Cyclical Ketogenic Diets Review

Keto Resource

Many people always desire to lose weight within a short period. Dieting is easy the first few days, but without a plan, one is subjected to peer pressure and can easily fall back on their program. Gaining weight is very easy for most people, but losing it is another task that needs patience as it does not happen overnight. The Keto 28 day challenge works towards helping individuals achieve their dreams by losing weight on shorter duration of time as compared to other diet plans. It focuses on making its users lose weight and become lighter. The reason why most people gain more weight even when they are on a new diet is the lack of a plan. Lacking a diet plan makes one to make bad choices when choosing the type of food to eat and the quantities that they take. It's time to take the 28 day Keto challenge to get back in shape and have that good and light body that you have always desired. The plan also makes an individual sleep better, wake up more rested, improve hair growth, and have more energy as compared to the earlier days without Keto. Read more here...

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Carbohydrates

Carbohydrates, which include starches, sugars and fibres, are the main providers of energy. They are best eaten unrefined, with 'nothing added and nothing taken away', as processing removes many vital nutrients as well as much of the fibre that can help prevent constipation. Foods to eat. These include complex carbohydrates, such as fresh fruit and vegetables, and wholegrains, such as wholemeal bread, brown rice and wholemeal pasta. Foods to avoid. These include simple carbohydrates, such as white sugar, white flour and bread, white pasta and sweets. These simply add 'empty' calories without providing any goodness.

Breast Feeding and Drugs

Human milk is a suspension of fat and protein in a carbohydrate-mineral solution. A nursing mother easily makes 600 mL of milk per day, which contains sufficient protein, fat, and carbohydrates to meet the nutritional demands of the developing infant. Milk proteins are fully synthesized from substrates delivered from the maternal circulation. The major proteins are casein and lactalbumin. The role of these proteins in the delivery of drugs into milk has not yet been completely elucidated. Drug excretion into milk may be accomplished by binding to the proteins or onto the surface of the milk fat globule. There also exists the possibility for drug binding to the lipid, as well as to the protein components of the milk fat globule. It is also possible that lipid-soluble drugs may be sequestered within the milk fat globule. In addition to lipids and protein, carbohydrates are entirely synthesized within the breast. All of these nutrients achieve a concentration in human milk that is...

Prepregnancy Supplementation

It is important to take a diet balanced in calories, carbohydrates, proteins and fibers. Folic acid is a type of vitamin B that is needed for the formation of blood cells and the development of baby's nervous system. It has been shown to reduce the chance of a baby having neural tube defects (spinal cord and brain abnormalities) (Figure 1.2). A simple

Fetal Risk Summary

Acarbose is an oral a-glucosidase inhibitor that delays the digestion of ingested carbohydrates within the gastrointestinal tract, thereby reducing the rise in blood glucose after meals (1). It is used in the management of non-insulin-dependent diabetes mellitus (type II). Less than 2 of a dose is absorbed as active drug in adults, but the systemic absorption of metabolites is much higher (about 34 of the dose) (1).

Breast Feeding Summary

Small amounts of acarbose, or its metabolites, are excreted in the milk of lactating rats (1). No studies describing the use of acarbose during human lactation, or measuring the amount of the drug or its metabolites in milk, have been located. Because the drug acts within the gastrointestinal tract to slow the absorption of ingested carbohydrates, and less than 2 of a dose is absorbed systemically, the amount of unmetabolized drug in the mother's circulation available for transfer to the milk is probably clinically insignificant. As with all drugs, however, the safest course while taking acarbose is not to breast feed until data on its safety during lactation are available.

Physical Activity and Exercise in Pregnancy

The nutritional needs of active pregnant women are not clearly defined however, it should be recognized that there is an additional caloric allowance for increased metabolism and greater energy expenditure both during and after activity. Pregnant women use carbohydrates at a higher rate than do nonpregnant women this is further increased during exercise, thus adequate carbohydrate intake is essential. Adequate fluid intake helps control the core body temperature and is essential to replace fluid loss during exercise.

242 Diet manipulations and treatment

Dietary measures are often suggested for the mildly symptomatic women, although little evidence supports these measures. Women may benefit from frequent and small meals, with high carbohydrate and low fat conLent. Salty foods may be tolerated better in the morning, and sour or tart beverages may be tolerated better than water (Quinlan 2003).

Early Beliefs And Practices

At this time dietary recommendations for pregnancy also were influenced by problems current in obstetric practice. In the days of the industrial revolution, children in Europe had poor diets and worked long hours in dark factories. Rickets was a common nutritional disorder that impaired normal bone formation during the growing years. His experience in the 1880's led the German physician Prochownick to advocate a fluid-restricted, low-carbohydrate, high-protein diet for women with contracted pelvis to be followed for 6 weeks prior to birth. Women using such a diet produced smaller infants who were easier to deliver. The diet may have had some justification in the 1880's, but it later gained in popularity and became a standard recommendation for women throughout a pregnancy even when the original rationale for it no longer applied.

Growth of placental amino acid transport capacity

Figure 9.3 Schematic of placental-fetal inter-relationships in humans for various aspects of placental lipid metabolism, fetal lipid uptake and metabolism, and fetal lipogenesis into adipose tissue. (Adapted from (1) Hay Jr WW. Nutrition and development of the fetus carbohydrates and lipid metabolism. In Walker WA, Watkins JB, eds. Nutrition in Pediatrics (Basic Science and Clinical Applications), 2nd edn. Neuilly-sur-Seine, France Decker Europe 1996, pp. 364-78 and (2) Hay.2) Figure 9.3 Schematic of placental-fetal inter-relationships in humans for various aspects of placental lipid metabolism, fetal lipid uptake and metabolism, and fetal lipogenesis into adipose tissue. (Adapted from (1) Hay Jr WW. Nutrition and development of the fetus carbohydrates and lipid metabolism. In Walker WA, Watkins JB, eds. Nutrition in Pediatrics (Basic Science and Clinical Applications), 2nd edn. Neuilly-sur-Seine, France Decker Europe 1996, pp. 364-78 and (2) Hay.2) Figure 9.4 Fetal fat content at...

Further Observations On Energy Costs

Theoretically the body can derive all of its energy from dietary or stored protein and fat. Carbohydrates are used preferentially by some cells and are required for intermediaries of the citric acid cycle, but they can be synthesized from protein. The exclusion of carbohydrate from the diet, however, has harmful effects. Because energy production is of primary importance, the body will use protein to manufacture citric acid cycle intermediaries and glucose if no preformed sources are available. This can impair growth. If the body must depend solely on dietary or stored fat for energy, metabolic products of fat oxidation accumulate in excess. These products, known as ketone bodies, cannot be metabolized when their concentrations reach high levels. Because they are acidic in nature, ketones disrupt the body's acid-base balance and can eventually lead to coma and death.

Nutritioninduced diabetes

When animals are fed a high carbohydrate diet, consisting mainly of fructose, they display features of Type 2 diabetes within a short time. Fasting hyperglycemia, hyperinsulinemia and hyper-lipidemia as well as insulin resistance develop.101-103 Some of these features can be ameliorated by supplementing the diet with fish oil104 or by troglitazone as a food admixture.105 Although this has been known for a long time surprisingly little use has been made of this model in pregnancy. One additional effect of the diet is the development of hypertension. This was also found in pregnancy106 suggesting that the fructose-induced diabetes may result in the development of sustained hypertension during pregnancy via the

Placental structure and morphology

Diabetes is associated with major modifications of the structure and organization of the placenta leading to a variety of pathologies referred to as global placental dysfunction (reviewed in references 35-37). The surface area is particularly increased in the periphery of the villous tree. The diffusion distance between the maternal and fetal systemic circulations is increased due to a thickening of the trophoblastic basement membrane with higher amounts of collagen, predominantly Type IV.38 Some collagens, e.g. Types IV, V and VI, contain a higher proportion of carbohydrates and it may be conceived that this is due to non-enzymatic glycation and mimics a situation of accelerated aging. The higher proportion of hyaluronic acid subfractions and heparan sulfate also contributes to increase the total glycosaminoglycan content of the villous connective tissue.39 The sum of these morphological modifications modifies trophoblast barrier function particularly transplacental transfer...

39fuel utilization in exercise and pregnancy

Measurements by indirect calorimetry reveal preferential use of carbohydrates during exercise in pregnancy 53 . The respiratory exchange ratio (RER) reflects the ratio between CO2 output and oxygen uptake (VO2). The RER provides information on the proportion of substrate derived from various macronutrients. For carbohydrate to be completely oxidized to CO2 and H2O, one volume of CO2 is produced for each volume of O2 consumed. An RER of 1 indicates carbohydrates are being utilized, while an RER of 0.85 indicates mixed substrate. Assessment of fuel utilization during pregnancy is important because of the possible effect of exercise-induced maternal hypoglycemia 53 . Such events are unlikely to occur during 45 min of moderate exercise, but could occur after 60 min of continuous moderate to strenuous exercise (Fig. 3.2). The tendency for higher respiratory exchange ratios during pregnancy and during exercise in pregnancy suggests a preferential utilization of carbohydrates. Soultanakis et...

3Can I begin a weight loss regime in pregnancy Would being underweight cause a problem in pregnancy

Take a balanced diet during pregnancy consisting of calories, carbohydrates, proteins and fibers. Dieting is a no-no in pregnancy. Your baby needs you to eat Your baby depends on you for its nourishment. Remember that if you eat well, your baby eats well and if you starve, your baby starves.

Gestational diabetes mellitus

HbA1c should be evaluated every 4-6 weeks17 to assess the response to the applied therapeutic regime and the accuracy of SMBG. Considering the physiological reduction of HbA1c levels noted in nondiabetic pregnant mainly due to lower gly-cation rate18 and increased erythrocytes volume,19 the target HbA1c level during GDM should be as close as possible to 5 .20 Urine or capillary ketones should be evaluated every morning in the first trimester as it can be useful in detecting insufficient caloric or carbohydrates intake in women treated with restricted caloric intake.21 Meals should be constituted of 50-60 of carbohydrates (breakfast 250 mg dL (13.9 mmol L), with ketonuria, exercise should not be performed until metabolic control has been normalized.27 The recent Australian Carbohydrates Intolerance Study (ACHOIS) demonstrated a relatively large population of GDM women for whom intensive treatment with either insulin or MNT or SMBG effectively reduces the incidence of perinatal...

913case study bulimia nervosa during pregnancy

T.J. is a 32-year-old Caucasian, married woman, gravida 2, para 1, seeking prenatal care in the 11th week of gestation. Medical history reveals current BN, the onset of which occurred in the third month postpartum of her previous pregnancy. Since the onset of BN at age 27, T.J. has engaged in binge eating-purging cycles at least twice per day, consuming approximately 2,200 kcal of high-fat, high-carbohydrate snack-type foods during each binge with subsequent vomiting. She reports problems with my teeth and frequent heartburn. T.J. denies laxative, diuretic, or enema use, but admits to moderate exercise of fast-paced walking of up to 2 h per day. She was dissatisfied with her body shape and inability to quickly lose weight after her first pregnancy and is fearful that she will lose control of her body weight during this pregnancy. She gained 47 lb during her first pregnancy. T.J. currently weighs 145 lb and is 5' 7 . Laboratory values are within normal limits. She reports having the...

Insulin algorithms for continuous insulin infusion pump therapy in pregnancy

The basal need is usually 50 of the total daily insulin dose (0.5I) and may be delivered using a constant infusion pump (Table 27.2) or by multiple doses of intermediate-acting insulin (Table 27.1). When using a constant infusion pump the basal need is calculated as an hourly rate (Table 27.2) and is delivered such that the calculated rate (0.5I or total dose over 24 h divided by 24) is given between 10 am and midnight. The rate is cut in half (i.e. 0.5I divided by 24 times 0.5) from midnight to 4 am, and increased by another 50 (i.e. 0.5I divided by 24 times 1.5) to counteract the morning rise of cortisol levels that are potentiated during pregnancy. Also, low-dose NPH before bedtime has been used by some clinicians to prevent the possible occurrence of diabetic ketoacidosis if the needle slips out of position during the overnight period. This dose of NPH insulin needs to be sufficient to provide protection from ketosis, or 0.1 unit of NPH times the weight of the women in kilograms....

10114Screening and Diagnosis of Gestational Diabetes Mellitus

Two approaches are used to screen and diagnose for GDM, the two-step and the one-step method 3 . The two-step method is used primarily in the United States. The first step is the oral glucose challenge test (OGCT). A solution containing 50 g glucose is consumed, and the plasma glucose level is checked 1 h later. If the test is 140 mg dl, the second step, the oral glucose tolerance test (OGTT) is administered after 3 days of unrestricted carbohydrates (at least 150 g day) and unlimited physical activity. The woman fasts for at least 8 h the night before the test. Blood is drawn for a fasting glucose level, followed by 100 g of glucose solution given orally and redrawn at 1, 2, and 3 h. The oral glucose tolerance test is discontinued if the fasting glucose is 126 mg dl or a random glucose is 200 mg dl. GDM is diagnosed if at least two of the values exceed the Carpenter and Coustan criteria (see Table 10.5).

10115Management of Gestational Diabetes

Tain normoglycemia, (2) to provide sufficient calories to promote appropriate weight gain and avoid maternal ketosis, and (3) to provide adequate nutrients for maternal and fetal health 61 . The American Dietetic Association provides an algorithm for MNT for GDM (Fig. 10.1). The Institute of Medicine's recommendations are used to determine the appropriate weight gain for women with gestational diabetes (38). The EER are the same for pregnant women without diabetes. Monitoring weight gain, and reviewing blood glucose, food and if necessary, ketone records are other useful tools to determine diet adequacy. The Dietary Reference Intakes do not provide a recommendation EER for obese women. Several studies used various calorie restrictions to determine minimum energy requirements, while avoiding ketonuria and ketonemia. A minimum of 1,700-1,800 kcal day appears to improve glucose control without increasing ketone levels 3, 58, 61 . consume adequate calories to promote appropriate...

Timing of initiation of pump therapy

At the preconception visits mainly to ensure that technical difficulties will be overcome by training prior to conception thus avoiding unnecessary ketosis and hyperglycemia, and to ensure proper patient selection. Nevertheless, initiation during pregnancy, provided proper patients are selected, can be achieved in an outpatient setting.34

Establishing bolus calculations

For example, the 32-year-old P2G2 Type 1 diabetic patient in her 17th week of gestation whose TDD is 52 plans to have a lunch consisting of 60 g of carbohydrates, and her current premeal glucose is 145 mg . In order to approximate her bolus dose one has to calculate the CF and the carbohydrate insulin ratio (CIR) The advantage in using a bolus calculator built into the insulin pump software is that it enables these calculations to be done simply by inputting the current glucose levels and the amount of carbohydrates in the planned meal. Beyond the advantage of the bolus calculators, simplifying calculations to the patient, one can program different CF and CIR during the day. This is an important feature during pregnancy were the morning insulin needed to cover carbohydrate is noted to be much higher than during the rest of the day. Additionally, as described before, the calculators take into account active insulin from previous boluses, decreasing the amount of active insulin present...

Should a pregnant woman with diabetes use an artificial pancreas

The benefits of an artificial pancreas are ever increasing and potentially vast. Current deficiencies with fully functioning models render them imperfect, though improvements are quick to come and it is possible that there could be a fully functioning and accurate model of the entire device within the next few years. Benefits of wearing an artificial pancreas include peace of mind, such as not having to worry about not having enough insulin or having too much insulin, not having to remember to take blood glucose readings multiple times every day, and not having to remember to inject oneself with insulin before every meal and before going to bed. In addition, with an artificial pancreas there would be fewer finger sticks, less counting of calories and carbohydrates, and, if the patient's insulin delivery device and continuous glucose sensor are internal, no devices to clip to one's hip or carry in one's purse. to become pregnant. It was feared that the high incidence of DKA in pregnant...

Prevalence precipitating factors and prognosis

Increased insulin requirements and accelerated ketosis imposed by pregnancy predisposes the pregnant diabetic patient to an increased risk of DKA. Several factors predispose pregnant diabetic women to ketoacidosis accelerated starvation, dehydration secondary to emesis, lowered buffering capacity (respiratory alkalosis of pregnancy), increased insulin resistance and stress. Box 44.1 summarizes the precipitating factors for the development of DKA in diabetic pregnancies.

Nutrition in preparation for labour

Complex carbohydrates are the body's main energy source and stocking up at this stage will ensure that glycogen reserves stored in the muscles and liver tissues are filled to capacity, ready to provide sustained energy for labour. Lack of energy in labour can trigger a downward spiral of tiredness, dehydration, weakness and demoralisation, very often leading to the need for medical intervention.

1 If you are diabetic during pregnancy

The diet for diabetes during pregnancy is similar to the healthy diet recommended for all pregnant women, except for the regular distribution and consistent intake of carbohydrate-containing foods (e.g. rice and alternatives, starchy vegetables, fruits and milk) throughout the day. In other words, having three meals and three snacks, with the same amount of carbohydrate-containing foods daily at each meal and snack. Contrary to popular belief, there is no need for pregnant women to consume glucose or any other sugars for energy, as carbohydrate foods are digested into glucose by the body. Hence, sugars and sweet foods are not recommended for pregnant women with diabetes, as they are high in carbohydrates, leading to high blood glucose levels, which are often low in nutrients and high in energy, leading to excessive weight gain.

1912 role of nutrition in postpartum depression 19121 Carbohydrate

Carbohydrates (i.e., bread, cereal, rice, potatoes, pasta, beans) play a vital role in delivering energy to the body and can influence mood. Carbohydrates are the brain's primary source of energy, making adequate dietary intake important to postpartum mental health. The delicate balance between carbohydrate and insulin can also affect mood. Balanced and consistent carbohydrate intake throughout the day can help ensure this balance between carbohydrate and insulin. Insulin increases markedly throughout the course of a normal pregnancy, and levels fall dramatically after delivery. Although the mechanism requires elucidation, it has been hypothesized that this drop in insulin levels following delivery may induce depression through a reduction in serotonin production 53 . Crowther et al. 54 demonstrated in a large randomized clinical trial that women with gestational diabetes mellitus (GDM) who received individualized dietary advice had lower rates of postpartum depression compared to...

2021 Changes in Food Consumption

Power of the average family and the low prices of calorie dense foods, e.g, fast foods and processed snack foods, have contributed to the rise in the consumption of low-cost, high-fat foods and refined sugar. For instance, in Santiago (Chile), for the equivalent of 3, it is possible to buy a meal at a fast-food restaurant that provides more than half of the daily caloric needs of an adult woman 4 . This example underlines the increase in the availability of energy, as it is shown in Fig. 20.1, which shows calorie availability in several countries from Latin America at different stages of development. In practically all of them calorie availability has increased, even in those that still deal with a serious problem of undernutrition like Guatemala. In Brazil, a country with a wide range of population from the socioeconomic point of view, average calorie availability increased from 2,072 calories in 1980 to 3,146 calories in 2003, a 52 increase 6 . Fat availability in these countries...

The Benefits Of Breast Milk

The carbohydrates and fats in breast milk provide en ergy for your newborn to grow fats are p articul arly important for brain development. In additi on , bre ast milk contains a complete spectrum of proteins, ensuring your baby has all th e necess ary ' ' buildi n g blocks ' ' for ge nerati n g n ew tissue, as well as all the valuable vitamins and minerals your baby needs.

Etiology of perinatal mortality

Diabetes affects the metabolism of all nutrients (carbohydrates, fatty acids and proteins), glucose being the most prominent. Glucose and those other metabolic fuels operating at the different stages of pregnancy may account for the multitude of pathologies inflicted upon the offspring of the diabetic mother. These pathologic conditions range from congenital malformations and intrauterine fetal death to macrosomia, respiratory distress and hyperbilirubinemia. Poor metabolic control may also induce alternations in levels of fatty acids and amino acids. This provides an altered environment in which the embryo and fetus of the diabetic mother may be exposed to changes in gene expression and increased teratogensis.22,23 Hyperglycemia by itself, is involved in the pathogenesis of factors contributing to PNM throughout the entire length of pregnancy.24 In vitro, high glucose levels generate free oxygen radicals which are linked to mechanisms of cellular damage.22-25 Not surprisingly, the...

4185 Other contaminants

Synthetic musk compounds, such as musk xylol, musk ketone, musk ambrette, and others, are among the nitroaromatics. These substances have a limited acute toxicity, but, like the organochlorine compounds, they seem to accumulate in the fatty tissue and persist in the environment. Current analyses of mothers' milk have indicated a mean of about 0.1 mg kg milk fat for musk xylol. The other compounds have levels two to three times lower Synthetic musk compounds arc added to detergents and cosmctics because of their fragrance, and thus dermal absorption is a likely path for their intake. There are no indications of toxic effects as a result of intake via mothers' milk. The studies to date on genera toxicity and on mutagenic and carcinogenic potential do not permit a conclusive judgment (Liebl 2000, Riinkus 1994). Since 1993, contamination of mother's milk with musk xylol has declined in Germany to about 0.02 mg kg milk fat, following a recommendation that this substance be avoided in...

Nutritional Disorders

Intrauterine Growth Retardation Pictures

The gastrointestinal tract of the newborn must process a relatively large amount and variety of foods soon after birth. The average term infant takes about 540 cc (18 ounces) of food daily by two weeks of age. In adults, correcting for body surface area, this would equal approximately 10 liters of fluid per day. In proportion to its size, the premature infant processes an even greater load. The infant's diet must contain the appropriate quantity of protein, carbohydrates, fats, minerals, vitamins, trace elements and water. The complexity of this task is especially obvious in the premature infant where the child's nutritional reserves are limited and the margin for error is small. Advances in perinatal medicine have resulted in the increased survival of smaller and smaller infants. This poses several special considerations when designing a nutritional plan for these infants, including the need for rapid growth, the immature functional development of the gut, and the presence of...

102historical background

Before 1921, women with diabetes were advised to avoid pregnancy or to abort if they conceived because of adverse perinatal outcomes. If the pregnancies advanced to the stage of fetal viability, the infants were often stillborn or were born with major malformations. Medical nutrition therapy was the primary method of management for pregnant women with diabetes prior to 1921 however, the diets were often severely restricted or nutritionally unbalanced. These dietary approaches varied from high carbohydrate-low protein, or high protein-high fat, to brief periods of starvation 4, 5 . Alcohol was often included because of its calming effect on the mother 6 .

74 confounding variables

Finally, carbohydrate metabolism in pregnancy can be characterized by the phenomenon of accelerated starvation that is, the fasting glucose decreases as pregnancy advances with an accelerated insulin response to meals 45 . Pregnant women with twin gestation have an accelerated response compared with singleton pregnancy 46 . This indicates that lower glucose in the fasting state can increase the depletion of glycogen stores resulting in metabolism of fat. Ketones may result, and ketonuria has been associated with preterm delivery. Compared with the recommended diet for women whose pregnancies are complicated by carbohydrate intolerance (diabetes), changes in diet composition for women with multiple pregnancies would be a lowering (40 ) of the carbohydrates to avoid more hyperglycemic peaks and an increase in the percent of fats (40 ) to provide more substrate. This adjustment in the distribution of the macronutrients may be important not only for nutritional value, but also for...

Data that may support higher GDM rate in multiples

Casele and co-workers conducted a 40-h metabolic study in nondiabetic gestations and compared the response to normal meal eating and the vulnerability to starvation ketosis in 10 twin and 10 singletons, matched for age and pre-pregnancy weight.11 Glucose, P-hydroxybutyrate, and insulin levels in response to meal eating from 8 a.m. to 12 00 noon on day 1 were similar in twin and singleton pregnancies. On day 2, however, when breakfast was delayed, a progressive but not significantly different decrement in glucose was observed in both twin and singleton pregnancies. On the other hand,

Brandstrup and H Okkels Pregnancy complicated with diabetes Acta Obstet Gynecol Scand 1938 18 1366332

Brandstrup noted that most of his patients had been considered to be well adjusted with insulin treatment, but that they still had high levels of blood sugar for the greater part of the day. He had previously undertaken physiological studies in pregnant rabbits on the passage of carbohydrates across the placenta after intravenous injection, and had shown that while glucose and the pentoses passed across by a process of slow diffusion, the placental membrane was almost impermeable to disaccharides, including saccharose and lactose.33 He described one patient treated in 1927, illustrated by a 24 h curve for blood sugar, who had been treated with two doses of insulin daily, felt well and was looked upon as treated

Milk Synthesis and Maturational Changes

Compared with mature milk, colostrum is richer in protein and minerals and lower in carbohydrates, fat, and some vitamins. This high concentration of total protein and total ash (minerals) and whey in colostrum and early milk gradually changes to reflect the infant's needs over the first two to three weeks as lactation becomes established. The total dose of such key components as immunoglobulins, which the infant receives from breastmilk, remains relatively constant throughout lactation, regardless of the amount of breastmilk provided by the mother. This happens because concentrations decrease as total volume increases as lactation is established and, at weaning, concentration increases as total volume decreases.

1351 Low Carbohydrate Diets

Low-carbohydrate diets are perhaps the most prolific of all weight loss plans. In 1992, Dr. Robert Atkins published Dr. Atkins' New Diet Revolution 28 . This was eventually followed by the publication of two subsequently revised versions of the book. The premise of this plan is to restrict carbohydrate intake so severely that ketoacidosis ensues. The plan, which provides only 20 g of carbohydrate during the Induction Phase, allows for extremely high-fat (particularly saturated fat) and protein intakes 28 relative to what is generally recommended as healthful for the general population 29 . It should be readily apparent to the practitioner that this amount of carbohydrate is inadequate for supporting pregnancy 1, 6, 29, 30 . More importantly, a state of ketosis during pregnancy is not consistent with a normal metabolic profile for gestation and can be problematic for both the mother and fetus 26, 31 . In addition, the amount of calories that is ultimately provided by this plan will not...

16 lifecycle approach to nutrition

Surveys show that about only about 3-4 of all Americans follow all of the Dietary Guidelines 35 . Although information about the principal sources of foods contributing to the nutrient intakes of pregnant women is scarce, one prospective study showed that low nutrient-dense foods were the major contributors of energy, fat, and carbohydrate whereas fortified foods were the primary sources of iron, folate, and vitamin C 47 . This study was done in a population of black and white women living in North Carolina over 50 of the women were

Recreational And Sports Activities

Ketosis and hypoglycemia are more likely to occur during prolonged strenuous exercise in pregnancy. Because of nausea, vomiting, or the feeling of fatigue that is prevalent in pregnancy, women may be unable to run long distances. In pregnancy, we advise the recreational athlete to reduce mileage to no more than 2 miles per day. This is a precautionary step intended to prevent complications such as hyperthermia or dehydration. Studies of women who averaged between 1.5 and 2.5 miles per day throughout pregnancy have shown no deleterious effects (6.7).

Nutrition and Health

Feldman, 2005 Epilepsy and the Ketogenic Diet, edited by Carl E. Stafstrom and Jong M. Rho, 2004 Handbook of Drug-Nutrient Interactions, edited by Joseph I. Boullata and Vincent T. Armenti, 2004 Nutrition and Bone Health, edited by Michael F. Holick and Bess Dawson-Hughes, 2004 Diet and Human Immune Function, edited by David A. Hughes, L. Gail Darlington,

Carbohydrate

Carbohydrates are valuable energy foods, but what is important is the type of carbohydrates you e at an d th e b alanc e within your diet. Complex c arbohydr ates , which release energy gradually, are better foods th an simple carbohydrates, which c ause fl uctuati ons i n blood- su gar levels th at affect the functionin g of body systems (see pages 16 17). Carbohydrate metabolism results in alcohol production . Simple carbohydrates produce alcohols th at c an be toxic to th e body, and hi gh ly re fine d foods are aci d produc ers. Include in your di et complex carbohydrates such as legumes, grains, and wholewheat breads and pasta. The secret to good carbohydrate intake is to avoid e atin g c arbs 1 ate i n th e day, when they will stay Ion ger in th e system, allowing more time for the production of alcoh ols, which need to be detoxified an d eliminated from the body. Ideally, you should eat complex carbohydrates with protein because thi s prolon gs th e di gestive process so th at...

B vitamins

The body has an increased need for B complex during times of stress, infection, pregnancy and lactation. They can also help to improve utilisation of other vitamins and minerals, with deficiency causing lowered absorption. In pregnancy, deficiency may lead to loss of appetite and vomiting, which can in turn lead to low birth-weight. B vitamins are needed for energy and the metabolism of carbohydrates and for the baby's developing nervous system. In particular, vitamin B3 helps to form serotonin, an important neurotransmitter that helps with sleep and mood. (For food sources see First trimester above.)

Vegetarians

A well-balanced vegetarian diet offers excellent nutrition, and the protein derived from combining vegetarian sources (such as nuts with pulses, nuts with seeds or pulses with seeds) is just as adequate as that from animal sources, with the advantage that it contains complex carbohydrates and fibre rather than saturated fat. However, there are a few areas where deficiencies may occur that need to be corrected during pregnancy and breastfeeding

Nutrition for labour

It is important for the mother to stock up on complex carbohydrates - the main energy source for the body - during the last 2 weeks of pregnancy. This means eating plenty of wholegrains, pulses and vegetables, to ensure that glycogen reserves stored in the muscles and liver tissues are filled to capacity. Labour can be compared in energy requirements to a marathon run. The last thing a woman

Vitamin Requirements

The process of energy production involves several other nutrients in addition to those that yield calories. The oxidation of carbohydrates proceeds in a series of reactions that convert glucose to pyruvic acid and then to acetylcoenzyme A. This last step depends on a coenzyme, thiamin pyrophosphate (TPP). As its name implies, TPP contains the B vitamin thiamin, and its availability can limit the rate at which energy from glucose is produced.

Management of GDM

Dietary control is very important not only for GDM patients, but also for normal pregnant women. The incidence of macrosomia is about 5-10 in most Chinese hospitals. If GDM is not detected and managed properly, the incidence of macrosomia could be as high as 50 . But if dietary control is carried out strictly, most patients do not need insulin therapy and the incidence of macrosomia could be greatly reduced. The ideal dietary control should provide the necessary nutrition to both mother and fetus, achieve well-controlled glucose levels, and avoid hypoglycemia and ketosis. The ideal body weight (IBW height - 100) should be calculated first, and the daily calorie requirement is calculated according to the standard of 30-35 kcal kg. The proportions of carbohydrate, protein, and fat are 40-50, 25-30, and 25-30 , respectively. In order to counter-balance the effects of day and night fluctuation of anti-insulin hormones of pregnant women, GDM patients are advised to have five meals a day....

Diet and nutrition

Most women suffering from sickness in pregnancy find that bland carbohydrates, such as rice, baked potatoes, pasta, scones, bananas, rusks, porridge and dry toast, are foods that they can tolerate. 'Little and often' is the rule, and such foods should be taken every hour or two, for instance snacks of fruit and seeds. This way they can avoid the daunting prospect of a full meal, while maintaining a reasonably steady blood sugar level. It has also been suggested that taking drinks separately from meals is likely to make a sufferer feel less sick.

Role of protein

Protein content in the ADA diet and euglycemic diet makes up 20 of the total daily caloric intake. Increased satiety has also been correlated with meals that are high in protein con-tent.41,42 Thus, this aspect could help morbidly obese patients manage their overall caloric intake especially when moderate caloric restriction therapy is being used. Low carbohydrate high protein diets in normal pregnant women have been explored notably in the Motherwell studies running from 1938 to 1977. The Motherwell studies suggested a link between increased protein content and low birthweight.43 Recent studies have expanded the initial Motherwell studies by looking at the offspring of these studies as adults. It has been hypothesized that increased protein intake can stimulate

Bolus calculators

Some of these factors are modifiable, such as the amount of carbohydrates (CHO) to be consumed and planed exercise some are non modifiable, such as the insulin sensitivity, which varies with the week of gestation and has diurnal variations. Additional factor to be considered is the insulin-action time (the pharmacodynamics) of the previous injected insulin boluses ('active insulin').

Type 1 diabetes

Inappropriate hyperinsulinemia, either absolute or relative, is the initiating cause of hypoglycemia in diabetes mellitus. Hyperinsulinemia is the rule in diabetes mellitus, both Type 1 and Type 2, because of the therapeutic delivery of insulin into the peripheral rather than portal circulation and because of the empirical algorithms used to administer insulin. Absolute hyperinsulinemia, due to excessive levels of circulating insulin because of an excess of dosage or irregularity of absorption, causes hypoglycemia more frequently during the hours preceding meals or in the first morning hours. Relative hyper-insulinemia is due to other conditions such as delayed or inadequate diet (especially as far as the range of carbohydrates is concerned), physical exercise, renal failure, excessive alcohol consumption, delayed gastric emptying. In these conditions usually hypoglycemia occurs after meals.20

Vegetables

Along with fruit, vegetables are the next level up the Pyramid, meaning they too should be eaten in abundance. They provide rich sources of vitamins and minerals, as well as fiber and carbohydrates. People who eat lots of fruits and vegetables appear to be healthier in many ways, including having lower risks of several kinds of cancer later in life. Eating a variety of fruits and vegetables ensures a good mix of nutrients. Within vegetables, for instance, your child should eat dark leafy greens, such as spinach and collard greens deep yellow vegetables, such as carrots and sweet potatoes starchy vegetables, such as peas, potatoes, and corn and dried peas or beans. If vegetables are not on your child's short list of things he'll eat (except for French fries), check Vegetable Strategies later in this chapter for some serving suggestions.

Focus On Bones

Th at are i nterwoven in a kind of matrix made up of water, mineral salts, and carbohydrates. Bone tissue i s not ri gi d, and it continu ally bre aks down an d rebuilds duri n g th e growi n g proce ss. At the center of mature bone is the bone marrow, some of which is soft tissue that produces blood cells and some of which is mostly fat tissue bone also has blood vessels runn in g throu gh it .

Pathogenesis

Pregnancy by itself is a state of insulin resistance. Insulin sensitivity has been demonstrated to fall by as much as 56 through 36 weeks of gestation.14 The production of insulin antagonistic hormones like human placental lactogen, pro-lactin, and cortisol, all contribute to this. The insulin requirement, for this reason, progressively rises during pregnancy explaining the higher incidence of diabetic ketoacidosis in the second and third trimesters. In addition the physiological rise in progesterone with pregnancy decreases gastrointestinal motility that contributes to an increase in the absorption of carbohydrates thereby promoting hyperglycemia. Acidosis is further exacerbated by the decrease in bicarbonate levels owing to bicarbonate neutralization of the ketone bodies prior to their excretion in urine.5 As a result, a compensatory respiratory alkalosis is added to the baseline relative respiratory alkalosis and metabolic acidemia (renal excretion of bicarbonate) of pregnancy....

Nutrition in labour

Views vary on eating and drinking in labour. In many developed countries there is a fear that the contents of the stomach will aspirate during anaesthesia this is called Mendelson's syndrome (Moir & Thorburn 1986). Since at the beginning of labour the possibility of anaesthesia cannot be entirely ruled out, food and drink are often withheld. However, to date there have been no randomised controlled trials on the wider effects of withholding food and drink during labour. Labour requires enormous amounts of energy. As the length of a labour cannot be predicted, restriction of fluids can lead to dehydration and ketosis (Ludka 1993). Lack of energy during labour may slow it down and make intervention more likely. Feeling hungry and thirsty can be unpleasant and add extra stress. During exercise, muscles contract, using glycogen converted from carbohydrates. Where there is insufficient dietary carbohydrate, body fat will be used as an alternative source, releasing fatty acids into the...

Rehydration

The rate of infusion of fluids is dependent upon the degree of electrolyte imbalance, the degree of ketosis and the oral intake and output of fluid. Usually on admission this would involve rapid infusion rates of 1 litre per 2-4-hourly frequencies due to being in a negative fluid balance state. Changes in weight help to determine the adequacy of rehydration and modification of the regime if warranted.

Biguanides

Alpha-glucosidase inhibitors act by slowing the absorption of carbohydrates from the intestine, thereby reducing the postprandial rise in blood glucose. The postprandial rise is blunted in both normal and diabetic patients. Gastrointestinal side effects require gradual dosage increments over time after initiation of therapy. This group of drugs may be considered a monotherapy in elderly patients but are typically used in combination with other oral anti-diabetic agents and or insulin. Acarbose, the oral agent in this group currently in use, may be added to most other available therapies.43,44

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Good Carb Diet

Good Carb Diet

WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.

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