)
cup liquids from 9mo on, dilute juices substantially
limit juice, Krause says 4-6oz/day, Siebert says 2oz/day
let child eat by set at beginning of meal, help when tired
do not force feed
amounts: 1 TBS serving of each food per year of age
1 year eat 1/3-1/2 adult intake, 3 year eat 1/2 adult, 6 year eat 2/3 adult

CHILD
risks of def: vegan, allergies, fad diet, behavior prob, poverty
prot: need 9.9g/kg body wt (vs 1.1g during year 1)
calcium: 1300 mg/day, most kids don't get this much
iron absorption better with meal including orange or apple juice or fruit

TEEN
prot: boys 52g, girls 46g
calcium 1300 mg
iron: boys 11mg, girls 15mg
folic 400mcg
teens get 75% or less of RDA of many nutrients, need multi, even gummi bear multi
#1 food: pizza
irreg meals, snacking, fast food, empty calories
adolescents buy $15 billion/year of food
schools provide junk too

AGING
catabolism outpaces anabolism at age 30
still need 2,000 cals a day or so even in old age
over age 65 men 2200, women 1978
protein is key throughout life, 1g/kg to keep nitrogen balance
sensory losses: zinc def, reduced appetite
keep an eye on: oral health (can they chew?), GI health, CV fx, renal fx
hydration status (is there urinary incontinence? dysphagia? why don't they drink?)
fluids: min 1500ml/day (constip is common, mb on stool softener)
overmedicated population
lactase production down
achlorhydria common
may not tolerate milk
antioxidants
B's esp 12, 6, folate
B12: 500mcg po, 1000mcg IM weekly x3wks
vit D: 800-1000
vit E: 100-200mg
MTHF: .8-1mg/day
calcium: 1200mg/day between meals
potassium: 4000mg/day to lower BP
vit C
zinc: men 15mg, women 12mg

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