Breastfeeding Nutrition – your queries answered by Rachel Conway

So, you are thinking about breastfeeding - Congratulations!

Breastfeeding is a privilege, but not one that comes without trials, tribulations and no end of well-meaning advice from friends, family and popular media. It can be difficult to tease out what is fact and what is fiction, particularly when your brain is muddled from lack of sleep. Let me break-down a few of the most discussed topics for you.

Calories – Breastfeeding consumes around 475 additional calories (2000 kilojoules)/day, even more than pregnancy does. It is easy to rely on high calorie snack foods at a time when you are low on sleep and energy. To avoid this plan to start your day with a large breakfast and prioritise feeding yourself while baby sleeps, basing meals around fruit, vegetables, wholegrain carbohydrates and protein. 

Iodine – In New Zealand it is difficult to obtain enough Iodine from diet alone due to low levels in our soil. Iodine is important for normal growth and brain development. Continue to take a 0.15mg Iodine only supplement for the duration of breastfeeding. These are available on script from your LMC, dietitian or GP.

Fluid – Fluid requirements increase in breastfeeding. Basically, all that fluid flowing out of you needs to be replaced. Drinking to thirst is generally enough and having a glass of something each time you sit down to feed is a good rule of thumb. 

Caffeine – Caffeine is excreted in breastmilk, although in low levels. Your usual cup or two of coffee or few cups of tea a day will not impact your infant. Excessive intake could lead to an unsettled, irritable baby. 

Alcohol – Alcohol passes into breastmilk at similar concentrations to blood alcohol levels. It is best to avoid alcohol consumption if you are intending to breastfeed in the next hour and limit consumption to 1-2 standard drinks. Check out this app for calculating when it is safe to feed: http://www.feedsafe.net/

Excluding foods – Removing a food group, particularly dairy from your diet is often suggested as a solution to an unsettled, irritable baby. Mums are often advised to avoid some vegetables such as cauliflower and broccoli – ‘they will give baby a sore tummy’. Please act with caution here. A Mother willing to try anything in the hope baby will sleep can be particularly vulnerable to well-meaning but ill-advised opinions. Vegetarians/vegans or anybody restricting food groups from their diet should contact a dietitian to ensure the nutritional adequacy. 

Please remember, while breastfeeding is the gold standard for infant nutrition, it is not for everyone and in a few cases not possible. If breastfeeding is not working for you or your infant at any time, infant formula is a completely acceptable alternative. Fed is ALWAYS best. 😊

https://www.healthed.govt.nz/resource/eating-healthy-breastfeeding-womenng%C4%81-kai-totika-m%C4%81-te-%C5%ABkaip%C5%8D

https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/maternal-diet.html#:~:text=Generally%2C%20women%20do%20not%20need,to%20restrict%20caffeine%20while%20breastfeeding.

Hydrate for Peak Performance

Nutrition Advice for Athletes from Kim - Hydrate for Peak Performance

It’s that hot and sticky time of the year again.   You may be competing in one of the many summer season sporting events or you may be training through the hot season for an event later in the year.   Keeping yourself well-hydrated in the hot weather and high humidity is particularly important for your training and competition performance.

How can dehydration impact on my sporting performance?

·         Increased heart rate and body temperature, which can make exercise feel harder

·         Poor concentration

·         Reduced skills

·         Early fatigue

·         Delayed recovery

How do I know if I’m dehydrated?

3 key indicators of dehydration:

1.      Thirst – is a sign you are dehydrated

2.      Urine colour – your urine should be clear or pale yellow in colour.  Dark coloured urine is a sign of dehydration

3.      Morning body weight – if this is significantly lower than usual, it is another sign of dehydration. 

Do you have 2 or more of these indicators? If so, it is likely that you are dehydrated.

 How do I know how much to drink?

Fluid needs vary from person to person.   A simple way to assess your fluid losses is to:

1.      Weigh yourself, in minimal clothing, before your training session or event.

2.      Weigh yourself again after the session.  Ensure you wear minimal clothing and dry off any sweat with a towel first.

3.      The weight you have lost reflects your total fluid loss.  E.g. 1 kg weight loss = 1L fluid lost

4.      Aim to replace 1.5 times the fluid you have lost over the next 3-6 hours.  E.g. 1L lost, means you need to drink 1.5L over the next 3-6 hours.

What are the best types of fluid to drink?

·         For sessions less than 1 hour and low in intensity, water is sufficient.

·         For events over 1 hour and/or high in intensity, sports drinks are beneficial as they provide additional carbohydrate and electrolytes (e.g. sodium) for recovery.

·         An ideal recovery drink after intense exercise is milk (plain or flavoured) as it provides fluid, carbohydrate, protein and electrolytes.

How can I prevent dehydration?

·         Drink a large glass of fluid when you wake up and with all main meals

·         Sip on water during the day and during training sessions

·         Start training sessions and events well hydrated

Tips for Eating to Support Recreational Activity

1. Planning ahead

It mightened seem obvious but writing a food and gear list is essential – it was something Sir Edmund Hillary excelled at:

-          make a list for each day of all the meals required and the food you need to take. What cooking gear do you need?

-          how many mouths are you catering for?

-          allow for snacks that are light, nutritious and easily accessible.

2. How to keep food weight and bulk down?

-          use dried alternatives like milk powder, dried fruit and dried soup/veges

-          try freeze dried meals, they have improved greatly since Sir Ed’s day!

-          allow for the heavier (fresh) food to be eaten in Day 1

-          use plastic bags (clear zip lock bags are great) instead of plastic containers

-          take dense (heavy grain) bread to avoid it getting squashed beyond recognition; and  crackers instead of bread for the final days – they don’t go stale and weigh less.         

3. Convenience AND Taste – you don’t need to forgo flavour

-          make your own dehydrated food -  great article in www.wildernessmag.co.nz/5376-2/

-          if you haven’t got a dehydrator then try packets of instant pasta, noodles, soup/sauces, instant puddings

-          bulk out the instant meals with some ‘light in weight’ fresh vegetables - such as mushrooms, courgettes, capsicum

-          we take fresh meat (like lamb steaks) for the first night then dried meals thereafter.

You need extra energy and fluid compared to a ‘normal’ day to support you for carrying gear, walking long distances over demanding terrain and coping with extremes in weather.

Sample Menu

Breakfast: You can enjoy a large breakfast to provide energy over the day.

Cooked – try refried potatoes (kept cold from the night before) with baked beans and ‘Egg in the hole’ bread (break an egg into a hole in the middle of a slice of heavy grain bread and fry)

OR cereal with dried pineapple and roasted almonds, milk made up from powder. Hot chocolate.

Lunch: Salami or tuna, cheese and cucumber sandwiches, cherry tomatoes are also good value. Take boiled eggs for your first lunch.

TIP: have a packet soup when you get to the hut to restore fluid and electrolytes.

Dinners – Night 1 = fresh food night: Lamb steaks with new potatoes and pre-made Greek salad. Dessert –fruit cake and cheese.

Night 2: Sweet and sour sausages (pre-cooked) – packet sauce (sweet and sour mix) with courgettes and rice. Dessert – rehydrated dried apricots with custard

Snacks: Have each person choose their own and carry them. Try – homemade scroggin, crackers and cheese, muesli/cereal bars

Fluids:  Water. Try it with dash of juice and pinch of salt helps with energy and electrolyte replacement when you are tramping for the whole day. Make your water easy to access and have a drink at each rest stop.

Many experienced outdoor adventurers have their favourite recipes/meals so ‘pick their brains’ for more good ideas.

Coeliac Awareness Week is 15-21 May

Many articles in the media indicate that It is a healthy choice to eat a gluten a free diet to improve health. However for people with coeliac disease it is essential, life changing  and the only treatment available.

What is coeliac disease and what are the symptoms?

Coeliac disease is a permanent intestinal intolerance to dietary gluten, a protein found in some plants. It induces an autoimmune reaction in the lining of the small bowel which causes villous atrophy (flattening of the mucosa). Everyone is different, common symptoms can include stomach and joint pain, tiredness, vomiting or diarrhoea.

What is so difficult about eating out with coeliac disease?

The main issue is cross-contamination. This can happen when very small amounts have been passed on from serving tongs, fingers or cooking utensils such as BBQs and toasters.

Cathy Khouri at Nutrition Care Ltd sees many people who have been diagnosed with Coeliac disease. The appointment time includes a full nutritional assessment and “A to Z“ advice about how to manage coeliac disease with diet.

Cathy has had patients return for further advice because they have been unwell or have had blood results that reflect the condition was poorly controlled. She recalled a careful review of intake for a young woman in a flatting situation. This revealed flatmates used the same dishcloth for wiping down benches before and after gluten containing and gluten free meals were being prepared, that may have been enough to trigger symptoms.  Cathyalso remembered a case of an older man who had received positive coeliac blood test results despite his best efforts to totally exclude gluten. After careful questioning and some discussion, it became clear that while he was on holiday, although he had chosen gluten free bread for toast, there would have been cross contamination from the hotel toaster.       

Where is gluten found?

·         Wheat and all varieties, such as spelt

·         Rye

• Barley
• Oats
• Derivatives of these products, such as malt

It is important to seek an accurate diagnosis and consult a qualified and experienced Dietitian. For more information see www.coeliac.org.nz

Good Nutrition for Long Distance Running - Countdown to the Hamilton Half

Training for the Hamilton Half Marathon and Auckland Marathon has begun!  Best advice for your nutrition preparation includes -

1. Fuel your training.  Your daily diet needs to be high carbohydrate, moderate protein and low fat.  Carbohydrate is your most important fuel source, so eat a variety of good quality carbohydrate foods (e.g. bread, cereals, pasta, rice and fruit) throughout the day.

2. Get your hydration right.  Keep well-hydrated by drinking a large glass of water with all meals and sip on water over the day.  Water is enough for training sessions under 60 minutes.  However, on race day and training runs over an hour, you need to replace carbohydrate and electrolytes as well.

 3. Use liquid forms of carbohydrate.  It is hard to consume solid food while running.  Sports drinks and/or energy gels are an easier option.  They are also convenient when it is not timely to eat and digest a solid meal, e.g. before an early morning training run.

 4. Optimise recovery.  In addition to fluid, consume a high carbohydrate, protein-containing snack, within 30-60 minutes after your training run.  Good choices include a fruit smoothie, flavoured milk, baked beans on toast, or a bowl of cereal with milk.

 5. Prevent mistakes on race day. 

·         Practise your nutrition strategies in training.

·         Never try anything new on race day.

·         Trial your pre-race meal before a long training run. 

·         Know what products will be provided at aid stations and trial them on training runs. 

·         Your best option on race day might be to carry your own carbohydrate and fluid sources.

Nutritional needs vary.  They depend on race distance, the type and intensity of training.  For individualised advice and nutrition plans specific to you and your sport/event, contact Kim Abbott at Nutrition Care.  Kim is an Accredited Sports Dietitian with Sports Dietitians Australia.

School Food Alert

BYO dinner at school for a meeting of 12-13 year old intermediate school children and their families. A big group – approximately 100-120 people. Time to be there with contribution to BYO meal was 6pm on Wednesday evening. We had plenty of warning with notice home from school.

Dilemma – both parents working, children busy with after school activities - sport and orchestra practices, family trickling in from 5pm. What food do we take for sharing and be there on time?

What happened? 3 tables were laden with food consisting of takeaway pizzas (about 25 but lost count), Chinese takeaways, cakes, chocolate biscuits, bags of potato chips, pies and savouries (some cold), sweets, sushi, cartons of plain pack soft drink etc etc. Less than 1/3 of one of the tables had homemade pasta dish, french bread with topping and salad, 1 basket of fresh fruit. My daughters eyes just about fell out of her head and then the scramble began for food – you can guess what disappeared first.

To reinforce that this type of BYO food is OK the meeting organiser then began to give out ‘prizes’ for students who ‘volunteered’ to stand up to be shown as an example of what to wear in certain situations (this group is planning a trip to Japan – very exciting). What were the prizes? – King sized block of chocolate.

So what’s the fuss?  No time – therefore pick up pizzas…right? It’s only one night.

No. Planning and actively delivering on healthy family food is part of good parenting and bringing up our children. Setting an example is really important. Setting expectations about what is normal food to provide to share with others as part of social engagement is really important.

BYO meal ideas for families in the same situation as our family on that evening – time poor and sticking to a budget:

·         HOMEMADE pizza – use pita bread or flat breads as base

·         Breadcases – fill with corn & bacon, spaghetti & cheese, fish

·         Filled pita pockets or dinner rolls, triangle sandwiches

·         salmon or asparagus rolls

·         wraps cut into small rings

·         salsa/avocado dip/hummus with crackers or vege sticks

·         mini meal balls, falafel, chicken drumsticks

·         quiche/frittata

·         fruit platter/fruit kebabs

·         HOMEMADE bliss balls, mini muffins

·         Soup made the day before (if you can keep it hot but would be welcome on wet winter evening)

These children are travelling to Japan. On their travels they will experience how a different culture values good food and is not prepared to accept any last minute stop at the takeaway shop as being OK.

See more ideas on this website: https://myfamily.kiwi/foods/dinner

Recovery Nutrition after Exercise

What are the consequences of not following good recovery nutrition strategies?

• ·         Tiredness and fatigue
• ·         Increased muscle soreness
• ·         Reduced performance at your next training session
• ·         Reduced physiological gains from the session you just completed

Who should focus on recovery nutrition?

Recovery nutrition is especially important for people who:

• ·         Exercise for prolonged periods of time (more than 60 minutes)
• ·         Train at high intensities
• ·         Have limited time between sessions, e.g.

o   two training sessions in one day

o   an evening session will be followed by an early morning session

o   competition with multiple events over 1 or more days

Nutrition has 3 main roles in recovery after exercise:

 ·         Refuel:  When we do intense or prolonged exercise our body uses some, or even most, of our muscle fuel (glycogen) stores for energy.  Carbohydrate consumed after exercise will help replace the fuel stores you have used, so you are refuelled for your next training session. 

 ·         Repair: Weight training or prolonged high intensity endurance exercise can damage muscle tissue.  Protein consumed after training will help to repair and rebuild muscle tissue.

 ·         Rehydrate:  Fluid and electrolytes (e.g. sodium) are lost through sweat when we exercise, which need to be replaced.  Water will be sufficient if the session was less than 60 minutes.  After longer and higher intensity sessions, a sports drink is a good choice as it provides fluid, electrolytes and carbohydrate.

 For maximum benefit, recovery nutrition should be consumed within 60-90 minutes of the exercise session.  This could be your next planned main meal, if it is within that timeframe.  If not, a post-training snack is important to get the recovery process started quickly.

 What are some good food choices to use for recovery nutrition?

• ·         500ml of low-fat flavoured milk
• ·         Smoothie made with milk, yogurt and fruit (e.g. berries, banana)
• ·         2 pottles of fruit yoghurt and a muesli bar
• ·         Bowl of cereal with milk, yoghurt and fruit
• ·         Small tin of tuna, a row of rice crackers (~10 crackers) and a piece of fruit
• ·         Small tin of baked beans on 2 slices of toast
• ·         2 poached or boiled eggs on 2 slices of toast
• ·         Protein sandwich (meat/tuna/cheese) with a pottle of yoghurt
• ·         Peanut butter on 2 slices of toast with a glass of milk
• ·         Tin of creamed rice

Is Trim Milk OK?

This week a patient of mine told me her work colleagues said “Why are you changing to trim lattes? … don’t you know they put sugar in trim milk”

Where do these blatant myths come from?

There has been much said, written, posted and filmed about sugar. Products labelled ‘lite’ or ‘light’ may have extra sugar added when the fat content is reduced. That Sugar Film was brilliant in raising our overall awareness of sugar that is contained in processed foods. But milk???

Facts about milk in NZ

There are many varieties of milk available, with different fat contents. As an example, the website a well -known milk brand says ‘we never add water to Anchor™ milk. The only difference is the proportion of the cream we skim off.’ 

So they remove cream to produce lower fat varieties. That means there will be higher quantities of some other nutrients such as calcium and lactose. Lactose is a sugar in milk and it is supposed to be there (I avoid the word ‘natural’ as what is that supposed to mean when you see it used on the labels of so many processed foods). Milk is milk… lactose is not added after the animal makes milk. Labels on milk do not list added sucrose or any other form of sugar of which there are many.

Whatever your age including milk in your day is good nutrition.  Lower fat milk can be beneficial if you are trying to control weight. Do you enjoy a large latte every day? If so changing to lower fat milk will help reduce your energy intake with this simple change.

Does your New Year’s resolution include a healthier you?

10 tips for a healthier you:

1. Award your health priority  
2. Make a simple change to your eating pattern such as ‘Have breakfast every day’. Write it down under “MY HEALTH is my top priority” Once that is second nature make another change – list that underneath the first change
3. Create a regular eating pattern – have three meals per day. Avoid skipping meals to compensate for overindulging at that party the night before. Instead have a lighter meal not no meal
4. Practice mindful eating – Eating with intention and attention, one simple change could be ‘Eat your evening meal sitting down and NO screens on’. Involve your family 
5. Increase your activity, be active most days of the week. Walking the dog, biking, Zumba classes, backyard cricket. Anything you enjoy 
6. Ensure you have the facts, don’t be side tracked by myths
7. Eating out…Request sauces and dressings to be placed‘on the side’. You can enjoy the meal without adding a lot of extra energy on top.
8. Ramp up your fibre intake by choosinggrainy bread, brown rice (it’s delicious) and wholemeal flour in baking (I use ½ wholemeal and ½ white for most baking especiallyChristmas cake)
9. Enjoy Christmas and New Year parties – don’t miss the festivities but compensate for extra energy intake by extending your walk or being more careful about portion sizes
10. Alcohol – keep your intake in check by drinking sparkling water with lime/lemon juice after a glass of wine. Keep the situation under control by planning ahead – offer to be the driver so you don’t drink.

 Here’s looking forward to more positive messages about eating changes in 2016. 

Merry Christmas and Happy New Year. 

Hefty Kids a Growing Trend

An interview with Cathy for the New Zealand Herald.