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The opinions expressed herein are the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only and is sponsored by Enfamil.
Moderator: Welcome to WebMD University: "Feeding Yourself, Feeding Your Baby." This event is sponsored by Enfamil. Our instructor today is Barbara Luke, ScD, MPH, RD, author of Program Your Baby's Health: The Pregnancy Diet for Your Child's Lifelong Well-Being. Barbara, tell us what you mean by 'program.'
Luke: The idea of how a baby grows before he or she is born can influence long-term health. It was originally proposed as a hypothesis by David Barker, MD. Dr. Barker is a physician and scientist in England and about 10 years ago, he looked at what people died of and their birth weight. What he concluded was that individuals born at low birth weight (less than 5 1/2 lbs) had a much greater risk of dying from heart disease, stroke, and diabetes than individuals well grown at birth (heavier than 5 1/2 lbs). This was originally known as the Barker Hypothesis. This theory had a lot of criticism when first proposed more than a decade ago. Over the past decade there have been thousands of studies that have proven this theory to be correct. Studies now look at how a child grew, not just birth weight, before that child is born: head circumference, abdominal circumference, length, and weight, and their risk for factors leading to obesity, diabetes, heart disease, and hypertension.
The idea of "metabolic programming" is really the concept that various organs in the body are plastic and vulnerable during certain periods of gestation before birth. If the environment before birth is not optimal, and by that I mean inadequate nutrition, the various organs will adapt to the circumstances at hand. For instance, if a mother is anemic during pregnancy, baby basically has a lack of oxygen. Blood carries oxygen to the baby. The baby adapts to this lack of iron. The consequences of adapting to a less than optimal environment before birth can be long lasting. For instance, children who did not receive adequate nutrition before birth develop a metabolism that hoards every available calorie. After birth, when food is plentiful, that metabolism has been set and those children are more prone to obesity and diabetes.
Now, the window of time when organs are vulnerable to the environment does not necessarily end at birth. The birth of a baby is a monumental occasion but children continue to grow throughout childhood. We know lung development continues for years after birth; the same with brain, kidney, and pancreas development. So the window of opportunity for optimal health goes beyond birth. This has both positive and negative implications. The positive implication is that parents still have time to lower their children's lifelong risks of chronic disease after birth. The negative implications are that they are still vulnerable to factors in the environment, including nutrition, after birth.
Moderator: For our WebMD University students who are in the third trimester or have already given birth, what should they do to "jump start" their, or their baby's, nutrition.
Luke: One of the best ways to boost children's health is to breastfeed. The composition of fat in breast milk is a reflection of the mom's diet. Particularly when children are born prematurely, the benefits from breast milk can be enormous. One of those benefits is the Omega 3 fatty acids, the essential fatty acids that help neurologic growth and vision development. So all women who breastfeed should make sure their diet contains ample amounts of foods rich in essential fatty acids. And a source for these fatty acids is fish. These foods are called essential fatty acids because our bodies can't manufacture them. We need to get them from food sources. Other sources rich in essential fatty acids are olive oil, canola oil, eggs (particularly Eggland's Best since the chickens are fed fish meal which affects the level of essential fatty acids in the egg yolk). Women who have had premature babies in particular should not only breastfeed but make sure their diets contain ample essential fatty acids. The fattier the fish, the higher the level of essential fatty acids. One warning, though, pregnant and breast feeding women should stay away from the very large fish such as shark, tile fish, and swordfish because of potential high levels of mercury.
Moderator: Can a vegetarian mom provide proper metabolic programming while pregnant or nursing?
Luke: Absolutely. But they need to plan their diet even more carefully. Vegetarian moms are at risk of having diets too low in protein and iron. They need to include ample sources of these nutrients. Most women begin pregnancy with little or no iron stores. And with the demands of pregnancy, most women quickly become iron deficient. One of my recommendations to all women during pregnancy is to eat protein and carbohydrate foods together every two to three hours. This has several beneficial effects:
Member: We are considering international adoption. One of the worries we have is getting a baby who has not received breast milk or other proper nutrition. What are the best ways to get an undernourished infant on track quickly?
Luke: As I said before, the window of time that a child's developing organs and systems are vulnerable and growing extend beyond birth. It's very tempting to try to catch up growth for an undernourished child after delivery. And this was the prevailing philosophy for many, many years, to really encourage basically overnutrition for children who were undergrown. The research on metabolic programming has shown that children who are undergrown who gain too much weight during childhood are at highest risk for diabetes, hypertension, and heart disease as well as obesity. This has been termed centile crossing, which basically means when a child is born below the 10th percentile and has been overfed during childhood and is now in the 90th percentile. The best approach, based on what we now know, for a child born below the 10th percentile would be to encourage some catch-up growth, but not so extreme.
Member: What foods should I avoid so as not to upset the baby while I am breastfeeding?
Luke: This is very individual. And some of this may be trial and error. Notorious culprits are chocolate, hot spices, and I would also add alcohol.
Member: Do you see anything wrong with breastfeeding until age 2 or 3?
Luke: Yes. The nutritional needs of young children exceed that which breast milk can meet by that age. The optimal time to breastfeed children is about a year, after which breast milk cannot meet the iron needs of the growing child. Developmentally, children need solid foods and much more variety than breast milk can provide. Particularly with older moms in their late 30s and early 40s, breastfeeding can deplete calcium in a mother's bones, as a word of caution. Her own risk of osteoporosis can be magnified if she's not eating adequately while breastfeeding.
Member: But what if they eat fine, but just want to breastfeed?
Luke: Sure. You can supplement. But a word of caution that mom also should watch her diet. The composition of breast milk is amazingly constant; often at the expense of the mom's own nutritional state. The composition of the fat in breast milk is really affected by the mother's diet but not much else.
Moderator: So breast milk takes what it need whether the mom gets enough or not?
Luke: Yes. The peak bone mass is achieved in their 30s for women. There is a slow decline until menopause and then that decline becomes rapid, particularly if a woman is not on hormone replacement therapy. With the trend toward having children later in life, the risk for osteoporosis increases if women are not careful about getting enough calcium.
Moderator: You touched on this earlier, Barbara, but this member joined us after we covered it. Please touch on it again:
Luke: What should you eat to make up for the depletions? The demands for breastfeeding are different than pregnancy: Much more calcium and less protein. So ample dairy foods are critical for lactation.
Member: With so much of baby's growth occurring in the first year, I'm wondering what I should eat as a nursing mom to help her development? I'm especially concerned about brain development.
Luke: Adequate protein, calcium, sufficient essential fatty acids are all important. I would recommend fish at least three to four times per week (shellfish, salmon, tuna). I recommend three to four eggs per week. Eat lots of dairy as well. Canned tuna, boiled shrimp, all shellfish, scallops, salmon, and any farm-raised fish would be safe to eat during pregnancy and when breastfeeding.
Member: Is it important to give a baby those liquid vitamin drops? Or can my child get everything she needs from breast milk? What about when she stops nursing and has to go on the bottle (I have to go back to work when she is 4 months old and will put her on formula then).
Luke: Part depends on which part of the country you live in and how much vitamin D exposure your baby will get from being in the sunshine. Many babies become iron deficient during that first year. Your doctor may then recommend iron drops. With a varied diet, children generally get enough of those nutrients.
Member: Is it okay to eat soy? I avoid milk and meat with added hormones, but wonder about natural phytoestrogens found in soy. I love to eat edamame beans. Could I be passing along hormones to my baby from eating a lot of soy?
Luke: It depends on what you mean by a lot of soy. A soy dish two to three times per week would not have any effect. But if you are eating a soy-based product three to four times per day, it may.
Moderator: Does your book mention how to prepare these metabolic programming foods? Not just what to eat, but how to make meals?
Luke: Program Your Baby's Health translates the research that has been done on metabolic programming into practical applications for today's parents. It has guidelines from preconception through pregnancy and for children from birth through adolescence. It has the newest CDC growth charts for children, as well as 60 recipes for busy parents.
Member: My baby goes to sleep, then wakes up and cries like she is in pain. It's not colic in that she isn't crying all the time, but it seems like a bout of colic that lasts for a while. Any ideas as to what might be going on? And what should I do?
Luke: It's really unknown what causes colic, and most children outgrow it. It's a very individual thing. And whoever does discover it, certainly deserves the Nobel Prize because it certainly tests the parents' patience.
Member: So we don't know what causes it but are we sure that food isn't connected?
Luke: They don't think so. It may be digestion. Some suggestions are to switch formulas, which may help digestion, but it may or may not help.
Moderator: We are out of time. Thank you, Barbara Luke, ScD, MPH, RD, for being our guest, and thank you members for joining us today. For more information, please read Program Your Baby's Health: The Pregnancy Diet for Your Child's Lifelong Well-Being.
WebMD does not provide medical advice, diagnosis or treatment. See additional information.
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