Vitamins for Pregnancy and Breastfeeding

It is important for expecting mothers to ingest a nutritious diet during all stages of pregnancy for her own health as well as the health of the child. The diet should balance carbohydrates, fat and proteins with a variety of fruits and vegetables. Where dietary intake may be inadequate, some expecting mothers choose to take vitamin supplements to ensure adequate nutrient levels are reached throughout the stages of preconception, pregnancy and breastfeeding.

Vitamin Supplements with Significant Evidence of benefit

• Folic Acid

Vitamin Supplements with some evidence of benefit

• Omega 3 Fish Oil
• Iodine
• Iron
• Calcium
• Vitamin D

Folic Acid (Vitamin B9)

There is significant research to suggest that the risk of child being born with fetal neural tube defects including spina bifida can be significantly reduced by ensuring that the mother ingests 400ug or 0.4mg of Folic Acid per day before conception. Whilst it is possible to ingest this amount in foods like spinach, green vegetables, melon, hummus, eggs and fortified foods, some mothers choose to take a daily vitamin supplement to ensure this level of folic acid is consistently achieved.

For best results, Folic Acid levels should be at recommended daily level of 400ug for up to three months before conception and for up to three months after birth.

Folic acid should never be taken in doses greater than 1000ug or 1mg per day.

Omega 3 Fish Oil

The DHA and EPA found in Omega 3 Fish Oil plays a vital role in a pregnant mother's health and baby's development, yet 98% of women don't meet the recommended amount of Omega 3 in their diet.

Fish oil plays a special part in the development of baby's brain, nervous system and eyesight. It also helps reduce the risk of developing pre-eclampsia, pre-term labour and post-natal depression in expecting mothers.

It is recommended that women ingest at least 900mg of fish oil a day during pregnancy which is equivalent to one serving of salmon. It's important to note that Omega 3s lower blood pressure and should never be taken in large amounts at once.

Iodine

Research suggests that pregnant Australian women are only getting half the recommended daily amount of iodine that babies need for optimum brain development. Iodine deficiencies in the developing foetus may lead to stunted growth, diminished intelligence and retardation.

Pregnant mothers are recommended to ingest 200ug of iodine per day and recommended amount for breastfeeding mothers is 270ug. This may be taken in supplement form or by eating seafood or salt fortified with iodine.

Iron

During pregnancy, a women's blood supply increases to supply nutrition to the growing foetus. Iron deficiencies during pregnancies can lead to anaemia.

Pregnant women should eat lots of leafy vegetables, whole grains, dried fruits, legumes and meat to ensure she ingests sufficient levels of iron. If sufficient levels of iron are not reached through the diet, a doctor may prescribe supplements.

The recommended daily dosage of iron for pregnant women is 27mg.

Calcium

Calcium is important for maintaining the bone integrity of a pregnant women and for helping the skeletal development of the foetus. It is recommended that pregnant women ingest 1200mg of calcium per day by consuming dairy products or through supplementation.

Vitamin D

Vitamin D must be present in the body to support the absorption of Calcium. Women who see very little exposure to direct sunlight may require supplementation of 10ug of vitamin D per day.

Disclaimer

Healthy Comparisons does not give or purport to give any medical or healthcare advice and is not qualified to do so. You should not under any circumstances substitute qualified medical advice with information found in this fact sheet. The information contained in this fact sheet does not take into account the physical state, medical status or health requirements of any particular individual which are relevant to the proper diagnosis and treatment of any problem, condition or disorder. You should never use or act upon this information without first properly consulting, and seeking proper information and advice from, a qualified healthcare professional. Healthy Comparisons, its related companies and its licensors expressly disclaim all responsibility for and liability in respect of the accuracy of the information provided in the website, its improper application and the consequences of anyone's failure to obtain a proper medical examination and advice from a qualified healthcare professional in the relevant circumstances.

© HealthyComparisons.com.au 2008

Several Leading Australian Pregnancy Vitamins Lack Vital Nutrients

Most women are aware of the benefits that prenatal and pregnancy vitamins can bring for mother and child~. However, a recent independent review conducted by a panel of Australian Naturopaths has shown that some of Australia's leading^ prenatal and pregnancy vitamin formulas could be significantly improved.

Review panellist and Naturopath Eliza Finn of CBD Natural Health commented that "It appears that some leading Australian over-the-counter products misleadingly lack the quality and variety of vital ingredients necessary for optimal nutritional support for mother and developing baby. While most products contain high amounts of folate well known to be necessary during pregnancy, they often leave out important, synergistic and essential nutrients needed such as other B-group vitamins, Vitamin A, Vitamin E, Calcium, Zinc and Omega-3 fatty acids that are also important during this time. "

The results of the review have been published on Australian vitamin information website HealthyComaprisons.com.au. Website Director Kristy Lee added "There are some fantastic products on the market, however it's important to note that not all products offer the rainbow and/or dosages of ingredients necessary to support their intended benefit. Expecting mothers should always research products well or consult a health professional before making purchases that affect mother and baby's health."

"HealthyComparisons.com.au not only provides important information about vitamins for expecting mothers, but provides product comparisons and reviews for 33 different health categories including Arthritis, Multivitamins, Menopause, PMS and even Weight Loss."

"Whilst the vitamin information and reviews do not replace the personal advice of a qualified health professional, they go some way towards ensuring that there is independent information available for Australian consumers".

For more information on the reviews and to meet the vitamin review panel, visit HealthyComparisons.com.au.

• ~Vitamin supplements may only be of assistance where dietary intake is inadequate.
• ^Top 16 Pregnancy vitamins as ranked by National Pharmaceutical Retail Sales Volumes provided by Synovate Aztec were reviewed.

Disclaimer

Healthy Comparisons does not give or purport to give any medical or healthcare advice and is not qualified to do so. You should not under any circumstances substitute qualified medical advice with information found in this fact sheet. The information contained in this fact sheet does not take into account the physical state, medical status or health requirements of any particular individual which are relevant to the proper diagnosis and treatment of any problem, condition or disorder. You should never use or act upon this information without first properly consulting, and seeking proper information and advice from, a qualified healthcare professional. Healthy Comparisons, its related companies and its licensors expressly disclaim all responsibility for and liability in respect of the accuracy of the information provided in the website, its improper application and the consequences of anyone's failure to obtain a proper medical examination and advice from a qualified healthcare professional in the relevant circumstances.

© HealthyComparisons.com.au 2008

Pregnant Women

This information is based on the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes, the Australian Dietary Guidelines, and The Australian Guide to Healthy Eating. These recommendations are for healthy women with standardised weight, height and estimated energy requirements and may not meet the specific nutritional requirements of individuals. Specific advice for individual needs should be sought from a qualified dietitian.

Healthy Eating Guidelines for Pregnant Women

The Australian Guide to Healthy Eating recommends the following servings per day:

• 4 - 6 servings from the bread, cereals, rice, pasta, noodles group.

An example of one serve is 2 slices bread; 1 medium bread roll; 1 cup of cooked rice, pasta or noodles; or 1 1/3 cups of breakfast cereal flakes.

There is an allowance of about 15g a day for poly or monounsaturated fats and oils that can be used to spread on breads or rolls or used elsewhere in the diet.

• 5 - 6 servings from the vegetables, legumes group.

An example of one serve is 75 grams of 1/2 cup cooked vegetables; 1/2 cup cooked dried beans, peas, lentils or canned beans; 1 cup of salad vegetables; or 1 small potato.

• 4 servings of fruit.

An example of one serve is 1 medium apple; 2 small pieces (150g) of fruit (apricots, kiwi fruit, plums); 1 cup of diced fruit pieces or canned fruit; 1/2 cup of fruit juice; or 1 1/2 tablespoons of sultanas.

• 2 servings from the milk, yoghurt, cheese group.

An example of one serve is 250 ml of milk; 250 ml of calcium fortified soy beverages; 40 grams (2 slices) of cheese; or 200g (1 small carton) of yoghurt.

• 1 1/2 servings from the meat, fish, poultry, eggs, nuts and legumes group.

An example of one serve is 65-100 grams cooked meat or chicken; 2 small chops; 2 slices of roast meat; 1/2 cup of cooked dried beans; 80-120 grams of fish fillet; 1/2 cup peanuts (almonds); or 2 small eggs.

Note: You get plenty of fats and oils from the amount used with cereal foods and from meat, eggs, cheese, peanut butter, margarine, etc so fats and oils aren’t included separately.

For more information check out the Australian Guide to Healthy Eating at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-pubhlth-strateg-food-recommend.htm

Energy requirements (kilojoules /day)

Energy requirements are increased with pregnancy to allow growth of the unborn baby and placenta.
For more information on energy requirements see a dietitian or follow this link to the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes

In a multiple pregnancy, where the mother is expecting twins or triplets for example, an even higher extra kilojoule intake is required.

Physical Activity

Doing regular physical activity has health benefits during pregnancy and also helps to prepare the body for childbirth. However, it is important to modify or choose a suitable exercise program because pregnancy affects the body's response to exercise

Be sensible about the level of physical activity undertaken. Consult a doctor, physiotherapist or health care professional to make sure the exercise routine is not harmful for pregnant women or unborn babies.

If the pregnancy is complicated (such as expecting multiples, having high blood pressure, heart disease, pre-eclampsia, or risk of premature births) it is best to talk to a doctor.

Healthy Eating for Pregnant Women

Healthy eating is important for pregnant women and their unborn babies. There are many nutritional issues to consider ensuring good health of both the woman and baby, during and after pregnancy. A wide varied diet is vital in supporting the growth and development of the foetus and the maintenance of the woman’s own health.

During pregnancy, there are increased requirements for most nutrients. Some of the important ones for discussion are:

• Energy (kilojoules)

• Iron

• Folate

• Zinc

• Vitamin C

Hormonal changes and the baby's growth during pregnancy may also affect the mother's response to food. Common concerns include:

• Constipation

• Morning sickness or nausea

• Indigestion

For the safety of the unborn baby, a pregnant mother should be mindful of:

• Listeria

• Mercury

• Alcohol

• Caffeine

• Artificial sweeteners

The Dietary Guidelines for Australian Adults are:

• Enjoy a wide variety of nutritious foods

  • Eat plenty of vegetables, legumes and fruits

  • Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain

  • Include lean meat, fish, poultry and/or alternatives

  • Include milks, yoghurts, cheeses and/or alternatives.
    Reduced-fat varieties should be chosen, where possible

  • Drink plenty of water

and take care to:

• Limit saturated fat and moderate total fat intake

• Choose foods low in salt

• Limit your alcohol intake if you choose to drink

• Consume only moderate amounts of sugars and foods containing added sugars

• Prevent weight gain: be physically active and eat according to your energy needs

• Care for your food: prepare and store it safely

• Encourage and support breastfeeding

For individual nutrient requirements such as those described below, the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes provides an average nutrient intake requirement for individuals and a value that would meet the needs of most individuals in the population. Because it is difficult to assess an individual’s exact requirement for a particular nutrient, you might like to aim for the upper figure to maximise the certainty that a sufficient amount of the nutrient is obtained from food. For more information go to Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes

Healthy Weight Gain

A healthy weight gain during pregnancy can vary between individuals and may depend, for example on the pre-pregnancy weight of the mother. It may be suitable for overweight women to gain less weight during pregnancy than women who are a healthy weight, as long as nutrient requirements of the mother and unborn baby are met. Women who are underweight should aim to gain more. Specific advice for individual needs should be sought from a qualified dietitian or health professional.

Healthy weight gain is mostly seen in the second and third trimesters (after the first 3 months) of pregnancy. This is the time of pregnancy when mother's energy (kilojoule) requirements increase. However, it is best to focus on food quality rather than quantity to meet the nutritional needs in pregnancy. There is no reason to increase food quantity to the point of ‘eating for two’ as this is likely to lead to extra weight gain.

Pregnancy is not a suitable time to be dieting or trying to lose weight. Dieting can have a negative impact on the unborn baby.

Iron

Pregnancy can deplete a mother's iron stores. Therefore, it is important to have an appropriate intake of iron to help build and maintain these stores. Low iron levels in early pregnancy have been linked to premature birth and low birth weight.

The average requirement for iron in pregnancy is 22mg/day but some women will need 27mg/day or more. A mixed diet of animal and plant foods can help you achieve your iron intake. Absorption of iron is better from animal foods compared to plant sources and the recommended dietary intakes are based on a mixed western diet.

Red meat is the best source of iron as well as also being a good source of protein and zinc. Other meats like chicken and fish also contain iron but not as much as red meat. Iron can also be found in leafy green vegetables, legumes and iron-enriched breakfast cereals.

Adding a glass of fruit juice or other foods rich in vitamin C (such as tomato, broccoli or capsicum) to a meal will increase the amount of iron the body absorbs. In contrast, tea, coffee and unprocessed bran can inhibit iron absorption.

Some women may benefit from taking an iron supplement if they are iron deficient, but it is best to take them according to your doctor' advice as supplementation may cause symptoms like constipation and be harmful in excessive amounts.

Folate

Folate is a B vitamin that is needed for healthy growth and development. Its requirements are increased during pregnancy for normal growth of the unborn baby. Adequate folate intake helps to prevent birth defects in the baby, such as spina bifida.

The recommended intake of dietary folate for pregnant women is 600µg/day throughout pregnancy. However, to reduce the likelihood of neural tube defects in the baby, it is recommended that women consume an additional 400µg/day folic acid through a supplement or in the form of fortified foods for at least one month before and three months after conception in addition to consuming food folate from a varied diet. (It should be noted that the folic acid used in supplements or used to supplement foods is almost twice as potent as dietary folate from natural sources)

Women who have a family history of neural tube defects may benefit from higher levels of supplementation and should consult their doctor during the planning of the pregnancy or as soon as possible. The nutrition information panel on food packages indicates how much folate is in a food, especially if extra folate has been added to the food product.

Discuss folate supplementation with your doctor, as it is best to use a folate supplement especially designed for pregnancy. Trying to meet folate needs from a regular multivitamin and mineral supplement may mean you take higher than recommended levels of other vitamins and minerals in order to get enough folate.

Good sources of folate include leafy vegetables, whole grains, peas, nuts, avocados and yeast extracts (eg marmite, promite, vegimite etc).

For more information, http://www.foodstandards.gov.au/foodmatters/folate.cfm

Zinc

Zinc is a component of various enzymes that help maintain structural integrity of proteins and help regulate gene expression, so getting enough is particularly important for the rapid cell growth that occurs during pregnancy. The average requirement for zinc during pregnancy is 9mg/day but some women will need as much as 11mg/day or more. Zinc can be found in lean meat, wholegrain cereals, milk, seafood, legumes and nuts.

Vitamin C

The need for vitamin C is increased in pregnancy due to larger blood volume in the mother and the growth of the unborn baby. Vitamin C is important for the formation of collagen which is especially important in blood vessels.

The average requirement for vitamin C during pregnancy is 40mg/day but because of individual variation, some women may need 60mg/day or more. Excellent dietary sources of vitamin C include fruit and vegetables.

Fibre & Fluids

Some women experience constipation especially during the later parts of pregnancy. A high fibre intake combined with plenty of fluid is encouraged to help prevent this.

High fibre foods include wholegrain breads and cereal products, legumes, nuts, vegetables and fruit.

Multivitamin supplements

Apart from the recommended folate supplement, it is best to obtain nutrients from a healthy diet. Multivitamins not designed for pregnancy should be taken with care as there are dangers associated with excessive doses of nutrients such as Vitamins A, D and B6.

Morning sickness and Nausea

Morning sickness is a common symptom of early pregnancy and, in many cases, goes away by the end of the first 3 months. It is caused by changes in hormones during pregnancy and may make eating difficult. Although it is called 'morning sickness', nausea (with or without vomiting) can happen at any time of the day.

Morning sickness does not usually cause any problems for the unborn baby. However, if a pregnant woman experiences severe and ongoing vomiting, it is important to contact a doctor.

Some food and eating suggestions that may help manage symptoms of morning sickness or nausea include:

• Eat smaller meals more often. Missing meals can make nausea worse.

• Avoid large drinks. Have frequent small drinks between meals.

• Limit fatty, spicy and fried foods.

• Food has a stronger odour or smell when it is heated, which may make nausea worse. If possible, have other people help with cooking, or prepare your food at times of the day when you feel better

• Try eating a dry biscuit before you get out of bed in the morning.

• Eat a healthy snack before you go to bed at night. This might include fruit (fresh, tinned, dried), crackers with hard cheese, or yoghurt.

• Avoid foods if their taste, smell or appearance makes you feel sick.

If vomiting, it is important to drink enough fluids. It may be easier to have lots of small drinks than to try and drink a large amount in one go. Try a variety of fluids such as water, fruit juice, lemonade and clear soups. Sometimes it can be helpful to try crushed ice, slushies, ice blocks, or even suck on frozen fruit such as grapes or orange segments.

Note: The stomach acids in vomiting can soften teeth enamel. It is best not to use a toothbrush to clean the teeth straight after vomiting as this may damage them. Have a drink of water to clean your mouth.

Indigestion

A pregnant woman may experience reflux or indigestion as the unborn baby grows, because it places more pressure on the mother's internal organs, including the digestive system.

To manage symptoms of indigestion try to:

• Eat small meals and nutritious snacks often.

• Separate drinking from eating. Drink outside of meal times.

• Limit high fat foods and highly spiced foods.

Listeria

Listeria is bacteria carried in some foods that can cause an infection called listeriosis, and may lead to miscarriage if it is transmitted to the unborn baby.

The best ways to avoid listeria infections include hygienic preparation, storing and handling of food. Foods should be eaten fresh, or thoroughly cooked, or well washed if eaten raw (fruit and vegetables). Leftovers can be eaten if they have been refrigerated immediately and stored for less than 24 hours.

The foods most likely to carry the bacteria, increase the risk of infection and therefore should be avoided, include:

• Soft and semi soft cheeses eg, brie, camembert, ricotta, blue, feta

• Soft serve ice cream

• Unpasteurised dairy products

• Pate

• Chilled seafood

• Salads - fruit / vegetable eg. prepared, prepackaged, smorgasbord/ salad bars

• Cold meats, including chicken eg. deli, sandwich bars, and packaged ready-to-eat

For more information, http://www.foodstandards.gov.au/_srcfiles/Listeria.pdf

Pregnant women need to be especially mindful of food safety.

Healthy tips:

• Always wash hands before preparing or serving food and after handling animals or visiting the toilet

• Animals can carry the toxoplasmosis parasite which can cause disease in humans so keep them out of the kitchen, avoid touching faeces and wear rubber gloves under garden gloves.

• Wash cook ware and utensils well after use

• Store raw foods down low in the fridge and check fridge temperature regularly

• Foods and left-overs that belong in the fridge should always be returned there as soon as possible

• Thaw frozen meats in the fridge

• Once cooked, pasta and rice should be stored in the fridge

• Look for "best before" and "use by" dates on packaged foods

Mercury

Advice in Australia about avoiding mercury poisoning, has been specifically developed for the Australian population. It is based on information about our diets, the fish we commonly eat and their mercury content.

Food Standards Australia New Zealand (FSANZ) advises pregnant women, and women planning pregnancy, to eat a variety of fish as part of a healthy diet. However, they should limit their intake of certain types of fish including:

• Shark (flake), broadbill, marlin and swordfish to 1 serve per fortnight (with no other fish to be consumed during that fortnight).

• Orange roughy (sea perch) and catfish to 1 serve per week (with no other fish being consumed during that week).

For more information http://www.foodstandards.gov.au/newsroom/factsheets/factsheets2004/mercuryinfishfurther2394.cfm

Alcohol

Drinking alcohol during pregnancy can affect the unborn baby by damaging the development of the baby's brain and slowing down physical growth. Babies affected by alcohol tend to have low birth weights. They may also have physical and behaviour problems at birth and throughout childhood.

It is not currently known what level of alcohol is safe to drink during pregnancy. Therefore, it is best to avoid drinking alcohol during pregnancy as much as possible.

Caffeine

Caffeine is a chemical found in many foods and drinks, including coffee, tea and cola. It affects the nervous system and can cause irritability, nervousness and sleeplessness.

While having large amounts of caffeine does not appear to cause birth defects, drinking high amounts of caffeine may make it more difficult to become pregnant and may increase risk of miscarriage.

It is best to limit the daily amount of caffeine to:

• 2 cups of coffee, or

• 4 cups of tea, or

• 4 cups of cola drink, or

• less than 1 cup of cola or energy drinks that contain extra caffeine.

Decaffeinated varieties are an option which contains little caffeine however safe levels of decaffeinated products for pregnant women are unknown. For more information about the caffeine content in food and drink, http://www.foodstandards.gov.au/foodmatters/caffeine/index.cfm

Artificial Sweeteners

The use of only some artificial sweeteners is considered to be safe during pregnancy. Food Standards Australia and New Zealand (FSANZ) has listed aspartame (marketed in food products as Equal, Hermesetas and Nutrasweet) and sucralose (Splenda) as safe to use during pregnancy.

Example of a Healthy Meal Plan for a Pregnant Woman

For this example we have based the daily energy requirement on a 28 year old, pregnant woman. Her height is about 1.6m and her weight is about 66kg in the middle of her second trimester of pregnancy. She works full-time in a predominantly standing occupation and participates in pregnancy exercise classes twice a week. Otherwise her level of physical activity is incidental around the home. Her daily energy requirement is about 11,300kJ. The meal plan is designed as a guide and meets recommended dietary intakes except for folate. The Nutrient Reference Values recommend an additional 400µg/day folic acid be taken as a supplement in addition to food sources for at least one month before and three months after conception. The meal plan is for a single day. The Australian Dietary Guidelines recommends eating a variety of foods every day to meet nutritional needs.

Energy Requirements (kilojoules/day)

• About 11,300 kJ/day ( cal/day)

Food	Quantity	Energy (kJ)	Protein (g)	Carbohydrate (g)	Fat (g)	Salt (Sodium, mg)
Breakfast
Muesli, untoasted, fortified	1 cup	1542	10.5	57.2	9.1	48
Milk, skim	½ cup	189	4.7	6.5	0.1	57
Canned peaches (natural juice)	10 slices	278	1.2	14.1	0	8
Wholemeal reduced salt bread	1 slice	330	3.5	13.4	0.7	80
Margarine, reduced salt	1 teaspoon	144	0	0	3.9	20
Jam	2 teaspoons	146	0	8.9	0	2
tea (black, no sugar)	1 cup	15	0.3	0	0.3	10
Nutritious Snack
Multigrain crackers	6 biscuits	608	2.2	17.9	7	195
Cheddar cheese, reduced fat	1 pre-packaged slice	288	6	0	5	151
Cucumber	8 slices	14	0.1	1	0	5
Apple & Pear juice, no added sugar	300ml	583	0.3	35	0	19
Lunch - Egg and salad sandwich
Wholemeal reduced salt bread	2 slices	583	6.2	23.7	1.2	141
Margarine, reduced salt	2 teaspoons	287	0	0.1	7.7	40
Boiled egg	1 large	372	7.8	0.2	6.4	73
Lettuce	1 med. leaf	3.3	0.1	0	0	2
Tomato	3 thin slices	30	0.5	0.9	0.1	3
Carrot, grated	1/3 cup	45	0.3	1.8	0	16
Apple, raw,unpeeled	1 large	473	0.6	26.1	0.2	2
Water	300ml	0	0	0	0	0
Nutritious Snack
Dried apricots	6 halves	188	0.9	9.3	0	8
Flavoured milk, chocolate	300 ml carton	671	15.6	21.6	1.6	97
Dinner - Beef and vegetable stir-fry
Beef, trimmed, cooked	110g	805	30.4	0	7.8	64
Almonds, cooked	1/5 cup	621	4.9	1.1	13.6	1
Spinach, cooked	1/2 cup	93	2.2	0.6	0.3	15
Corn, cooked	3 tablespoons	190	1.3	8.4	0.4	3
Green beans, cooked	1/3 cup	45	0.7	1.2	0.1	10
Carrot, cooked	1/3 cup	50	0.3	2.1	0	17
Oil, sunflower	2 teaspoons	340	0	0	9.2	0
Stir fry sauce	6 teaspoons	185	0.4	3.9	3	242
Rice noodles, cooked	1 cup	917	4.4	47.1	0.9	31
Water	300 ml	0	0	0	0	0
Nutritious Snack
Chocolate beverage base, fortified	4 teaspoons	107	0.9	4.1	0.7	20
Milk, reduced fat	1 cup	377	9.4	13	0.3	114
Wholemeal toast	2 slices	434	4.3	17.1	1.3	219
Peanut butter (no added sugar or salt)	3 teaspoons	487	5.2	1.5	9.7	0

Variation to energy expenditure depending on physical activity level for a women 28 years, about 1.6 m in height, weighing about 66 kg in second trimester

Lifestyle/Exercise level	Energy requirement (kJ/day)
At rest, exclusively sedentary or lying (chair-bound or bed bound)	8,000 kJ/day
Exclusively sedentary activity/seated work with little or no strenuous leisure activity, eg office employees	9,100-9,650 kJ/day
Sedentary activity/seated work with some requirement for walking and standing but little or no strenuous leisure activity eg drivers, students	10,200-10,750 kJ/day
Predominantly standing or walking work eg housewives, salespersons	11,300-11,900 kJ/day
Heavy occupational work or highly active leisure eg construction workers, high performance athletes.	12,500-13,600+ kJ/day

© Commonwealth of Australia 2005

Healthy Eating - Breastfeeding Women

This information is based on the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes, the Australian Dietary Guidelines, and The Australian Guide to Healthy Eating. These recommendations are for healthy women with standardised weight, height and estimated energy requirements and may not meet the specific nutritional requirements of individuals. Specific advice for individual needs should be sought from a qualified dietitian.

Healthy Eating Guidelines for Breastfeeding Women

The Australian Guide to Healthy Eating recommends the following servings per day:

• 5 - 7 servings from the bread, cereals, rice, pasta, noodles group.

An example of one serve is 2 slices bread; 1 medium bread roll; 1 cup of cooked rice, pasta or noodles; or 1 1/3 cups of breakfast cereal flakes.

There is an allowance of about 20 g a day for poly or monunsaturated fats and oils that can be used to spread on breads or rolls or used elsewhere in the diet.

• 7 servings from the vegetables, legumes group.

An example of one serve is 75 grams or 1/2 cup cooked vegetables; 1/2 cup cooked dried beans, peas, lentils or canned beans; 1 cup of salad vegetables; or 1 small potato.

• 5 servings of fruit.

An example of one serve is 1 medium apple; 2 small pieces (150 g) of fruit (apricots, kiwi fruit, plums); 1 cup of diced fruit pieces or canned fruit; 1/2 cup of fruit juice; or 1 1/2 tablespoons of sultanas.

• 2 servings from the milk, yoghurt, cheese group.

An example of one serve is 250 ml of milk; 250 ml of soy milk; 40 grams (2 slices) of cheese; or 200 g (1 small carton) of yoghurt.

• 2 servings from the meat, fish, poultry, eggs, nuts and legumes group.

An example of one serve is 65-100 grams cooked meat or chicken; 2 small chops; 2 slices of roast meat; 1/2 cup of cooked dried beans; 80-120 grams of fish fillet; 1/2 cup peanuts (almonds); or 2 small eggs.

Note: You get plenty of fats and oils from the amount used with cereal foods and from meat, eggs, cheese, peanut butter, margarine, etc so fats and oils aren't included separately.

For more information check out the Australian Guide to Healthy Eating at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-pubhlth-strateg-food-recommend.htm

Energy requirements (kilojoules / day)

The energy needs of a breastfeeding mother are increased because of milk production. In fact, the energy requirements for breastfeeding mothers are, on average, 2,000 kJ (445 kCal) per day more than that of a usual adult woman's daily energy needs. These energy requirements are based on full breastfeeding in the first 6 months and partial breastfeeding after that time.

While it is normal (and expected) that mothers put on weight while pregnant, it is not recommended that mothers follow a weight loss diet after childbirth. Breastfeeding naturally allows for gradual weight loss. If you gain weight after birth, it is most likely that you are eating too much food, or choosing foods that are high in energy (kilojoules).

Note: Because there is individual variation in milk production, levels of physical activity and weight loss during lactation, it is difficult to make an exclusive recommendation on energy needs during breastfeeding.For individualised advice, please consult a dietitian.

Physical Activity

Regular, moderate physical activity is good for health. It appears that most breastfeeding women can participate in some exercise without affecting their lactation. However, it is important to note that sometimes, if feeding straight after exercise, a baby may appear unsettled during feeding due to lactic acid in the breast milk. This does not hurt the baby and usually the lactic acid levels drop within two hours.

It is best to combine exercise with balanced eating and adequate nutrition. It is also important to drink plenty of fluids when breastfeeding and exercising. On a rare occasion, a breastfeeding mother may find she needs to limit her exercise so that her milk supply does not drop.

Benefits of Breastfeeding

The Australian Dietary Guidelines strongly recommend breastfeeding. Breast milk is natural and especially 'designed' for the human baby. It has many health benefits for the baby and also the breastfeeding mother.

Mother

• Breastfeeding helps in the physical recovery from childbirth.
• Breastfeeding helps the mother in weight stabilisation after pregnancy and childbirth.
• Breastfeeding may possibly also reduce the risk of some cancers, such as breast or ovarian cancer.
• Bonding happens between the mother and baby during breastfeeding.
• Breast milk is inexpensive and does not need to be prepared.

Baby

• Breast milk provides all the nutrients a baby needs for at least the first 6 months of life. For the following 6 months, breast milk continues to be an excellent source of nutrition when combined with other suitable foods.
• Breast milk is dynamic and living. It constantly changes in its nutrient composition to meet the needs of the baby throughout different times of feeding.
• Breastfeeding provides protection against disease later in life. It helps boost the immune system to fight illness and infections. The baby is also less likely to develop allergies.
• Breastfeeding reduces the likelihood of later diseases and health risks including obesity, diabetes, heart disease and some childhood cancers.
• Breast milk is ready when your baby needs it.
• Breast milk is hygienic.
• Babies digest breast milk easily.
• Breast milk contains a lot of natural substances that help a baby's development and growth.

Healthy Eating for Breastfeeding Women

Breastfeeding mothers have a slightly increased requirement for most nutrients compared to mothers who do not breastfeed as many vitamins and minerals in a breastfeeding mother's diet are transferred into the breast milk. Therefore, it is important for the mother to eat adequately for her own nutrition combined with the nutrition of her baby. A breastfeeding mother should eat regular nutritious meals and snacks to meet the extra energy (kilojoules) needed for making breast milk and feeding. Consuming a variety of foods each day is important in meeting both the mother's and baby's nutritional needs.

The Dietary Guidelines for Australian Adults are:

• Enjoy a wide variety of nutritious foods
• Eat plenty of vegetables, legumes and fruits
• Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain
• Include lean meat, fish, poultry and/or alternatives
• Include milks, yoghurts, cheeses and/or alternatives.
  Reduced-fat varieties should be chosen, where possible
• Drink plenty of water

and take care to:

• Limit saturated fat and moderate total fat intake
• Choose foods low in salt
• Limit your alcohol intake if you choose to drink
• Consume only moderate amounts of sugars and foods containing added sugars

• Prevent weight gain: be physically active and eat according to your energy needs
• Care for your food: prepare and store it safely
• Encourage and support breastfeeding

For individual nutrient requirements such as those described below, the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes provides an average nutrient intake requirement for individuals and a value that would meet the needs of most individuals in the population. Because it is difficult to assess an individual's exact requirement for a particular nutrient, you might like to aim for the upper figure to maximise the certainty that a sufficient amount of the nutrient is obtained from food. For more information go to http://www.nhmrc.gov.au/publications/_files/n35.pdf

The nutrients of particular concern during breastfeeding are:

• Protein
• Folate
• Zinc
• Vitamin A
• Vitamin B6

Protein

A breastfeeding mother needs additional dietary protein to build the protein in her breast milk. Protein is vital for the growth, maintenance and repair of cells. The average requirement for protein during breastfeeding is 54 g/day but because of individual variation, some mothers will need 67 g/day or more. Protein is found in a wide range of foods such as meat (including fish and poultry), eggs, dairy, legumes (such as beans, pulses and soy products) and nuts. Smaller amounts of protein are found in grain-based foods such as bread and pasta.

Folate

Folate is a B vitamin that is needed for healthy growth and development. On average, breastfeeding mothers require 450 µg/day of folate but some will need as much as 500 µg/day or more. Folate can be found in leafy vegetables, wholegrains, peas, nuts, avocado and yeast extract (eg promite, vegemite, marmite etc).

Zinc

Zinc is a component of various enzymes that help maintain structural integrity of proteins and help regulate gene expression. Breastfeeding mothers require on average 10 mg/day of zinc but some will need 12 mg/day or more. Zinc can be found in lean meat, wholegrain cereals, milk, seafood, legumes and nuts.

Vitamin A

Vitamin A is vital for normal growth and helps provide resistance to infections. Breastfeeding mothers require on average 800 µg/day of Vitamin A but because of individual variability some will need 1,100 µg/day or more. Vitamin A can be found in milk, cheese, eggs, fatty fish, yellow-orange vegetables and fruits such as carrots, pumpkin, mango, apricots, and other vegetables such as spinach and broccoli.

Vitamin B6

Vitamin B6 is important for the metabolism of protein and the formation of red blood cells. Breastfeeding mothers require on average 1.7mg/day of Vitamin B6 but some will need 2 mg/day or more. Vitamin B6 can be found in muscle and organ meat, poultry, fish, wholegrains, brussel sprouts, green peas and beans.

Water (Fluids)

Breastfeeding mothers should drink an additional 700 ml/day (at least) above non-lactating requirements to replace the fluid lost through breastfeeding. This equals to a total of 9 cups daily, and can be in the form of water, milk, juice and other drinks (avoid alcohol and limit caffeine-containing fluids, such as coffee, tea and cola). However, pure water should be everyone's main drink.

It may be helpful to have a drink at the time of each breastfeed, as well as drinking regularly throughout other times of the day.

Foods that may adversely affect a breastfed baby

Some foods that breastfeeding mothers eat or drink can affect the baby:

• Alcohol
• Caffeine
• Spicy and other possible irritating foods

Alcohol

The level of alcohol in breast milk is almost the same as a mother's blood alcohol level. It appears that an occasional drink of alcohol is not harmful. However, it is advised to have minimal amounts of alcohol when breastfeeding a baby, especially in the first three months. Ways to limit the baby's exposure to alcohol also include choosing low alcohol drinks, eating before and while drinking, and avoiding breastfeeding for two to three hours after drinking, or choosing to have an alcoholic drink immediately after breastfeeding.

Drinking alcohol in large amounts or very often can be dangerous for the baby. An intoxicated mother should not breastfeed. High intakes of alcohol may affect the mother's ability to look after her baby and increases her risk of developing depression. Large quantities of alcohol have also been seen to displace good nutrition.

Caffeine

Some breastfeeding mothers report that their baby is unsettled, irritable, or even constipated if they drink large volumes of coffee, strong tea, or cola. However, there appears to be individual variation in how much caffeine is found in breast milk after having a high caffeine drink.

Poor milk supply may sometimes be related to caffeine intake. Caffeine can also affect the nutrient make up of breast milk. The iron levels in the breast milk of a woman who drinks more than three cups of coffee a day during pregnancy and the early phases of breastfeeding, are one-third less than that of a mother who does not drink coffee.

It is advised that during breastfeeding, caffeine consumption should be limited to 2 to 4 cups of coffee, tea or cola per day.

Note: It has been found that cigarette smoking compounds the effects of caffeine in breastfed babies.

For more information about the caffeine content in food and drink:

• http://www.foodstandards.gov.au/whatsinfood/caffeine/
• http://www.breastfeeding.asn.au/bfinfo/drugs.html

Spicy and other Irritating Foods

Some breastfed babies may get upset or unsettled if their mothers eat a lot of rich or spicy foods, or particular fruits or vegetables. If suspicious that a food being consumed is affecting the baby, stop eating it for a few days. If the baby settles down, try the food again to see how it affects the baby. It may be helpful to avoid that food if the baby becomes unsettled again. It is advisable to speak with a dietitian or nutritionist for further advice if avoidance of several different foods is occurring.

How long should a mother breastfeed?

Exclusive breastfeeding is recommended for the first six months of a baby's life. After this period, further breastfeeding is recommended to supplement the baby's nutrition while the baby is gradually introduced to solid foods.

For further information on how long to breastfeed, and when and how to wean http://www.breastfeeding.asn.au/bfinfo/weaning.html

Example of a Healthy Meal Plan for a Breastfeeding Woman

This example is based on a 33 year-old woman, fully breastfeeding. Her height is about 170 cm, and maintains regular moderate exercise including walking her baby in a pram as well as running after her other children (aged 2 and 4). She is not employed outside the home. Her energy requirements are about 12,300 kJ per day.

Variation to Energy Expenditure depending on Physical Activity Level for a 33 year old breastfeeding woman, about 1.7 cm in height.

© Commonwealth of Australia 2005

Is poor thyroid function impacting your fertility?

If you have been unsuccessfully trying to get pregnant for more than 6 months, before you embark on invasive medical procedures and spend thousands of dollars for assisted reproductive technology, ensure that your thyroid is functioning at its optimum.

Many women don't realize that good thyroid function is necessary for fertility, the ability to conceive and to maintain a pregnancy.  An under (or over) functioning thyroid can prevent you from achieving that much desired pregnancy.  While there are many and varied reasons for infertility, suboptimal thyroid function may be that "missing link" especially for those with no specific reproductive problems.

A full thyroid evaluation is essential, and should be done as soon as possible for any woman who wants to get pregnant, especially if she –

• Has been trying unsuccessfully to get pregnant for more than 6 months
• Has had two or more miscarriages
• Has an irregular menstrual cycle
• Has any family history of thyroid problems.

What Does the Thyroid Gland Do?

The thyroid gland is located near the front of the throat, just below the voice box & just above the collar bones. Every cell in the body depends upon thyroid hormones for regulation of the body's metabolism, blood calcium levels, energy production, fat metabolism, oxygen utilization, balance of other hormones & weight maintenance.

Hormones involved with thyroid function include Thyroid Releasing Hormone (TRH) released from the hypothalamus in the brain, which stimulates the pituitary gland at the base of the brain to release Thyroid Stimulating Hormone (TSH) which in turn stimulates the thyroid gland to produce Thyroxine (T4) & Triiodothyronine (T3).  Much of T4 is converted to T3 (the active form) in the liver.  Thyroid hormones are synthesized from iodine and the amino acid Tyrosine (from protein), and the conversion to the active form is reliant on the trace mineral Selenium.

Healthy Thyroid function can be affected by –

• Exposure to environmental toxins – electromagnetic radiation, chemicals, pesticides, heavy metals e.g. mercury & fluoride
• Genetic susceptibility
• High levels of stress
• Nutrient deficiencies
• Autoimmune disorders
• Infections
• Other hormone imbalances e.g. oestrogen dominance, high prolactin levels

How Does Hypothyroidism (Low) affect fertility?

Anovulatory cycles – not releasing an egg / ovulating.  This makes pregnancy impossible.

Luteal Phase Problems –  With a short second half of the menstrual cycle a fertilized egg can't implant securely and ends up leaving the body at the same time that menstruation would occur (very early miscarriage) & is often mistaken as a regular period.

High Prolactin Levels – due to elevated levels of Thyroid Releasing Hormone (TRH) and low levels of Thyroxine (T4) resulting in irregular ovulation or no ovulation.

Other Hormonal Imbalances – reduced sex hormone binding globulin (SHBG), oestrogen dominance, progesterone deficiency, all of which interfere with proper reproductive hormone balance.

Your check list for thyroid assessment:

1. Do you have any of the common signs & symptoms associated with low thyroid function?

• Inability to conceive / infertility
• Miscarriage
• Menstrual irregularities
• Period pain
• Low libido
• Lethargy & fatigue
• Susceptibility to the cold / cold hands & feet
• Inability to lose weight
• Changes in texture of skin, nails, hair, hair loss
• Recurrent infections
• Constipation

2.  Is your basal temperature consistently below 36.5° C? Take your oral temperature at rest first thing in the morning before moving out of bed for 7 -10 days in the first 14 days of your cycle.  Your temperature should be between 36° and 37° C but ideally above 36.5°C.

3.  Blood Tests - For full thyroid assessment you require readings for TSH, T4, T3, rT3 & Thyroid Antibodies.  TRH may also be required.  For optimum fertility, your TSH level should be between 1 and 2.  Your doctor or naturopath can order these tests for you.

4.  Urinary Iodine - Iodine is a key component of thyroid hormone.  Excessive iodine as well as a deficiency of iodine can result in low thyroid function.  Your doctor or naturopath can order this test for you.

5.  Diet & Lifestyle - Our modern western diet is a major contributor to increasing thyroid health problems. Foods detrimental to thyroid health include refined grains, simple sugars, soy products, peanuts & peanut products, caffeine, hydrogenated oils, cigarette smoking and alcohol.  Excessive consumption of vegetables such as cabbage, broccoli, turnips, Brussels sprouts have the ability to block the absorption of iodine.

Exposure to heavy metals e.g. mercury (amalgam fillings) and fluoride (water supply, toothpaste) may also be detrimental.

Stress management is imperative.  Stress results in elevated levels of cortisol, the main hormone released by the adrenal glands.  Increased cortisol will inhibit the conversion of T4 to the active T3 hormone.

Exercise is beneficial as it will stimulate thyroid hormone secretion and increases tissue sensitivity to thyroid hormones.

Treating thyroid function is not a magic cure for all fertility issues but I have found that for many women, once thyroid health has been improved, their fertility issues were resolved and they have gone on to have a healthy pregnancy and enjoyed the treasures of motherhood.

If you suspect that less than ideal thyroid health may be contributing to your fertility difficulties or just impinging on your health generally, take action now!

Want to know more?

Email chris@christinesullivan.com.au Visit www.christinesullivan.com.au Call 07 3857 8515

Christine Sullivan is one of Brisbane's leading Naturopaths in the field of natural fertility, women's health, preconception care, pregnancy, family, infant and child health.

With qualifications in Naturopathy, Herbal Medicine, Nutrition Medicine and Natural Fertility Management as well as more than 20 years of clinical experience, Christine seeks to provide excellence in nutrition medicine and natural health care through supporting, informing and educating women of all ages to achieve optimum health.

Parenting begins before conception - The importance of preconception health care.

The birth of a child is a time of great joy and one of life's most profound experiences.  This joy is increased when there are no adverse outcomes and both mother and baby have come through a trouble free and healthy pregnancy, birth and infancy.

I have been professionally involved with mothers and babies for over 30 years now and, as a naturopath, have been treating couple with fertility problems for the past 22 years.  While I am increasingly concerned at the number of couples now needing assistance in this area, I have also had the incredible privilege of being able to help so many couples in their quest for a health pregnancy and have been able to share in their joy with the arrival of a healthy baby.

In the last few decades there has been a worrying increase in reproductive health problems and infertility.

Recent research shows that  –

The incidence of infertility has tripled during the last 30 years –

• One couple in six now considered to be infertile
• One woman in five will have a miscarriage
• One woman in three will suffer some degree of post natal depression
• One baby in ten is born prematurely
• One child in thirty will be born with some type of congenital defect
• One child in ten is likely to have either learning or behavioral problems
• One child in five is likely to develop asthma, allergies or recurrent infections

Unfortunately, the reasons for these alarming statistics are often dismissed with phrases such as "nobody really knows" or "it's just one of those things".  The thing is that nearly every aspect of your reproductive health is adversely affected in some way by 21^st century living conditions, diet and lifestyle!

The good news is:--

The combined evidence of many eminent researchers has shown that conditions such as sub fertility miscarriage, poor foetal health, breast-feeding difficulties, behavior & learning problems, allergy and poor immunity are preventable and treatable with sound preconception health care programs which are then combined with continued healthcare throughout pregnancy.

What is preconception care?

• A program for both prospective parents aimed at increasing the likelihood of conception, improving your pregnancy outcomes and optimizing the health of your baby.
• Focus is on restoring optimum health and, in the case of infertility, to address and remedy the causes of your problem rather than just override it.
• Aims at ensuring an adequate supply (through diet, lifestyle & supplementation) of all essential nutritional factors known to be vital for the health of your sperm and ova and for optimum foetal development
• Reduces exposure (through lifestyle changes, environment, detoxification) to those factors known to compromise your  health in general and are harmful to sperm, ova and foetal development
• Begins at least four months prior to intended conception to ensure health of sperm and ova (take 100 -116 days to generate and mature) is optimal well before conception.
• Is achieved through the use of natural medicines such as nutritional supplements, individualized herbal formulations, education re dietary and lifestyle changes, cycle charting and timing techniques.

Who should use preconception care programs?

• Anyone considering a pregnancy
• Those couples experiencing difficulties with fertility
• Those couples using assisted reproductive technology e.g. IVF etc.  Recent studies have shown that good preconception nutritional health care will more than double chances of success
• Those with family histories of allergy or other health issues
• Those couples who are not infertile but would like to improve general health, have a trouble free pregnancy, delivery, breastfeeding experience and to give their child the healthiest start to life.

How can you learn more?

For further details regarding a comprehensive natural approach to fertility and preconception care visit www.christinesullivan.com.

The natural way to a better pregnancy and breastfeeding experience

While overjoyed at being pregnant, many mothers-to-be are searching for safe and effective natural solutions to common pregnancy discomforts.

Early pregnancy

Morning sickness is often one of the first symptoms of pregnancy, and taking Ginger in the first trimester of pregnancy can often relieve this discomfort. Sip it as a tea or take it in capsule form to get you through this difficult stage.

Expectant mothers also report feeling excessively tired during the early weeks of pregnancy. Unfortunately the options are limited, except to rest whenever possible. Spirulina, a plant algae that is considered safe to take in pregnancy, contains a rich source of nutrients that can help to increase energy.

Last trimester

Heartburn and acid reflux commonly occur in the later stages of pregnancy. This is due to the hormone progesterone relaxing the valve at the top of your stomach, causing a small amount of stomach acid, sometimes with partially digested food, to surge upwards into your oesophagus.

Eating small meals more frequently will prevent your stomach becoming overfull and pushing up under your diaphragm. If possible, try to eat your main meal at lunchtime and your evening meal early in the evening so that your body has time to digest your food before you go to bed. Avoid spicy, rich, fatty and fried foods or anything else that triggers the symptoms. Sugar, tea, coffee and certain food additives may also exacerbate heartburn. The herbal remedy, Slippery Elm, can help relieve heartburn during pregnancy.

Preparing your body for the birth is also important. Raspberry Leaf has along tradition of use and is again growing in popularity for its ability to tone and strengthen the muscles of the uterus in the last trimester of pregnancy. Raspberry Leaf should never be taken in the first or second trimester due to its stimulating effect on the uterus. A study undertaken by midwives at Westmead Hospital in Sydney in 2000 demonstrated the safety of Raspberry Leaf (2.4 g daily) taken from 32 weeks until the commencement of labour. The study identified no side effects for mother or baby, and also suggested that Raspberry Leaf reduced the incidence of artificial rupture of membranes, forceps and ventouse births. Taking Raspberry Leaf shortened the second stage of labour by an average of 10 minutes but made no difference to the length of the first stage of labour.

Stretch marks

This unpopular consequence of pregnancy develops as a result of the skin being excessively stretched. While there is no foolproof method for preventing stretchmarks, massaging your expanding belly with pregnancy body oils can greatly reduce the likelihood of their occurrence. Eating a well-balanced, healthy diet rich in nutrients such as phytochemicals, essential fatty acids, vitamins and minerals is thought to help maintain strong and healthy skin, and may also help prevent stretch marks. Vitamins A, C and E and the minerals zinc and silica in particular may assist in the formation of collagen, helping to make your skin more elastic so it can stretch better and bounce back quicker after the birth.

Some recent research has tried to link stretch mark formation to a group of steroids called glucocorticoids. The most common glucocorticoid is cortisol.Aim to reduce stress in your pregnancy as much as possible. The best anti-stress nutrients are magnesium and B Complex

Breastfeeding

Although there is no argument that 'breast is best', in reality it is not always possible to produce sufficient milk. However one herb may provide a simple and natural solution. Blessed Thistle has been used traditionally since the 1500s to boost maternal milk production. This bitter liver herb, a reputed 'heal-all', can also stimulate a weak appetite, therefore having a positive effect via mother's milk on babies who are poor feeders.

If you are breastfeeding, remember to drink lots of fluids (at least two litres of filtered water daily) and eat plenty of wholegrains, cereals, fresh fruits and vegetables, and foods that provide plenty of protein, calcium and iron. Eat nutritious snacks such as yoghurt, wholegrain sandwiches with tinned salmon, tuna or cheese, veggie sticks with hummus dip or fresh seasonal fruit. When the time is right for both you and your baby, the herb Sage is great for weaning. Sage is an anti-hydrotic herb, which means it has the ability to control excess glandular secretions. For most people this means drying up excessive sweat, but sage is equally as effective in drying up breast milk. Start by taking 400-500mg with a meal twice daily for a week. If your breasts still feel sore and engorged, you can increase the dosage to up to 2000g daily. If you have been gradually reducing your feeds you should not experience this kind of discomfort.

Always discuss with your healthcare professional the suitability of taking any herbs or supplements when pregnant or breastfeeding.

Infertility

Infertility, which affects as many as one in six people, is usually defined as the failure to conceive after a year of regular sexual activity during the time of ovulation. It may also refer to the inability to carry a pregnancy to term. Pinpointing the exact problem can be difficult. Ovulation, fertilisation, and the journey of the fertilised ovum through the fallopian tube and finally into the uterus are highly intricate processes. Many events must work together perfectly for pregnancy to occur.

Male Infertility. In 40 per cent of infertile couples, problems affecting the male partner are either partially or wholly the cause of infertility:
Deficient Sperm Production: Ninety per cent of male infertility is caused by the failure to produce enough sperm. Azzospermia occurs when no sperm is produced while oligospermia is diagnosed when a few sperm are produced. Since most sperm are destroyed before ever reaching the egg, the more sperm there are the better the chances that one will successfully fertilise the egg. Over the last few decades, sperm count has been declining steadily. Many studies have linked this alarming trend to our modern high-fat, nutrient deficient diet. Since sperm are highly vulnerable to free radical and oxidative damage, healthy sperm formation requires an adequate and ready supply of the proper nutrients and antioxidants. Other possible reasons for low sperm count include increased scrotal temperature, varococeles, environmental factors (pollution and exposure to heavy metals), and exposure to synthetic oestrogens.
Varicoceles: A varicose vein around one of the two spermatic cords can cause blood to pool in the testes. This, in turn, causes the temperature to increase in this area. Higher temperatures decrease sperm production and can lead to infertility.
Infections: of the reproductive organs such as Chlamydia trachomastis attack and destroy the sperm.
Ductal Obstruction: Blockage or damage to the spermatic tubes which is usually caused by a sexually transmitted disease, infections, or a congenital abnormality.

Ejaculatory Dysfunction: These disorders are characterised by the failure to deliver sperm to the vagina. Impotence, or the inability to maintain an erection for intercourse, can be caused by a high fat diet (fatty deposits clog the arteries in the penis), by drugs used to treat high blood pressure, and by the nerve damage caused by diabetes.

Female Infertility

For women, the most common causes of infertility include:

Polycystic Ovarian Disease: This disease is the most common cause of ovulation disorders in women and is characterised by the presence of many minute cysts in the ovaries, by excess production of androgens, and by infrequent periods (oligomenorrhoea) or absent periods (amenorrhoea). The failure to ovulate is the most common cause of female infertility.

Age: After the age of thirty-five the quality of your eggs begins to diminish, and it becomes harder to become pregnant and carry a foetus to term.
Pelvic Inflammatory Disease: This infection of the reproductive tract can lead to blocked or damaged fallopian tubes and is usually caused by sexually transmitted diseases, miscarriages, abortions, childbirth, or an intrauterine device.

Ovulatory Dysfunction: This occurs when a woman's ovaries are not producing eggs or producing fewer eggs than usual because of age, hormonal imbalances or other problems.

Uterine Fibroids: These benign uterine tumours occur in 40% of women and can interfere with embryo implantation of foetal growth.

Endometriosis: This occurs when the tissue which lines the uterus (endometrium) grows into growths or lesions outside of the uterus.

Pelvic Adhesions: These are usually caused by surgery or infection, and can occur when scar tissue forms between two or more internal organs. When this tissue affects the ovaries or fallopian tubes, infertility can result.

Nutrients
A healthy diet is crucial to a successful pregnancy and a healthy baby; many people are unaware of the fact that diet can help to correct hormone imbalances that may affect your ability to conceive. There are also certain foods and drinks that are known to lower fertility.

Vitamin A
Is important in reproductive gland function.

B Complex
It is now known that folic acid can prevent spina bifida in your baby, and it is essential that you get plenty both before and during pregnancy. The B-complex family of vitamins are necessary to produce the genetic materials DNA and RNA. Together with vitamin B12, folic acid works to ensure that your baby's genetic codes are intact. Research has shown that giving B6 to women who have trouble conceiving increases fertility and vitamin B12 has been found to improve low sperm counts.

Vitamin C and Bioflavonoids.
Important in sperm production. It enhances sperm quality, protecting sperm and the DNA within it from damage. It also keeps the sperm from clumping and makes them more motile. Pycnogenol or grape seed extract is a powerful antioxidant bioflavonoid that may increase sperm count

Vitamin E
Is needed for balanced hormone production. It is known as the 'sex vitamin' that carries oxygen to the sex organs and increases sperm count.

Selenium
Selenium is an antioxidant that helps to protect your body from highly reactive chemical fragments called free radicals. It can prevent chromosome breakage, which is known to be a cause of birth defects and miscarriages. Good levels of selenium are also essential to maximise sperm formation. Blood selenium levels have been found to be lower in men with low sperm counts.

Zinc
Is an essential component of genetic material and a deficiency can cause chromosome changes, leading to reduced fertility and an increased risk of miscarriage. Zinc is necessary for your body to utilise efficiently the reproductive hormones, oestrogen and progesterone. It is found in high concentrations in the sperm as it is needed to make the outer layer and tail of the sperm. Interestingly, several studies have also shown that reducing zinc in a man's diet will also reduce his sperm count.

Essential Fatty Acids
These essential fats have a profound effect on the reproductive system and they are crucial for healthy hormone functioning. For men essential fatty acid supplementation is crucial because the semen is rich in prostaglandins which are produced from these fats. Men with poor sperm quality, abnormal sperm, poor motility or low count, have inadequate levels of these beneficial prostaglandins.

L-Arginine
This is an amino acid found in many foods and the head of the sperm contains an exceptional amount of this nutrient, which is essential for sperm production. Supplementing with L-arginine can help to increase both the sperm count and quality.

L-Carnitine
This amino acid is essential for normal functioning of sperm cells. According to research, it appears that the higher the levels of L-Carnitine in the sperm cells, the better the sperm count and motility.

L- Tyrosine
Alleviates stress and aids in stabilising moods.
Also…
>> Dimethylglycine (DMG). Increases oxygen supply in the blood to all tissues.
>> Octacosanol. The heart of wheat germ. Aids in hormone production.
>> Phosphatidyl choline. Improves the transmission of messages from the brain to the genitals, thus increasing sex drive.
>> Acetylcholine increases sexual pleasure.
>> Manganese maintains sex hormone production.
>> Para-aminobenzoic acid (PABA) plays a role in restoring fertility in some women.

Herbs
>> Agnus Castus (Vitex or Chaste tree berry) is the herb of choice for helping to restore hormone imbalance and increasing fertility. It is particularly helpful for those women who have a luteal phase defect (shortened second half to the cycle) or those with high prolactin levels, because it stimulates the proper functioning of the pituitary gland which controls the hormones.
>> Astragalus extract has been reported to stimulate sperm motility.
>> Damiana, ginseng, sarsaparilla, saw palmetto, and yohimbe enhance sexual function in men.
>> Damiana, dong quai, false unicorn root, ginseng, gotu kola, licorice root, and wild yam root are good for women.
>> Green oat extract is an excellent aid if the reason for infertility is the man's inability to maintain an erection
>> Ying-yang-huo, a Chinese herb also known as horny goat weed is a male aphrodisiac, and may increase sperm count and semen density.
Recommendations

Alcohol
Drinking any alcohol at all can reduce male and female fertility by half - and the more you drink, the less likely you are to conceive. One study showed that women who drank less than 5 units of alcohol a week (equal to five glasses of wine) were twice as likely to get pregnant within six-months compared with those who drank more.

Research has also shown that drinking alcohol causes a decrease in sperm count, an increase in abnormal sperm and a lower proportion of motile sperm. Alcohol also inhibits the body's absorption of nutrients such as zinc, which is one of the most important minerals for male fertility.

Caffeine
There is plenty of evidence to show that caffeine decreases fertility. Drinking as little as one cup of coffee a day can halve your chances of conceiving. One study showed that problems with sperm: sperm count, motility and abnormalities, increase with the number of cups of coffee consumed each day. That includes colas, chocolate, and black teas.

Xenoestrogens
Xenoestrogens are environmental oestrogens, coming from pesticides and the plastic industry. When you are trying to conceive, one of the most important things you need to do is to balance your hormones. It is extremely important to avoid anything that might cause an imbalance, and one of the main culprits is the xenoestrogens. One of the best ways to eliminate an excess intake of xenoestrogens is to buy organic produce.

Smoking
Smoking has definitely been linked with infertility in women. It can even bring on an early menopause. Smoking can decrease sperm count in men, making the sperm more sluggish, and it can increase the number of abnormal sperm.

Stress
Infertility is stressful, but do all you can to reduce the stresses in your life.

Sperm
Sperm count reaches its highest level after two or three days of abstinence from any sexual activity, but sperm that remains in a man's body for longer than a month is less effective at fertilising an egg.

You need to take into consideration that you are unique. The above-mentioned suggestions are valid and will help everyone; however, you may have an additional concern that requires more selective care. You may have a hidden allergy or illness that contributes to your infertility. Seeing a qualified nutritionist, naturopath or holistic practitioner is well worth your investment of time and money. Good eating, good living and good luck! TT

© Samar Tarabay, Quest Nutritionist
For further information on the Quest range of products or for other nutritional information contact the Quest nutritionists on 0121 359 0056 or email nutrition@questvitamins.co.uk

What you need to know about: male fertility status, preconception health and pregnancy outcome.

Part 1. 

Last month I wrote about the importance of preconception health care – getting your bodies ready to conceive.  A healthy potential mum and dad mean healthy sperm, eggs and babies.

Women are more often the ones to take the initial steps to improve health prior to conception but my blog this month is focused on the GUYS (as well as the women who love and care for them!)

Until recently men's health and fertility status have often been overlooked when planning a pregnancy, preconception, and in the early stages of investigations regarding failure to conceive.  Recent medical research suggests that 6% of males are classed as "infertile" and somewhere between 40% and 90% of males have "deficient sperm production of unidentifiable origin".  It is certainly my experience in clinical practice that an increasing number of males have suboptimal fertility.

When you consider that the male contributes 50% of the genetic make up of his child and that 40% – 50% of human infertility is now attributed to male factors, optimizing fertility in men is obviously vital to achieving conception and improving pregnancy outcomes.  Studies are showing increasingly the impact of male health on all conception, foetal health and pregnancy issues.  Even miscarriage can be attributable to male factors.

The importance of optimum health of BOTH partners before conception cannot be emphasized enough.  At the instant that the sperm and egg combine, an irreversible blueprint is formed for the future development of that baby (who will grow into an adult and live for a minimum of 80 years – hopefully). The health of the sperm and egg at conception will reflect the health or toxicity of the environment (mum & dad's body) in which they have grown.

HEALTH OF THE LITTLE SWIMMERS!

While some cases of male fertility issues are due to anatomical abnormalities such as varicoeceles, ductal obstructions and such, it is estimated that 40-90% will be due to poor sperm production and quality secondary to specific nutritional and environmental factors.

Men produce around 2,000 – 4,000 sperm per second!  This amazingly busy job requires optimal nutrition and an absence of chemicals and toxins to ensure it is continued.  Sperm take around 115 or more days to develop and because they are so tiny and vulnerable, they are very easily damaged by heat, oxidants (free radicals), chemicals and radiation during this time.

These little guys need to 'fed' and protected properly with a nutrient dense diet and in some cases some nutritional supplementation.  Below is a list of some of the most vital nutrients for male fertility.  And then some means of assessing the health of sperm.

HOW IS MALE FERTILITY ASSESSED?

Traditionally, assessment of male fertility is via a semen analysis. 

Primarily, this looks at

• Volume of Semen – ideally 1.5 – 5ml.  Low volume may be due to dehydration.
• Viscosity - thick viscous semen may impair the journey of the sperm toward the egg.  Increased viscosity may be due to dehydration.  Increase neutral fluid intake and decrease alcohol & caffeine drinks that contribute to dehydration.
• Sperm count – how many million sperm per milliliter.  Ideally this should be at least 60-100 million per ml.  Less than 20 million is classed as infertile
• Motility – ability of sperm to swim forward rapidly (and reach their target!).  This is a good indication of the quality of the sperm.  A minimum of 50% should be moving rapidly in the one direction.  The higher the percentage of "rapidly motile" sperm the better.
• Morphology – the form of the sperm i.e. the amount of malformation.  Most labs accept 70-80% abnormal as ok.  Obviously the lower the percentages of abnormal sperm the better as abnormally formed sperm are less able to successfully penetrate and fertilise the egg.  Increased abnormalities can be due to nutritional deficiencies, toxic and free radical (oxidant) damage.
• Sperm Antibodies – May be assessed if there is a history of inability to conceive.  In a small number of men the immune system produces antibodies against the sperm themselves.  Sperm coated with antibodies will clump together and have difficulty moving and penetrating cervical mucus and the egg membrane.

Blood Tests – male reproductive hormones may be checked if infertility is suspected.

Thorough naturopathic and nutritional assessment covering diet, lifestyle and nutritional status will also give a good indication of fertility potential.

A period of 4 month's preconception care including improved diet and lifestyle, improved nutritional status, nutritional supplementation where required plus the use of various herbal formulations will increase male fertility dramatically.

Remember guys, you are 50% of the equation!

Undertaking a preconception health care program is the ultimate in preventive medicine and is one of the most loving and responsible choices a couple can make for their child's health.  What you do for a few months will have lifelong effects for you, your child and future generations.

Next month: Part 2: factors than can affect male fertility as well as more on diet and nutrients.

By: Christine Sullivan

• Visit www.christinesullivan.com.au
• Email chris@christinesullivan.com.au
• Call 07 3857 8515

Progesterone (bioidentical) Restoration - Nutrition & Environmental Medicine Fact File

About the Author

Dr Greg Emerson is the Founder and Medical Director of the Emerson Health and Wellness Centre which opened in October 2005. He is a consultant in Nutritional and Environmental medicine. He is also a senior specialist in Emergency Medicine and in Diving and Hyperbaric Medicine. For 18 years he practiced in several large public hospitals including a period of time as an Associate Professor of Emergency Medicine at a major trauma hospital in Canada and as the Director of a leading Diving and Hyperbaric Medicine Unit. He is a lecturer, examiner and current board member for the Australian College of Nutritional and Environmental Medicine and a past-examiner for the Australasian College of Emergency Medicine. A long personal battle with illness led him on a profound exploration of healing processes and the prevention of illness. He reappraised both his medical focus and the way he approached health care delivery.

He believes in the intrinsic ability of the body to heal itself if the underlying cause of the illness is addressed. His practice revolves around three core principles, in the belief that almost all non-traumatic illnesses will respond to these principles:

• Elimination of food and chemical sensitivities
• Alkalinisation and detoxification
• Balancing of hormones

Dr Emerson regularly lectures both within Australia and internationally on Nutritional and Environmental medicine. He also runs his own successful international medical conference. His mission is to provide people with the knowledge, tools and motivation to live a life of extraordinary health, vitality and longevity.

Problems in becoming pregnant    

Most women expect to become pregnant when they feel the time is right to have a baby. However, only about eight out of ten women will achieve a pregnancy within twelve months of trying, and about one in eight women have difficulties getting pregnant. Fertility drops, as you get older: it takes longer for a woman to become pregnant when she is more than 35 years old. There are many simple things that you can do to increase your chances of becoming pregnant. If these ideas do not help, reproductive medicine units can help in many different ways.

Problems that may reduce fertility or make it harder to become pregnant
What you can do to improve your chance of becoming pregnant
Why you should not smoke
Exercise regularly and eat a healthy diet to reach your ideal body weight
When should you get help?
How can you get help?
What services does a reproductive medicine unit provide?
Problems that may reduce fertility or make it harder to become pregnant

These symptoms or situations may indicate that you may have a problem getting pregnant:

Having irregular periods
Past pelvic infection
Unusual pain with intercourse or your periods
Endometriosis
Partner's surgery for delayed descent of testicles
When a couple are having trouble getting pregnant, about 40% of the time there is some problem with the woman, about 40% with the man, and in about 20% of couples there is no identifiable cause.

What you can do to improve your chance of becoming pregnant

You are most likely to become pregnant if you have intercourse around the time you ovulate, which is when an egg is released. If your menstrual cycle is regular, then you will usually ovulate around 14 days before your next period starts.

Some women can tell when they are ovulating because their cervical mucus becomes more plentiful and slippery. Some women also experience a sharp pain low down on one side of their stomach. Many women find that their libido (desire for sex) increases around the time they ovulate.

There are several simple steps that you can take to increase your chances of becoming pregnant, these include:

Become aware of your cycle so you 'get the timing right'
Stop smoking
Exercise regularly and moderately
Eat a healthy diet and lose some weight if you are overweight
Reduce coffee (and other caffeine drinks), alcohol and drugs
Reduce exposure to toxins, heavy metals, chemicals, organic solvents
Find ways to reduce stress and to relax
Try and get 6–8 hours sleep every night.
Stopping smoking and losing some weight if you are overweight are two of the most important steps you can take to improve your fertility. We have included more information about these lifestyle changes in the next two sections.

Why you should not smoke

Your baby deserves to begin their life without being exposed to smoke, either in your womb or in their home. Quitting smoking can improve your fertility and reduce the chance of many other problems.

Women who smoke have:

Three times as much infertility: it is directly related to the number of cigarettes you smoke
Poorer results with fertility treatments
50% Higher miscarriage rate
Earlier onset of menopause (the age when monthly periods stop).
Each cigarette you smoke while pregnant will reduce the blood flow to your uterus for one hour, resulting in less oxygen for your baby. Women who smoke have a higher rate of babies who have growth restriction in the uterus, more birth abnormalities and a higher rate of infant death.

To learn more about the fantastic health benefits of quitting, go to the section Avoid tobacco, drugs and alcohol. Smoking also causes problems in men: for their fertility, their health and the health of their children.

Men who smoke have:

A reduced sperm count
A higher risk of impotence (problems with erection)
Increased birth defects and higher rate of childhood cancers in their children
Increased asthma in their children.
If you have a partner who smokes he can improve his own fertility and health by quitting smoking at the same time as you. It's one of the most positive things you can do together in preparing for parenthood. When you are both non-smokers you will feel so good about yourselves and the fact that you are giving your future child the healthiest possible start in life.

Exercise regularly and eat a healthy diet to reach your ideal body weight

Your fertility will be best when you are close to your 'ideal' body weight - that is, not overweight and not underweight.
Overweight women have:

More ovulation problems
Reduced pregnancy and live birth rates
Medical complications and high blood pressure in pregnancy.
If you are overweight, you can improve your fertility by losing weight through regular exercise and by eating a healthy diet.

Research shows that overweight women who lose weight through exercise and a healthy diet have:

More regular ovulation
Increased pregnancy rates
Reduced miscarriage rates
Reduced birth defects in their babies.
Talk to your doctor, midwife or the staff at your community health centre for more information about healthy weight loss.

Underweight
Women who are underweight due to a heavy exercise program, very strict diets or other chronic health problems are also more likely to have fertility problems.

Reducing the amount of exercise done and eating a healthy and varied diet can both improve fertility.
If you have a chronic health problem, talk to your doctor to see if there are ways that your fertility can be improved even though you have this health problem.
When should you get help?

If you are a younger woman, you should give yourself 12 months before beginning to check why you are not pregnant. If you are over 35 years old, then six months of trying is probably long enough before getting help. It's important to remember that both you and your partner will need to have your fertility checked - this is not just a woman's problem. If you or your partner has any obvious problems, you may want to get help earlier than this.

Will you need IVF (in vitro fertilisation)?
There are many different forms of treatment to help fertility that including IVF (in vitro fertilization). These treatments might include laparoscopic surgery and treatment for ovulation problems. The treatment that is best for you or your partner will depend on what is causing your problem. Sometimes simple medicine will help.

How can you get help?

The first step is to see your own doctor who will ask you some questions, examine you and do some tests. Your doctor may then refer you for specialist treatment to a private obstetrician or to a reproductive medicine unit in one of the metropolitan hospitals. Staff at a reproductive medicine unit will work out a plan to help overcome your particular problems. Reproductive medicine units deal with all forms of infertility.

What services does a reproductive medicine unit provide?

The services offered by a reproductive medicine unit include:

A full medical check of both partners to work out the cause of infertility
A specialised plan for checking egg growth in women and possibly drug treatment
A range of surgery (laparoscopy, hysteroscopy and gynaecological surgery) for checking and treating female infertility
A specialised laboratory for checking male infertility.
Reproductive medicine units can help with many different types of reproductive technology options including:

IVF
Injection of selected sperm into eggs (ICSI)
Collection of sperm from the testis
Donor insemination
Freezing and storage of embryos and sperm.
Infertility is a physical, emotional and social condition that affects both partners. The staff at reproductive medicine units understands how infertility and fertility treatments can affect you and your relationship. For these reasons, the units offer specialised counselling before, during and after pregnancy.
Link to Reproductive Technology Site
 
Copyright 2002-2007 SA Department of Health   

Factors Affecting Male Fertility   -  Part 2

As I mentioned last month, men have often been overlooked during preconception preparation and fertility issues.  Research now shows that males have a vital contribution to a couple's fertility, the outcome of the pregnancy, the formation and health of their children.

There is a growing body of evidence showing an alarming decline in sperm counts and quality over the last 50 years.  Because this decline is so recent in terms of evolutionary history, it is clear that the combination of 21^st century environment, lifestyle and dietary factors are interfering with spermatogenesis.

The QUALITY of sperm is of utmost importance.  While you can test for numbers, motility, shape etc, sperm are not tested to see if they contain too many toxins or if they have sufficient nutrients to form a healthy embryo.  These days, in a few specific cases, sperm can be checked for DNA damage.

WHAT SORT OF THINGS AFFECTS A MAN'S FERTILITY?

Factors that can affect male fertility, sperm vitality, count, motility and morphology include:-

• Poor diet and nutritional status:  Diet is so critical.  Every mouthful must count. 

Diets high in refined, processed foods and empty calories and low in fibre, vegetables & protein will be nutrient deficient.  Nutrient deficiencies affect all semen and sperm parameters resulting in defective sperm, poor fertilization and fertility and an increase in poor pregnancy outcomes, impaired foetal and child health.

Research shows without doubt that a healthy lifestyle and a nutritious diet with adequate protein, complex carbohydrates, nutrient dense foods, "good" fats and one that is high in fresh fruit and vegetables provides a greater nutritional basis for health in both partners and can improve fertility, conception and foetal development as well as the health of your child well into adulthood.

Your body is made up of what you eat, digest, absorb & utilise and so your baby's body will be made from what both of you eat, digest, absorb & utilise for the 4 or more months before conception.

• Occupational and environmental toxins:  Exposure to  pesticides, herbicides, agricultural chemicals,  petrochemicals, plastics, xeno-oestrogens, radiation / X-rays, electromagnetic fields (computers, mobile & cordless phones), toxic heavy metals, petrol fumes, paints, glues, household cleaning chemicals & insecticides can have a devastating effect on male fertility.       Men are more often in toxic occupations.  Some examples of 'at risk' occupations include IT workers & CRT screen users, pilots, flight attendants, frequent flyers, dentists, radiographers, hairdressers, motor mechanics, farmers, builders, pest controllers and those working in manufacturing & in laboratories. Sperm are more vulnerable than ova.  Because they are so tiny, more exposed and develop entirely with in their present environment, they are very easily damaged by oxidants, chemicals and radiation during the 115 or so days of their development. Sperm count can be reduced either by direct effects on testicular function or by altering hormone systems.   If you are in any of these occupations take stringent measures to protect yourself from the toxins.  As well as improving all other lifestyle factors, increase antioxidant nutrient protection.   Testing for heavy metal toxicity and a thorough detoxification program can also be helpful.
• Infections:  Genitourinary infections such as Chlamydia, Candida and the like as well as other bacterial or viral infections.  These may affect the prostate or seminal vesicles.  White blood cells generated as a result of the infection damage sperm and the testes through the effect of oxidation and free radical production.  Hence good antioxidant nutrient status is vital.  Genitourinary tract infections have been shown to be responsible for infertility, miscarriage and foetal growth problems.

Have a thorough medical check well before considering conception to ensure you are free of all infection or give yourself plenty of time to have the infection treated and totally resolved several months before your conception attempt.

• Testicular Overheating:  Even an increase of 2° C in the testes is enough to kill sperm and reduce their production. Overheating, such as from high fevers, saunas, and hot tubs, saunas, being overweight & excessive exercise may temporarily lower sperm count. Persistent exposure to high temperatures during work may impair fertility. Resist excessive exercise, saunas, wet suits, bike pants, tight fitting underwear etc.  Wear loose fitting, natural fibre clothing while exercising and have a cool shower or bath immediately after.
• Prescription drugs:  Drugs that are prescribed to help manage and treat certain illnesses can sometimes have a negative effect on fertility e.g. antibiotics, blood pressure medications, antidepressants, anti-ulcer, anti-inflammatory and steroids are all families of prescription medications that may have a negative effect on sperm parameters, potency and fertility.  Some also deplete your body of vital nutrients.  Speak with your health care professional if you are taking any of these and are considering a conception.  There may be natural alternatives or supplements to counteract nutrient depletion.
• Recreational Drugs: Cocaine or heavy marijuana use can reduce the number and quality of sperm by as much as 50%.  Sperm actually have receptors for certain compounds in marijuana that decrease volume of seminal fluid, impair the sperm's ability to swim and also inhibit their ability to penetrate the egg.
• "Social Poisons"
• Cigarette Smoking:  Sperm count, motility, morphology and lifespan are all adversely affected by cigarette smoking, alcohol and other such mutagenic agents.  Stop smoking now!!  At the very least stop smoking completely at least 4 months prior to conception.  There are 4,000 active substances and 40 mutagens in cigarettes!  An increase in morphologically abnormal sperm has been found to be a direct cause of foetal malformations.  Also, sperm have a receptor to which nicotine can attach and thus reduce the ability of the sperm to attach to or penetrate the ova.  Of course, conception can not then take place!                                                                                                                       A study in 2002 found that men or women who smoke have lower success rates with assisted reproductive technologies.                                                                              Smokers have seriously compromised nutritional status and levels of vitamin C may be up to 40% lower than non smokers impairing ability to deal with infective agents, chemical & heavy metals.  Cigarette smoking also reduces the availability of folate which is just as important to male fertility for healthy sperm and is vital in the prevention of birth defects.  Supplementation with vitamin C, folate, zinc and bioflavonoids is vital if you are a smoker
• Alcohol:  Alcohol can enter the testes directly and impair testosterone production, reduce semen quality, increase sperm abnormalities and foetal abnormalities.  It seriously affects metabolism and status of vital nutrients such as essential fatty acids, vitamin E, B vitamins, zinc which are required for sex hormone production and fertility.  Alcohol appears to have a direct effect on chromosomes and its ingestion is thought to be a contributing factor in many miscarriages. One binge drinking bout can seriously affect spermatogenesis and sperm formation.  Since sperm take around 115-116 days to develop, you should abstain from all alcohol for at least 3-4 months prior to conception
• Caffeine:  The most ubiquitous social drug.  Found in coffee, tea, cola drinks, chocolate, some medicines and some foods.  It has harmful effects of all aspects of reproductive health.  Studies in the US have found that the ingestion of the equivalent of two cups of strong brewed coffee per day can decrease fertility by up to 50 % and has bee linked to chromosome damage..  In males, excessive consumption will adversely affect the way in which sperm move forward i.e. their rapid motility.  Ingestion of caffeine at mealtimes inhibits the absorption of iron and destroys B complex vitamins
• Immune, autoimmune factors & other illnesses:  Poor immune function can result in sperm antibody production.  This can result in sperm clumping together and unable to swim toward or penetrate the ova.  Severe immune compromise and auto-immune disease can affect overall reproductive health and be responsible for miscarriage.  Your immune system is continually under bombardment from toxins and pollutants and will often need support.  A healthy lifestyle and good nutrition is essential for a healthy immune response.  Consider supplementing with vital immune nutrients such as vitamin C, zinc and bioflavonoids and immune modulating herbs such as Echinacea, Astragalus, Albizzia & Baical Skullcap.
• Varicocele: This is an abnormally enlarged and twisted (varicose) vein in the spermatic cord that connects to the testicle. It may partially obstruct the passages through which sperm pass, elevate temperature in the testes, reduce oxygen supply to the sperm, increase oxidant damage to sperm  and have been associated with abnormalities in cellular material in the sperm. This should be checked by a urologist if you suspect there may be a problem.  In some cases surgery has been found to be helpful (but not all).  Plenty of antioxidant nutrients will be of value here.
• Undescended testes – The failure to descend may create an inhospitable environment for proper sperm development. Sperm are highly sensitive to factors such as pH and temperature.  Normally sperm require a temperature 1 degree cooler than basal body temperature.  The scrotal sac facilitates this by having the testes away from the rest of the body.  
• Endocrine (hormonal) factors: Low testosterone levels may be the result of poor nutrient status, specific nutrient deficiencies, exposure to 'hormone disruptors' such as alcohol, environmental oestrogens, toxic chemicals and heavy metals as well as increased stress hormones
• Injury: Avoid injury from heat and pressure in the testicular region.    Cycling excessively may affect fertility. Pressure from the bike seat may damage blood vessels and nerves that are responsible for erections.
• Stress: In the short term, stress can result in little or no sperm being added to the ejaculate.  Long term stress depletes vital nutrients and affects hormone balance.  Increased stress hormones results in reduced testosterone levels and reduced sperm production.

Make your 50% contribution toward the health of your child the very best it can be.

Remember, it takes about three to four months for sperm to mature so you need to follow a preconception care regime for a minimum of 4 months.  The sperm now being ejaculated were formed in your health condition 3-4 months ago.

Want to know more?

• Visit www.christinesullivan.com.au
• Email chris@christinesullivan.com.au
• Call 07 3857 8515

Breastfeeding

Breastfeeding or formula feeding    

Breastfeeding will give your baby the healthiest start in life. Medical research is finding out more and more about how beneficial breastfeeding is for you and your baby. Almost all women can breastfeed their babies. In fact it is rare that a mother does not produce breast milk.It is perfectly normal to have some ups and downs with breastfeeding, especially during the first few weeks. Some women take longer to establish a milk supply that meets their baby's needs. But with the right support and advice, you can usually overcome any problems so that you and your baby can enjoy all the benefits of breastfeeding.Some women will have breastfeeding difficulties that are hard to overcome and they may choose to feed their baby with formula. Sometimes formula feeding provides an alternative that works well for a mother and her family. Whatever the reasons, if you have chosen to feed your baby formula the midwives will provide support and information.Generally your hospital will encourage you to breastfeed, but will support and help you whichever way you feed your baby. 
  
Why breastfeeding is so ideal    

When you are pregnant, your body makes milk for your baby. It is the perfect food as soon as your baby is born, even if your baby is born prematurely. Up to 6 months breast milk is all the nourishment your growing baby needs. Between 6 and 12 months of age, your milk is still able to provide your baby with most of the ingredients they need as you slowly introduce other foods.Breastfeeding is good for you and your baby, even if you are unwell, pregnant, playing sport or menstruating (having your monthly periods). Breast milk is always fresh, the perfect drinking temperature, satisfies your baby's thirst and hunger, is convenient, portable and ready for your baby. In fact, the more your baby breastfeeds, the more milk you make.
Why is breastfeeding good for your baby?      

Breastfeeding is the ideal way to feed your baby because:

Breast milk is a complete food for your baby's growth and development
Breast milk contains antibodies that helps to protect your baby from germs and illnesses, like diarrhoea, chest and ear infections
Breast milk contains long chain fatty acids that help your baby's brain develop
It is a great way to calm and comfort an upset baby
It develops a special closeness between you and your baby
Breast milk is easier to digest than infant formula or cows' milk
It helps the baby's jaw and tooth development. When is formula feeding necessary?     It may be necessary to feed your baby formula:When you just cannot overcome problems with breastfeeding
If your baby has a special reason to have formula, such as a metabolic disease, and cannot have breast milk
In some cases if you are very ill
If you are HIV positive (have the virus that causes AIDS)
If you do choose to feed your baby formula, no matter what the reasons, you should be reassured that your baby will thrive.

 Copyright 2002-2007 SA Department of Health   

Healthy eating during pregnancy   

When you are pregnant, it is especially important to eat healthy food—it will give you the best chance of staying well by not missing out on important nutrients like iron and calcium. Healthy foods will also help your baby to grow and develop.

What is healthy eating?      

Healthy eating is a vital part of your overall health. The guidelines for healthy eating are the same when you are pregnant as they are through the rest of your life. These healthy eating guidelines are the same for all members of your family and include eating:

Lots of different healthy foods—not just the same foods every day
More bread, rice, pasta, oats and cereals (especially wholemeal and wholegrain)
More fruits and vegetables
Less fat (less chips, snack foods, fried food and fatty take-aways)
Less sugar (less cakes, biscuits, soft drinks and lollies)
Less salt, by choosing reduced-salt processed food (by reading labels), using less salt in cooking and at the table.
It's also important to drink plenty of water every day. You should drink 6 - 8 glasses of water a day.
If your diet hasn't been as healthy as it could be, pregnancy is a great time to make some changes. Begin by making a few small changes that you can stick to. Once these changes are part of your everyday lifestyle, think about some more changes you can make.

Here are some simple, practical ideas that will help you start thinking about ways to make your eating healthier:

Have a piece of fruit for a snack instead of chocolate or biscuits
Carry a small bottle of water with you so you can avoid buying soft drinks while you're out
Replace a couple of meat-based meals each week with a dish based on beans or lentils
Have a look in your book shop or library for vegetarian recipe ideas
Include fresh fish or canned fish (such as tuna or salmon) regularly in your diet
Experiment with different grains such as barley, faro, couscous and brown rice to add more variety to your diet
Cut up raw salad vegies such as carrots, celery and mushrooms - store them in snap lock plastic bags in the fridge for snacking on throughout the day
Choose reduced or low fat dairy products instead of the full cream type
Try snacking on air-popped popcorn instead of chips and other fatty snacks.

Do you have to eat any special foods?    

When you are pregnant you will need to make sure that you eat foods with plenty of calcium, iron, fibre, protein and folic acid—each of these nutrients is especially important when you are pregnant:

Calcium is needed for your baby's bones and teeth. Calcium-rich foods include dairy products such as milk, cheese and yoghurt. If you drink soy milk, ensure it is calcium enriched. You will also find calcium in almonds, bony fish such sardines and salmon.
Iron is important for healthy blood (so you don't get anaemia). Good sources of iron include red meat, fish, chicken, eggs and wholegrain foods. A vitamin C source such as tomato or orange juice with every meal will help the iron to be absorbed.
Fibre and plenty of fluid is needed to prevent constipation. There is fibre in fruit and vegetables (especially if you do not peel them), wholemeal and wholegrain bread, rice, pasta and cereal (like porridge, Weetbix and VitaBrits).
Protein is needed to help the baby grow. Meat, fish, chicken, eggs, milk, cheeses, nuts, tofu, dried beans and peas are all good sources of protein.
Folic acid or folate is needed to help prevent spina bifida in your baby and is also important for your blood. Folate is in many green vegetables, chickpeas, soybeans, oranges, bananas, strawberries, cereals, nuts and Vegemite.
Even if you eat plenty of folate-rich foods, you will still need to take a folic acid tablet for the first 3 months of your pregnancy. Women who are planning to become pregnant need to take a folic acid supplement at least one month before pregnancy. See the section Preparing for Pregnancy. 
 
How much weight will you put on?    

As your baby continues to grow inside you, your body will change shape and size. It is healthy and normal to put on about 10–13 kg when you are pregnant. But it may be fine for you to gain less or more. The weight you put on is not just the baby. It is also the fluid around the baby, the placenta (the afterbirth), extra blood in your body, and your breasts getting bigger. If you eat healthy food and only eat when you are hungry you will put on the right amount of weight for you.

Copyright 2002-2007 SA Department of Health   

Colostrum and Pregnancy

Newborns need to fight against disease and infection from the moment they come into the world. But nature, which provides life, provides mothers with a weapon to help their babies survive. And that weapon is colostrum.

Usually, colostrum begins in the breasts of pregnant mothers in the third month of pregnancy. In some, it may not appear until after the birth. Both are normal circumstances.

When colostrum is being produced, breasts grow and veins may be seen through the skin. As these changes take place, the areola becomes larger and darker and nipples become more erect. The breasts now become heavier, preparing mother to breastfeed.

Some mothers may experience slight blood leakage through the nipples. This is due to the increased number and rapid growth of blood vessels in the growing ductal system and is no cause for alarm.

There is a difference between colostrum produced in the mothers of premature babies and the mothers of full-grown babies. The colostrum produced in the mother of a premature baby is designed to suit the needs of a premature infant, whereas colostrum produced in the mother of a full-term baby contains nutrients and immunes required for growth in a fully term baby.

Colostrum is the most important food a newborn can receive in order to fight off bacteria that begin colonization on his skin and in his mucosal membranes at the moment of birth. The colostrum coats his intestines and protects him from bacteria and viruses. Unlike milk, colostrum is easily digestible by the newborn. Researches have proved that babies that receive colostrum from their mothers' breasts grow up to be stronger and healthier than those who are artificially fed.  

Colostrum And Pregnancy provides detailed information on colostrum, colostrum benefits, colostrum milk, colostrum and pregnancy and more. Colostrum And Pregnancy is affiliated with Ultrasound Pictures. 

by: Damian Sofsian