Vitamins, weight gain, preterm birth and more

Ironically, despite excessive caloric intake, many obese women are deficient in vitamins vital to a healthy pregnancy. This and other startling statistics abound when obesity and pregnancy collide. Together, they present a unique set of challenges that women and their doctors must tackle in order to achieve the best possible outcome for mom and baby.

In the December issue of the journal Seminars in Perinatology, maternal fetal medicine expert Loralei L. Thornburg, M.D., reviews many of the pregnancy-related changes and obstacles obese women may face before giving birth. The following myths and truths highlight some expected and some surprising issues to take into account before, during and after pregnancy.

“I treat obese patients all the time, and while everything may not go exactly as they’d planned, they can have healthy pregnancies,” said Thornburg, who specializes in the care of high-risk pregnancies and conducts research on obesity and pregnancy. “While you can have a successful pregnancy at any size, women need to understand the challenges that their weight will create and be a partner in their own care; they need to talk with their doctors about the best way to optimize their health and the health of their baby.”

Myth or Truth?

Many obese women are vitamin deficient.

True

Forty percent are deficient in iron, 24 percent in folic acid and 4 percent in B12. This is a concern because certain vitamins, like folic acid, are very important before conception, lowering the risk of cardiac problems and spinal defects in newborns. Other vitamins, such as calcium and iron, are needed throughout pregnancy to help babies grow.

Thornburg says vitamin deficiency has to do with the quality of the diet, not the quantity. Obese women tend to stray away from fortified cereals, fruits and vegetables, and eat more processed foods that are high in calories but low in nutritional value.

“Just like everybody else, women considering pregnancy or currently pregnant should get a healthy mix of fruits and vegetables, lean proteins and good quality carbohydrates. Unfortunately, these are not the foods people lean towards when they overeat,” noted Thornburg. “Women also need to be sure they are taking vitamins containing folic acid before and during pregnancy.”

Obese patients need to gain at least 15 pounds during pregnancy.

Myth

In 2009, the Institute of Medicine revised its recommendations for gestational weight gain for obese women from “at least 15 pounds” to “11-20 pounds.” According to past research, obese women with excessive weight gain during pregnancy have a very high risk of complications, including indicated preterm birth, cesarean delivery, failed labor induction, large-for-gestational-age infants and infants with low blood sugar.

If a woman starts her pregnancy overweight or obese, not gaining a lot of weight can actually improve the likelihood of a healthy pregnancy, Thornburg points out. Talking with your doctor about appropriate weight gain for your pregnancy is key, she says.

The risk of spontaneous preterm birth is higher in obese than non-obese women.

Myth

Obese women have a greater likelihood of indicated preterm birth – early delivery for a medical reason, such as maternal diabetes or high blood pressure. But, paradoxically, the risk of spontaneous preterm birth – when a woman goes into labor for an unknown reason – is actually 20 percent lower in obese than non-obese women. There is no established explanation for why this is the case, but Thornburg says current thinking suggests that this is probably related to hormone changes in obese women that may decrease the risk of spontaneous preterm birth.

Respiratory disease in obesity – including asthma and obstructive sleep apnea – increases the risk for non-pulmonary pregnancy complications, such as cesarean delivery and preeclampsia (high blood pressure).

True

Obese women have increased rates of respiratory complications, and up to 30 percent experience an exacerbation of their asthma during pregnancy, a risk almost one-and-a-half times more than non-obese women. According to Thornburg, respiratory complications represent just one piece of the puzzle that adds to poor health in obesity, which increases the likelihood of problems in pregnancy. She stresses the importance of getting asthma and any other respiratory conditions under control before getting pregnant.

Breastfeeding rates are high among obese women.

Myth

Breastfeeding rates are poor among obese women, with only 80 percent initiating and less than 50 percent continuing beyond six months, even though it is associated with less postpartum weight retention and should be encouraged as it benefits the health of mom and baby.

Thornburg acknowledges that it can be challenging for obese women to breast feed. It often takes longer for their milk to come in and they can have lower production (breast size has nothing to do with the amount of milk produced). Indicated preterm birth can result in prolonged separations of mom and baby as infants are admitted to the neonatal intensive care unit or NICU. This, coupled with the higher rate of maternal complications and cesarean delivery – up to 50 percent in some studies – in obese women, can make it harder to successfully breast feed.

“Because of these challenges, mothers need to be educated, motivated and work with their doctors, nurses and lactation professionals to give breast feeding their best shot. Even if you can only do partial breastfeeding, that is still better than no breastfeeding at all,” said Thornburg.

Below is an article from a new study that demonstrated exercise helps us make better food choices. http://www.eurekalert.org/pub_releases/2011-11/f-sf-ehu112911.php

A healthy diet and the right amount of exercise are key players in treating and preventing obesity but we still know little about the relationship both factors have with each other. A new study now reveals that an increase in physical activity is linked to an improvement in diet quality. Read the rest of this entry

When buying olive oil I often wondered how there could be so many brands at such different prices.   If you go into Whole Foods the unit price cost per gallon can vary dramatically.  Trader Joe’s sells its ‘organic extra-virgin’ olive oil quite inexpensively.     In addition, one can see distinct color variations between oils in clear bottles.  What does this difference mean in terms of phytonutrients, taste and integrity?

The term ‘extra virgin’ is one that most people including myself are not clear on its definition.   ‘Extra Virgin’ is a baseline standard that embraces any oil made by solely mechanical means, instead of chemical treatment.  It also must have less than 0.8 percent of free acidity, a laboratory measurement of rancidity or free-radicals. Extra-virgin oils also are forbidden to have “disgusting odors such as rancidity, putridity, smoke, and mold”.    Unfortunately the label can say ‘extra-virgin’ even if it does not meet the above standards.

The rancidity level of an oil is interesting.  I most certainly notice a difference between how high a heat I can apply to different olive oils.  Some oils start to impart a rancid smell rather quickly in the frying pan, while others I notice can cook longer.  Olive oil should not be heated at a high temperature, but I noticed some impart a rancid smell even at low temperatures.  (Rancid oils are probably one of the most common ways people increase the oxidative stress in their body.  Olive oil loses its antioxidant potential as it sits, even in closed containers.)

Some of the answers to may questions regarding olive oil quality have been answered by the UC Davis Olive Oil Center.   They released a report stating that 73 of the tested brands of olive oils sold in the United States failed standards for ‘extra-virgin’ olive oil:   “Our testing indicated that the samples failed extra virgin olive oil standards according to one or more of the following: (a) oxidation by exposure to elevated temperatures, light, and/or aging; (b) adulteration with cheaper refined olive oil; and (c) poor quality oil made from damaged and overripe olives, processing flaws, and/or improper oil storage.”

In other words most olive oils sold in groceries skimp out in some way to lower the price.    So many of us buy a ‘first-cold pressed’ oil that is not technically ‘extra virgin’ even though the label states it is ‘extra virgin’.  Olive oil really isn’t much different than nutritional supplements.  You get what you pay for.   In general the more expensive oil the better it did in testing, but sometimes even expensive oils failed a certain category.  (In this study they did not purchase oils from Whole Foods or Traders Joe’s, but rather typical standard American grocery stores found in California.)

Whole Food’s top shelf stocks olive oils that over $120 per gallon.   I’ve had the pleasure of using that olive oil when I was a personal chef for an affluent client.   And boy was this olive oil different!   The flavors and aroma were dynamic and one could tell it significant superiority to the olive oil in my kitchen cupboards.   There most certainly is a difference in quality between a not so expensive oil and more pricey ones.

The question is it worth the difference?   If you are a ‘foodie’ then maybe so.   In terms of health for the general population I am not convinced.   Is having say an extra 0.5% less rancidity worth paying an extra $.50 cents per ounce?  Given all the ways our food can be oxidized I’m not sure it is worth the extra cost.

There is a new book that will be released in a few weeks about the business of olive oil.   It should be an interesting read to get an understanding of how oil is manipulated.

All in all the slick business world of olive oil should be of little concern given the grander lies on a global scale effecting us  socioeconomically.   But it is good to know a bit more about what we are actually purchasing.

Here is an Ode to Olive Oil.

Yours In Health,

George Mandler

Acupuncturist and Licensed Dietitian / Nutritionist

For so many years when people tell me they use honey in their tea or other foods I always question to make sure it isn’t honey from a plastic squeezable bear.    I am surprised how many people use inexpensive ‘honey’ from a standard grocery.   You get what you pay for.  

There is a great new article from the Food Safety Network entitled “Tests Show Most Store Honey Isn’t Honey”.  Please read it to learn about what was found in store bought honey.   The results aren’t sweet.

We all have food sensitivities to some degree. If and when they manifest as overt symptoms is very space and time dependent. Genetically engineered foods will only increase the likelihood that people will become more sensitive to foods (the technical term is a loss of oral tolerance) as potential antigens from one food/chemical is spliced into a completely different food.

We must stop the madness of Monsanto and other pharma giants from controlling all seeds.   (for more info click here).

Please sign this petition to request labeling on Genetically Engineered foods.   We have a right to know if we are eating a genetically altered food.   The ignorance so many so called experts display when they say there is no harm with GE foods is baffling.   I had constant battles with my biochemistry professor about this.  Hopefully he has opened his eyes to the dangers.

If more food is clearly labeled “Genetically Modified” there will be less demand and less madness.   Obama has already let Alfalfa seeds slip on through, now the government wants to not inform people if they are eating GE foods. Please sign, this is important for future generations.

Yours In Health,

George Mandler LDN LicAc

In the last few weeks two awfully designed studies regarding vitamin supplementation created some negative headlines around choosing to supplement.

One study published in JAMA wrongly concluded that “vitamin E” increases the risk the prostate cancer.  Problem was they weren’t using Vitamin E, just a portion of it.  The use of only 1 portion of the Vitamin E class of molecules (in this case alpha-tocopherol) leads to other well documented deleterious consequences.  This study was a faulty design with faulty assumptions whose mistake was made countless times in studies over the past 20 years regarding Vitamin E metabolism.  But for some reason previous data was ignored.  There are additional faults with this study and the hyperbole conclusions spun by the mainstream media ‘health writer’ pundits is extraordinary.   I’ll blog on this soon. Read the rest of this entry

It has been known that cereals that contain oats, soy, corn are most likely contaminated with pesticides and/or genetically modified if they do not have the USDA Organic label. I typically do not recommend cereals with a lot of grains such as Kashi because of the potential food sensitivity issues.  So many grains eaten at once increase the likelihood of an immune response stemming from a food sensitivity.   But now the Cornucopia Institute has released a new report explaining how ‘natural’ cereals that are not so natural.   The full text is below and a good read…..or if you do not want to read the 4 minute video is here.

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In case you haven’t seen Food Matters it is available for free viewing until October 8th.

See:  http://foodmatters.tv/screeningevent2

Interesting how chocolate is often associated with ‘love’ and ‘heart’ given its known benefit on the cardiovascular system . A review study just presented in Paris – a city that is renowned for its love of food and chocolate – showed that individuals who ate the most chocolate had a 37% lower risk of cardiovascular disease and a 29% lower risk of stroke compared with individuals who ate the least amount of chocolate.

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It is known that diseases of mental health are related to free radical damage (oxidation) of fatty acids in the brain.  For example in Alzheimer’s amyloid plaques in the brain are known to be a result of oxidative damage.    A recent randomized double blind placebo controlled study was just released demonstrating that antioxidants can help improve memory scores and in some cases verbal scores.   Read the rest of this entry