EXERCISE FOR HEALTH

Every person must exercise. So many young adults today have insulin resistance and are at risk of developing diabetes mellitus, particularly if one or both of their parents are diabetic. And you know,  if we adopt healthy lifestyles i.e. eat the right foods at the right times in the appropriate amounts, exercise daily and have adequate and healthy sleep, not only can we prevent diabetes but also reverse it .

We can say exercise consists of physical activities that are planned and structured. We repeat the same movements many times or do the activity repeatedly for a specific length/period of time. It helps us to become physically fit.

What does physical fitness mean? Physical fitness means we are able to perform physical activities in a sustained manner with ease and agility and do not feel fatigued within a very short time. It implies that our muscles are strong enough to work against resistance and also have endurance i.e. they are able to contract repeatedly during a given period of time without one’s feeling exhausted. Also the joints should be flexible through a full range of motions. Fitness includes having a good /healthy body composition, have speed, agility and balance, also have good resistance to infection and if injured be able to recover as quickly as possible.

How do we ensure that we are physically fit? By being physically active and to the extent possible incorporating physical exercise in our daily routines.  Physical fitness needs to be developed and does not happen if we exercise sporadically. Exercise should be part of our routine as much as eating and using our cell phones are.

What are the benefits?

Before doing any exercise, it is important to do warm up exercises. These involve simple bending and extending different joints. Doing so helps to improve flexibility and prepares the body for undertaking exercise. Warm up exercises are generally done for 5 to 10 minutes and are not strenuous. Similarly cool down exercises are to be done after the exercise regime/set of exercises is completed for 5 to 10 minutes. These should be an integral part of every exercise regimen.

We can classify exercises as follows:

  1. Isometric exercises – Muscles of thigh and leg muscles are contracted without moving the knees or hips. Usually carried out for rehabilitation /special purposes. No special equipment is needed and there is minimal chance of injury.
  2. Isotonic exercises – Muscles and joints are moved, or their length is increased like bending/stretching the limbs. Sit ups and push ups are examples of such exercises. Such exercises help to improve circulation. In weight training such exercises can be done with dumbbells.
  3. Isokinetic exercises – Machines are used while exercising, to control the range and speed of motion. These are a combination of isometric exercises and weight training eg working out on an exercise bike set at a particular speed.
  4. Strength building exercises – These are basically isometric, isokinetic and isotonic exercises. They help to improve muscle strength and mass, bone strength as well as improve metabolism.
  5. Aerobic exercises – These are also called cardio exercises, because they are useful for cardiovascular conditioning. With aerobic exercise, the heart rate increases as does the rate of breathing that should be sustained through the exercise session. This helps to improve fitness of lungs and heart. Familiar examples are walking, jogging, running, spinning, skipping, bicycling, aerobic dancing, etc. This form of exercise involves moving the muscles rhythmically in a sustained manner. Another example is use of cardio machines. Aerobic exercise helps us to burn energy, and in weight loss as well as weight maintenance.
  6. Resistance exercise – Muscle groups are moved against exercise or applied force or weight or gravity. This helps to improve muscle mass and strength, with practice and perseverance. In the beginning many individuals particularly older persons or those who are obese or who have less muscle mass may find it difficult to do these exercises.
  7. Weight-bearing exercise – Groups of muscles are moved against resistance/applied force/weight/gravity. These exercises help to improve bone mass and to condition the body and give it strength. It is useful for postmenopausal women and persons having osteoporosis. However, person doing this exercise should do so with caution, not have jerky movements as there is risk of injuries. These exercises can be performed in bouts for short periods of time, as they cannot be done for long periods. E.g. weight lifting.
  8. Flexibility exercise – These are activities or exercises that are used to preserve or extend range of motion around a joint. Such exercises involved rotating or flexing the extremities. Yoga is an example; most people are familiar with. Zumba, pilates, tai chi and dancing are included as well.
  9. Balancing and stretching exercise – These exercises combine activities that aim to increase lower body strength while also trying to reduce the risk of falls. The focus is on harmony and helps the person to relax besides improving physical stability and flexibility. Yoga, dancing, gentle stretching, and tai chi are all balancing and stretching exercises. Such exercises are associated with less risk of injuries.
  10. Cardiac exercise – These are body movements that increase the heartbeats and improve the efficiency of oxygen uptake, enhance fitness, and can help to reduce/prevent cardiac disorders or diseases. Exercises like brisk walking, jumping, and cycling are examples. If endurance exercises are done, lower speed and intensity should be used and if done at faster speed and high intensity, it should be not be undertaken without guidance and supervision.

Exercise for specific target age groups: Children and teenagers can undertake and sustain exercise or physical activities for quite a long period of time eg 60 minutes. However, many adults particularly older persons may not be able do exercise for more than 30 minutes. Of course, those who are very physically fit and are used to exercise may be able to sustain it for longer periods. One group which should be considered is pregnant women, who should be advised moderate amount of physical activity daily. Persons with health problems also need to be given exercise prescriptions that are different from those we recommend otherwise. Persons having asthma, high blood pressure, diabetes, osteoporosis or even they are simply obese, need to be evaluated for their ability to undertake exercise first and can be given exercise prescription that is approved by their supervising physicians. For such individuals, simple walking preceded by warm-up exercises can be prescribed.

We have used the word moderate and vigorous when talking about physical activity. Based on the intensity, physical activity is classified into three levels:

The World Health Organization in 2010 has given recommendations for different groups are follows:

If an elderly person has poor mobility, he/she should do exercise at least thrice/week in order to enhance balance and prevent falls. Twice in a week, the individual must do muscle strengthening exercises. There may be persons whose health condition does not allow them to undertake any of these activities. Such persons should do whatever physical activity is possible.

In addition, the American Heart Association states that one should spend less time sitting and even light intensity activities can be useful to offset the risks due to being sedentary. Also, one should gradually increase the amount and intensity of exercises.

A few words about yoga will not be out of place. Yoga is not just physical exercise and performing physical postures. In addition to these it helps one to achieve breath control and metnal focus and besides physical fitness by improving muscle tone and strength, improving flexibilityand health, it will help enhance mental and spiritual health. Other physical benefits are improvement in respiration, and vitality in general.

Unbox appetite/ Lunch box

Unboxing the lunch natuarlly stimulates the gastric juice and exhilirate the taste buds. Finding the favourite food multiplies the pleasure of eating from the tiffin box. It is to be enjoyed and shared with the peer group. Lunch box cuisine varies with age, meal time at the work place, food culture (of the family as well as of the peers) and also the time availability of the time and the cooking skill of the person who cooks the food and pack the box. On various occassions, it is packed for the long journey. While writing I am recalling my lunch box and I am sure you must be in the same state with your tiffin.

Let us plainly understand some of the basic concepts and characteritics of the tiffin/lunch box or khane ka dabba.

For the young children

Lunch box for the children is a hidden treasure to be revealed during recess time. What it should contain and what are important concerns:

  • Box itself need to be attractive and comfortable enough to carry and open.
  • Inside the food should be eye appealing by shapes, colour and texture and also familiar, e.g. spinach paratha or vegetable sandwitch can be cut into triangles, square, ractangles, round. Add green peas, red carrort or green spinach and yellow corn for colour flavour and texture
  • Give different foods on different days and avoid too many varieties on the same day. Children often find difficult to eat many things at a time and when they are in hurry to finish lunch and go for play during short period of recess
  • Food should be clean, safe and easy to eat. It is likely that children do not eat if the food is tToo hard to chew, too spicy or Clean food and clean boox, spoon is of utmost important
  • Be very careful about using sugar, salt and fat/oil in food preparation (high fat high sugar and high salt or HFSS). Regular consumption of HFSS may ruin the health of the children or lead to obesity.
  • Recipes in lunch box should be nutrient dense and at the same time easy to consume and favourite, e.g. dal paratha with vegetable or spinach paratha with dry dal.
  • Children spends several hours in school hence the lunch box items should not be treated as snack rather a complete meal. Therefor food preparation should be like a meal and should provide one third of the day’s requirement of the energy and nutrients
  • Staple cereals, sources of good quality protein, and fruit/vegetable/nuts or seeds should be included.
  • The meal should be filling enough so that the child should not either feel hungry or overfed to avoid nutritional gaps and hinderance in his or her performance.
  • Packed lunch should be dry or semi solid. Avoid liquid or oily preparations to avoid spillage in school bags on books etc.
  • Food should be palatable enough even when cold or dry. For example, noodles, dosa are unpalatable when cold. Salads are not a good choice for packed lunch for school children it gives low energy and takes time to consume. Whole fruits are a good choice.
  • Food should not become soggy, mushy, mixed up, or ferment in lunch box

For adults

Basic characteristics are almost same, the difference lies in the situations like who prepares the lunch box food. If a lady of the house cooks and packs the food for the husband or any other person who is unaware is a different matter than who cooks and pack and know what is inside.

But certainly, peer group appreciation, sparkling eyes and mouthwatering on opening the lunch box are still the critical deliberation

Outshine in Old age

Life begins at 60 is a famous proverb. It speaks volume. After 60, we may be free from some of the liabilities but we are never free from the race of breath in and breathe out. So, my friends this life stage also have its own beauty and inherent characteristics. Each stage mirrors your previous years of life and old age is a true reflection and reminiscence of that.

A gentleman in his 70s can walk, play, and does all his personal, professional as well as household chores by himself. For him age may just a chronological number. Another woman in her 40s only continues to grumble for aches and pain and blames her age. Both are live examples in our population at large and give us insight to look deeply the scenario of the term “old age”.

World Health Organization (WHO, 2014) defines 60+ years to be referred as the older or elderly persons. Further classification can be done – oldest old (normally those who are 80+) and centenarian (100+) and even super-centenarian (110+).

Age continues to increase in numbers after birth and aging is a natural (normal) biological process that may slow down certain cellular and physiological processes in the body. The rate of deceleration varies in different population for myriad factors. No doubt certain past experiences can’t be reversed but careful attention at early stage is warranted.

Though it is hard to pinpoint the day aging begins but the neglect or the misuse of the body for any unprecedented reason may increase the vulnerability of the body for illnesses, diseases, infections, accidents, or traumas that have a cumulative effect on health and nutritional status later in life. On contrary, perseverance in taking care of the body in given 24 hours along with active life and positive attitude stimulate smooth sailing. Physical, physiological, psychological conditions, social prestige, financial status, personal life style, family composition, family support are the factors which drastically influence health of the elders. Further loneliness, boredom, depression worrying and lack of food accessibility including restricted food intake for any degenerative chronic disease seriously affect the health outcome. Hence it is crucial to address these factors along with seeking help from friends, family or other community services are effective ways to enhance health and quality of life of elders.

Natural bodily Changes in Elders and Associated Problems and Solutions

Functions of most systems and organs diminish with progression of the adulthood. Apparently, these are visible in the speed and robustness in the physical activities, body contour, skin texture and mental turgor. Invisibly there may be less delivery of oxygen and nutrients to tissues of body, decreased elasticity of the cell membranes, poor absorption of nutrients and diminished digestibility of food, frequent nutrient deficiencies, altered distribution of body fat and low muscle mass and low blood supply to different types of muscles. Waist to hip ratio also increases. There may be lack of protein synthesis in the body which impacts voluntary muscular movement. Loss of muscle mass and the reduced muscle strength and function are referred as sarcopenia. It is not always related to body weight. Obese persons can also be sarcopenic.

Many older persons have frequent aches and pains in different parts of the body and there is high risk of frequent falls and fractures. Arthritis, rheumatism, osteoporosis, and other related problems are common in senior citizens. Regular walk, mild exercise, and sun bath support bone health. Resistance exercises improves muscle mass, reverse sarcopenic effect and thereby strength of the body. Dehydration and dryness are common among elders and need constant attention. Therefore, elders need more water than young adults due to decreased thirst mechanism. Elder man needs 2.8 liters of water then a woman in the same age may require 2.5 liters only. More physical work and hot weather increases the fluid requirement. Maintaining the balance in the body fluids, electrolytes and acid-base is critical in old age. Low /high sodium or potassium may be hazardous in certain clinical conditions like high sodium in cardiac disease and potassium in kidney problem. There are marked changes in kidney function that may be due to reduced number of nephrons and reduced glomerular filtration rate (GFR). It may also be due to imbalance in water, electrolytes, and protein intake.

Immunity though is very important in every age but cannot be ignored in old age for better health and fast recovery from any setback. Poor nutrient intakes impair the immunity hence adequate intake of protein, energy, vitamin A, C, E and minerals like copper, zinc, iron, and selenium helps to synthesize immune system components like antibodies, neutrophils, and T- cells. There is decreased secretion of saliva, gastric juices, and stomach acid and digestive enzymes coinciding with loss or altered sensations of taste and flavour which restrict the nutrient absorption. There is slow movement of food in the alimentary canal resulting in constipation. Use of laxatives to prevent constipation should be discouraged because they interfere with absorption of important nutrients. Judicious selection of food may improve the digestion. Elders often face denture problems or swallowing of food that affects the food intake. Soft and soggy textured food may make swallowing easier. Worry and heavy curry and eating at erratic time can exacerbate the problem of indigestion and other health problems. Circulatory system is affected in terms of losing the elasticity of blood vessels and pooling the blood in feet and legs causing edema. Oxygen carrying capacity is reduced by low production of red blood cells. Further pressure on the heart is increased due to narrowed arteries that often result in cardiac problems.  Frequent episodes of headache, vision disturbances, loss of balance, confusion, dizziness for no specific visible reason need attention and connect with the doctor. It is important to know the effects and side effects of medications that are prescribed for the older person.

 Besides all other changes many elders tend to suffer from the loss of hearing and vision and fine and gross motor control (holding and handling of objects).

Among women there is reduction of estrogen during menopause (cessation of monthly periods) and increase in prolactin may lead to fat accumulation.

The loss of short-term memory and disorientation is commonly observed that is due to poor nerve transmission.

Many elder persons are frail which calls for extra concern because the frailty is cumulative decline in multiple physiological systems. The frail person exhibits weakness, exhaustion unintentional weight loss and slowness and clumsiness in various motor and physical activities. Frails are highly susceptible for high morbidity, disability, hospitalization, and mortality.

Factors affecting nutrition of elderly people

Nutritional requirements of elders

 Energy requirement gradually decreases with age due to reduced BMR and physical activities. With age, anabolic rate reduces and catabolic rate increases that leads to degeneration. Repair and regeneration of newer cells occurs at a slower rate. The heart slows down and its ability to pump blood is less compared to a young adult. Consequently, older people have less energy and stamina to work.

Protein requirements are higher 1.0-1.5 g/Kg of body weight. Adequate intake of good quality protein is warranted to avoid loss of muscle mass and support muscle protein synthesis. It is necessary to consume enough carbohydrate and fluid (water) along with protein. Adequate intake of vitamin A, B complex, C, D, E and K as well as calcium, magnesium, selenium, zinc, phosphorus, sodium, and potassium, is must. Sufficient dose of folate, vitamin B12, and vitamin B6 helps to prevent cognitive decline. Additional amount of fiber which is obtained from several plant foods is highly appreciable not only to prevent constipation but also many complications of chronic diseases.

In addition to the recognized essential nutrients, consumption of phytochemicals will have additional benefits for being anti-inflammatory, anti-microbial, anti-oxidant, and anti-mutagenic and prevention of many chronic diseases like cancer and heart disease. Consuming diverse variety of plant-based foods including whole grains, fruits and vegetables, spices and herbs in suitable forms would be beneficial as they would provide both micronutrients, phytochemicals and at the same time enhance taste, flavour, appearance, and texture in the diet.

 Dietary guidelines for elders: 

  • Higher intakes of fruits, vegetables, nuts, dairy, and whole grains may delay muscle strength and cognitive decline which is common in advanced age.
  • Older persons have small appetite: hence small, frequent, and nutrient dense (especially micronutrient) foods should be included. Major meals can also be small and with few dishes. Variety of ingredients can be added in one dish only.
  • Invite friends and relatives to share meals with the elderly person.
  • Nourishing, digestible, easy to chew and easy to swallow foods and beverages are preferred. Milk shakes, fruit yogurt, biscuits, pancakes, idli etc. can be good choices.
  • Try to make meal platter or dining table more welcoming and attractive. Offer familiar, well liked foods.
  • When an elderly person has poor appetite or complains about digestive problem(s), it should be taken care.
  • Ensure 4-5 serving of fruits and vegetables and cut down on fried foods containing trans fats
  • Add full cream dairy products. The fat is easily digested, cream increases energy and calcium content of the diet. It can also facilitate the peristalsis.
  • Add some amount of butter to vegetables and bread etc to increase energy content and enhance flavour of the diet.
  • Consume fat from whole foods such as nuts, seeds, beans, and fatty fish to get high in ω-3 and ω-9 fatty acids
  • Avoid refined fats and fatty spreads
  • Emphasize healthy traditional vegetable- and legume-based dishes.
  • Limit traditional fat rich dishes and heavily preserved/pickled dishes.
  • Ensure adequate intake of fluids preferable in the form of gravy in the vegetable or pulse or meat preparation, soups, and other beverages. Of course, regular, and adequate intake of water is advisable, especially in hot weather. Adequate fluid intake is necessary for maintaining body temperature and functioning of digestive system. It will reduce constipation which is quite common in this age due to reduced motility of the intestine and reduced physical mobility.
  • Fluid intake may be inadequate because of decreased thirst sensation and reduced ability to conserve water and because they want to avoid frequent urination. Reliance on laxatives, use of prescribed diuretics, infections, immobility and excessive use of caffeine or alcohol put the person at risk of dehydration.
  • In case of medical problems such as kidney disease, fluid intake and output should be monitored and fluid intake should be determined in consultation with the doctor.
  • Some signs of dehydration are mental confusion, decreased urine output, constipation, nausea, lack of appetite, dry lips, and elevated body temperature.
  • Include natural sources fibre (non-starch polysaccharides) such as whole grains, fruits, and vegetables to reduce constipation. It will also help to control better blood sugar control.

Nutritional deficiencies and Related Problems in old age

Nutrition is an important determinant of health in the elderly especially those who may have any illness. Importance of nutrition has been increasingly recognized as a significant factor for persons older than 65 years of age. Malnutrition in the elderly often goes undiagnosed. Common indicators are involuntary weight loss, abnormal BMI, decreased dietary intake and deficiencies of specific micronutrients. Presence of morbidity such as diabetes, heart disease etc. increases the risk of malnutrition. Often the weight loss goes unrecognized, because since some weight loss is expected as muscle mass decreases. Isolation and depression exacerbate the problem. Elderly population has commonly been found to have cobalamin (vitamin B12) and folate deficiency. Intakes of protein and calcium may be low and vitamin D deficiency can occur since the person may not be exposed to sunshine. There may be increased risk of falls and fractures. Low vitamin D status has been linked to higher risk of decline in cognition as well as muscle strength, low moods, and depression.

Low intake of B vitamins, especially folate, B12 and B6 may increase risk of low functionality, cognitive decline, heart disease and stroke. Inadequate intake of dietary protein has been linked with poor muscle function and decline in physical capacity leading towards sarcopenia.

Lower intake of energy and protein rich foods for prolonged period results in PEM and older person become frail and finds difficulty in walking and maintaining balance. Intake of other nutrients like B- vitamins, iron, calcium, zinc and electrolytes also affects the degree of malnutrition and body functioning. PEM not only affects the physical stature but also the mental functioning.

Elders who have limited access to food, living alone, low income and poor transport facilities are vulnerable to PEM. It is important that the elderly live the last stage of life with dignity and have as good a quality of life as is possible.

Exercise in old age:

Exercise is essential to increase muscle strength and muscle mass in older persons to maintain their functional status and independence. Certain aerobic and strength-training exercises are appropriate for individuals age 60 and older. If not done in earlier life they must be undertaken under able guidance and always first be discussed with one’s health care provider. Older persons can do stationary cycling regularly and strength training 2 to 3 days a week, with a day of rest between workouts.

Before undertaking exercise, or before a dietitian advises exercise, it is important that the elderly person be first evaluated for ability and risks by a physiotherapist, who can then advise the type of exercise, its frequency, duration, and intensity.

Besides muscle health, exercise helps a person to feel fresh, improves insulin sensitivity and improves mood. In addition, for those who can go out of the home for exercise, it provides a great opportunity to make friends.

Regular consumption of dairy products, ragi flour, sesame seeds, sweet lime, guava, amla, egg etc. can fulfill the increased demands for protein, calcium, vitamin D and vitamin C. Plain safe drinking water, soups and juices are good. The combination of rice, pulses and one GLV and starch vegetable will do better than fried fast foods. Milk, fruits, and nuts in different forms can be given to provide nutrients and improve digestion. Inclusion of complex carbohydrates, protein, omega 3 fatty acids, vitamin A and C rich in the diet and exclusion of salt, sugar, refined and processed foods and saturated and trans-fats are essential for good cardiac health.

Various physical challenges necessitate special attention like modifying the texture of food or supplying appropriate cutlery.

Regular contact with friends and relatives, through visits and telephone calls, can help prevent these problems. Mental exercises and involvement also support the cognitive functions and attentiveness.

Life Begins in the Womb: Treasure it and nourish it

Pregnancy is one of the most beautiful experiences in a woman’s life time. The whole family anxiously looks forward for the birth of a beautiful and healthy baby. The baby is the fruit of her life- a life giving birth to another life. Couples often plan their babies but a large percentage of pregnancies in India are unplanned. Lifestyle and nutrition during pregnancy is often of great concern, but the preparation and care done before in pre-pregnancy or pre-conception period is critical because it lays a strong foundation for a healthy pregnancy without any problems or complications, and a favorable and successful pregnancy outcome.

Conception begins with the fertilization of the ovum by the sperm to form a zygote. After fertilization, cell division occurs very rapidly and forms a blastocyst which is implanted in the inner lining of the uterus i.e. the endometrium. Thereafter the embryo is formed followed by the formation of different organs and tissues, each of which have specialized functions. Growth and development of all of these continue throughout. Good maternal nutrition is imperative at every stage of pregnancy, everyday being important.

Oxygen and nutrients are reached to the foetus through the umbilical cord. The umbilical cord also picks up the waste from the foetus and gets rid of through the mother’s body via the placenta. The placenta is a special organ that is formed which connects the mother and foetus. It synthesizes many important compounds including hormones that are important for maintaining the foetus and ensuring a healthy pregnancy. Hence placenta is can be called the foetal life line.

 

7-month fetus in womb

The entire period of 9 months of pregnancy is divided into three trimesters each having typical features that are shown in the table.

Table Typical features of each trimester of pregnancy

Typical features I Trimester II Trimester III Trimester
Periods in each trimester Conception to 12 weeks 13 – 28 weeks 28-40 weeks (birth)
Expected gestational weight gain (Kg) 0.6- 1.0 3.0-3.5 6.0-8.0
Changes occurring in pregnant woman Missed menstrual periods

Risk of morning sickness, Possibility of headache

Food cravings/ aversions or pica (craving for eating non-food items like mud, chalk)

Frequent urination, Constipation

Weight loss or gain or no change may occur

Some women may experience general aches and pains

Darkening or itching of the skin in some sensitive parts of body

 

 

More pressure on abdomen may cause some discomforts in women in walking, sleeping, bowel movement

 

Changes occurring in the foetus Formation of all major organs and tissues particularly the neural tube, spine and brain begin to form

Formation of eyes

Development of blood vessels

 

Bone marrow begins to make blood cells.

Facial features appear

Taste buds appear on tongue.

Footprints and fingerprints are formed.

Hair growth begins on head.

Lungs are formed, but do not function yet

Sexual organs begin to form

At 11 weeks all organ systems are functioning

Kidneys begin to function and make urine

Fine hair begins to grow on the head

Downy hair

a protective waxy coating on the whole body (vernix) develops

Foetus gains weight steadily, body fat increases.

and is getting bigger

Lungs mature

Limbs are fully formed with finger nails and toenails

Baby’s organs begin to function, although lungs and kidneys are fully mature.

Baby may turn into a head-down position for birth.

 

Stretch marks on skin

 

 

Crucial micronutrients needed during each trimester DHA, iron, calcium, folic acid, vitamin D, protein DHA, iron, calcium, folic acid, vitamin D, vitamin A, vitamin B6, choline, vitamin B12, protein DHA, iron, calcium, copper, zinc, magnesium, folic acid, vitamin D, vitamin A, vitamin B6, choline, vitamin B12, protein

Physiological Changes during Pregnancy

  • Generally, in a well-nourished mother, body weight is increased by about 8-12 Kg in 9 months of pregnancy. GWG is comprised of weight of the foetus, amniotic fluid, placenta as well as the weight gain of the maternal tissues like uterus and deposition of adipose tissue. Weight gain usually occurs in the second and third trimesters. It is greatly influenced food and nutrient intake, level of physical activity and medical condition (if any). Low weight gain increases the risk of intrauterine growth retardation (IUGR) and mortality of the foetus or neonate.
  • There is about 45-50% increase in blood plasma volume for the formation of new red blood cells (RBC) and to facilitate oxygen and nutrient supply to the foetus and for newly formed maternal tissues. This is one of the causes of natural fall in the haemoglobin level (by 1-2 mg/100ml) causing anaemia in pregnant women if additional iron and protein intake is low.
  • There is increased oxygen demand for tissue development is naturally compensated by improved efficiency of lungs, cardiac output and increased BMR.
  • Gastro intestinal motility is slowed down which is advantageous to allow more time for absorption of the nutrients. This improves absorption of iron, calcium, vitamin B12 and other nutrients.
  • Renal functions are also altered in order to excrete metabolic wastes of both mother and foetus and sodium retention increases.

Nutritional status of the pregnant woman is often governed by the numerous factors.

Nutritional Requirements during Pregnancy

Nutritional requirements during pregnancy are different in the three trimesters and vary with age, body weight, body size; dietary pattern and nutritional status of the mother during her adolescence and pre-pregnancy period.

Energy: Energy cost of pregnancy (kcal) relates to the energy deposited in the form of tissue deposition, gestational weight gain and increase in BMR.  It is much higher need of energy in 2nd and 3rd trimesters that relates to the additional need of 350 kcal/d and 600 kcal/d respectively. Since energy needs as recommended by Indian Council of Medical Research and National Institute of Nutrition (ICMR-NIN, 2020) for a woman is according to activity pattern that is sedentary, moderate, and heavy activity and a healthy woman require 1660, 2130 and 2720 kcal/d. when the same woman gets pregnant additional energy needs can be added, e.g. a office going pregnant woman would require 2010 kcal/d in second trimester and 2260 kcal/d in third trimester.

Protein: A normal woman need 45.7g of protein per day. During second trimester additional protein requirement would be 9.5 g/d that will be 55g/d and in third trimester it will be 67.5g/d. Additional protein intake will take care of the physiological changes occurring in the body such as expansion of blood volume and protein deposition in foetus, uterus, and placenta and breasts; for the formation of new cells, enzymes, hormones, antibodies, muscles, collagen, skin, blood, bones etc.

At the same time, protein, and energy ratio (PE ratio) is also important. Protein quality of the foods consumed is equally important but protein supplements during pregnancy are not advisable as they disturb the PE ratio and there may be adverse consequences.

Fat: A pregnant woman is required to consume 30g fat/d. Besides quantity of fat intake, the food sources and quality of fats are extremely important. Hence it is necessary to ensure adequate intake of DHA and long chain polyunsaturated (LCPUFA) is crucial for the foetal development of brain and retina. Fat plays important role in functions and formation of the cell membranes, hormones, and other biological compounds. Omega-3 fatty acids also play a role in determining the length of gestation, maturation of organs. Experts suggest consumption of 100-200mg DHA per day, to support optimal pregnancy outcome.

Micronutrients:  Supply of micronutrients from the peri-conceptional period throughout pregnancy is crucial. Requirements for most vitamins and minerals are increased significantly. Adequacy of iron, folate, and vitamin B12 are very crucial at the time of conception and throughout pregnancy for RBC production and sustained cell division for enlargement of uterus, growth of placenta and foetus. Increased requirement of B- vitamins like thiamine, riboflavin, niacin, pantothenic acid supports energy metabolism.

In the first 28 days after conception there is formation and closure of neural tube (precursor of the brain and spinal cord) and folate is essential for closure of it. This closure is very important for maintaining brain development. Hence folic acid requirements are significantly increased to 570 µg in pregnancy. Like folic acid, vitamin B12 is required for normal cell division and cell differentiation and for development and myelination (formation of cell membrane of the nerve cells) of the central nervous system. Vitamin B6 facilitates several metabolic processes in nervous system via biosynthesis of neurotransmitters. Vitamin B2 (riboflavin) helps to release energy from macronutrients for the formation and functioning of the skin, lining of the digestive tract, blood cells and other vital organs in the foetus. 80mg of vitamin C is needed for formation of collagen, connective tissues, cartilage, muscles, and the lowest layer of skin.  Energy is critically required for cell division and development and later by the foetus as it becomes active. Choline (Betain is a precursor of choline) is a lesser known nutrient but it is critically involved in methylation (donation of methyl group) to homocysteine to form methionine, formation of memory part in hippocampus (brain part), formation of acetylcholine and normal membrane functions.

Since the foetus depends fully on maternal vitamin D supplies. 25(OH)D readily crosses the placenta and it is activated into 1,25(OH)2D by foetal kidneys. Also, vitamin D is important for maintaining maternal calcium homeostasis. However, vitamin D supplementation for pregnant women is not recommended by the World Health Organization.

During pregnancy vitamin A requirements are increased to 900µg/day for growth, cell differentiation, formation of epithelial lining and immune system as well as vision. Vitamin E is an anti-oxidant and hence protects against oxidative stress and protects the intrauterine growth. Vitamin K is needed for formation of prothrombin that has a role in blood coagulation. It is very crucial in neonates. Women on anticoagulant therapy need to be cautious of this vitamin.

Minerals in pregnancy

Iron is critical during pregnancy hence its requirement is increased from 29 to 40 mg /day for synthesis of haemoglobin (important for transporting oxygen to the developing foetus), myoglobin and certain enzymes expansion of blood volume, synthesis of maternal organs, storage of iron in the foetal liver and loss of iron through blood loss at the time of delivery. Iron is also required for neurological development. During the last trimester, the foetus accumulates considerable amount of iron that will be used in the first six months of postnatal life (when the baby is breastfed and milk is a poor source of iron

A pregnant woman needs 250 µg/d iodine to produce foetal thyroid hormones (as the foetal thyroid begins to function only around the twelfth week of gestation); development of normal brain development and maturation of brain cells and for growth, formation and organs and tissues as well as metabolism of glucose, proteins, lipids, calcium and phosphorus, and thermogenesis.

Calcium requirement is 1000mg/day during pregnancy which is same as normal woman because maternal absorption is increased in correspondence to the foetal demand. Calcium is maximally deposited in foetus during the 3rd trimester. Adequate maternal intake not only to supplies adequate calcium to the foetus but also to maintains the maternal bone reserves.

Zinc is also important for structural, metabolic, and immune functions that include cell growth, development, and differentiation. It also supports brain development. Its retention increases with the progress of pregnancy.  Zinc is important for nucleic acid metabolism, participates in DNA synthesis (thus is important for protein synthesis) and formation and stabilization of enzymes hence its requirement is also increased during pregnancy @ 14.5mg/d. Plasma copper concentrations progressively increased during pregnancy and return to normal after delivery.  This increase relates to the synthesis of ceruloplasmin, due to altered levels of oestrogen.

Effect of Nutritional deficiencies 

Single nutrient deficiency is uncommon and multiple nutrient deficits during pregnancy results in of intrauterine growth retardation (IUGR). It alters the rate of growth and development of the fetal organs and tissues. Nutrients are diverted to some important organs such as the brain at the expense of other organs (liver, pancreas, and muscles). These organs are compelled to adapt. There are many scientific evidences that indicate that nutrient deficiencies may contribute to the development and progression of several metabolic disorders in adulthood or manifestation of non- communicable diseases such as rheumatoid arthritis, metabolic disorders (obesity, type 2 diabetes), cardiovascular disease, and cancer are of “foetal origin”. Hence, we can say that the “impact of foetal under nutrition persists throughout life”.

Nutritional challenges exerted by maternal nutrient intake during foetal development influence foetal growth, birth weight, and foetal survival and more importantly have long term implications in terms of functional, metabolic capacity and the risk of chronic, non-communicable diseases in later life of the off spring. Generally, the foetus adapts to the nutritional imbalance by metabolic structural and functional changes. Any nutritional imbalance brings profound changes in maternal and foetal metabolism and physiology.

Protein energy malnutrition is common among pregnant women for various reasons that result in low maternal blood volume, reduced growth of placenta and the foetus, oedema and growth retardation. Deficiency of essential fatty acid like omega -3/DHA impair the brain development particularly the visual acuity.

Deficiency of folic acid is linked to higher risk of several adverse outcomes of pregnancy such as spontaneous abortion, low birth weight, pregnancy-induced hypertension, neural tube defects, and preterm delivery. Children born to B12– deficient mothers may show developmental abnormalities and anaemia. Vitamin A deficit not only leads to foetal growth retardation but also in low birth weight. Deficiency of choline may raise the risk of preeclampsia, premature birth even maternal and neonatal deaths.

Maternal anaemia during pregnancy is associated with neurological defects, low birth weight, perinatal, maternal, and infant mortality as well as higher risk of premature delivery. Hence iron supplements are generally recommended to improve the pregnancy outcome.

Iodine deficiency increases the risk of spontaneous abortion, perinatal mortality, birth defects and neurological disorders. Maternal deficiency of iodine during pregnancy results in foetal hypothyroidism that can cause mental retardation (cretinism). Deficiency in later stages of pregnancy has less severe impact than in the early part of pregnancy. WHO has stated that iodine deficiency is a preventable cause of brain damage? UNICEF recommends that antenatal supplements including zinc, iron, and folic acid to be given to pregnant women in developing countries because they are likely to have low dietary intakes of these micronutrients.

Dietary Guidelines for Pregnant Mothers

  • Eat well – balanced meals with plenty of fresh fruits and vegetables
  • Increase intake of folate and iron rich foods along with vitamin C rich foods
  • Include foods rich in omega-3 fatty acids, calcium, and vitamin A rich foods
  • Increase intake of complex carbohydrate foods
  • Eat whole fruits instead of fruit juices
  • Ensure that the RDA for protein is met by good quality protein sources such as egg, milk, oily fish, and pulses
  • Avoid alcohol, caffeine, smoking, tannin rich foods like tea, coffee, cola beverages, high fructose corn syrup, sugar -sweetened beverages
  • Avoid ultra-processed and packaged foods
  • Reduce intake of salt, sugar, and refined foods (refined flour, refined sugar, and refined oil)
  • Regularly drink 8-10 glasses of water or fluids like buttermilk (without salt) or milk
  • Avoid skipping meals
  • Eat small size meals at a time and eat several times a day, preferably at regular timings
  • and consume freshly prepared meals
  • Pregnant women should do regular exercise like walking. Before undertaking heavy exercises in a gymnasium, the mother should consult her obstetrician.

Dietary Fiber

Traditionally the Indian population’s diet consisted of surviving on dal/chhole or rajma, roti / unpolished rice. Often people ate parboiled rice and subji and cucumber or salad. Frequently, chutney was also included in the meal.
All over the world it has been found that people who ate whole grains, plenty of fruits and vegetables as per the season, had less health problems, particularly non-communicable diseases like diabetes mellitus and heart disease. Unfortunately, we have changed our dietary habits and with this, more and more people have developed diabetes. Do you know that India is home to the second largest number (77 million) of adults with diabetes worldwide? Initial studies highlighted that there were differences between diets like the ones our older generations consume. Research on why these differences existed revealed that their diets contained something that had been overlooked and that was fiber or what we call dietary fiber.

Dietary fiber (commonly called roughage or bulk) acts like a brush in our gastrointestinal tract, helps to remove the waste and toxins from our bodies and significantly reduces the risk of several health problems ranging from constipation to cancer.

DF are also referred as non-starch polysaccharides (NSP) which are carbohydrate fraction excluding starch and free sugars. Since NSP are not digested hence they do not provide calories whereas starch and free sugars are digested thus provide calories. NSP content of cereals is comparatively low but once the starchy portion in some cereal by-products has been separated away the NSP content is greater. NSP is present in cell wall of the grain and is mostly present in the bran or husk.

Dietary fiber is primarily present in a variety of plant foods in various forms and in varying amounts. DF includes components like cellulose, hemicelluloses, lignin, gums, mucilage, fructo-oligosaccharides, pectin, and other associated minor substances. Each type of fiber differs from each other in its physical form (particle size), water holding capacity and chemical composition. Hence, they have different physiological action(s) on the body. These characteristics are evident in the functional changes that occur during cooking and digestion. Three major mechanisms are believed to be responsible for the benefits of DF, including bulking, viscosity, and fermentation.

In general, DF is divided into two types:

  1. Soluble Dietary fiber (SDF) which dissolves in water
  2. Insoluble Dietary fiber (IDF) which does not dissolve in water

Soluble Dietary fiber (SDF): SDF are soluble in water and form a gel-like material. They include non-cellulosic polysaccharides such as pectin, β-glucans, gums, mucilage, guar gum, gum-Arabic and arabinoxylans. Most of the SDF are fermented in the colon by the bacteria; increase viscosity of the contents in the gut/intestines and exhibit prebiotic effect.

Some of the SDF are fermentable fibers which promote the growth of beneficial bacteria in the intestine. These bacteria in the colon, produce short chain fatty acids (SCFA), which bring favourable changes in the gut thereby they confer numerous beneficial effects and thus improve our health.

The SCFA also play an important role in regulating metabolism, inflammation, and development of disease. They have been found to be anti-inflammatory, antitumorigenic and antimicrobial. They also have a role in maintaining homeostasis (equilibrium) in the gastrointestinal tract and of the immune system.

Hence, they delay gastric emptying, regulate blood glucose levels, lower serum cholesterol levels, thereby help normalize stool formation by softening hard stool in constipation and firming loose or liquid stool in diarrhoea.

Soluble fibre is present in foods like oats, apples, citrus fruits, psyllium (isabgol), barley, flaxseed etc. Soluble fiber can help lower total blood cholesterol levels and lower low-density lipoprotein (LDL) levels. Soluble fiber can provide us with 2 kcal/g.

Insoluble Dietary fiber (IDF): IDF is not soluble in water and consists mainly of cell wall components and includes cellulose, hemicellulose, and lignin. In plants, cellulose gives rigidity and strength to plant cell walls. It is present in bran of cereals, millets, and pulses as well as nuts, vegetables (green leafy vegetables, immature /green beans), and fruits.

It provides bulk to the food and gives satiety and several health benefits such as weight management. It promotes movement of the material through the digestive system, and increases stool bulk and is helpful for persons who either have constipation or irregular stools.

The amount of soluble and insoluble fiber varies in different plant foods. To receive the greatest health benefit, eat a wide variety of high-fiber foods. Insoluble dietary fiber is also acted upon by the bacteria in the large intestines or colon.  Including enough insoluble fiber in the diet could also help to manage blood sugar and reduce risk of developing type 2 diabetes.

 So the benefits of a high-fiber diet are:

  • Normalizes bowel movements by increases the weight and size of your stool as well as softening it. Bulky stools are easier to pass, and decrease chance of constipation. Conversely, for a having loose, watery stools, fiber may help to solidify the stool because it absorbs water and adds bulk to stool.

 

partial view of woman holding paper made large intestine on grey background
  • Helps maintain bowel health, reduces our risk of developing hemorrhoids (piles) and problems like diverticular disease, colon cancer as well as blood pressure and inflammation.
  • Aids in achieving healthy weight. This is because foods that are high in fiber foods are more satiating and tend to be more filling. So we will not feel hungry soon as we do in case of low-fiber foods, so we are likely to eat less often and stay satisfied longer. Also more fiber generally means that the energy density of the food will be less i.e. they will be less “energy dense,” i.e. they have fewer calories for the same volume of food.
Female leg stepping on weigh scales. Healthy lifestyle, food and sport concept.

To reap the physiological effects of the fiber, several form of fiber like bran (wheat bran, oat bran, apple fiber, soy bran, etc.), guar gum, β-glucans are used by food processors to develop innovative, health promoting or functional products by modifying the texture, rheology and other properties of food systems and improve the marketability of food products. For example, bran is added to the wheat flour while making noodles. Other fiber rich cereal products in the market are whole grain bread, biscuits, and steamed bread etc.

Recommended intake of dietary fiber

The Indian Council of Medical Research and National Institute of Nutrition (ICMR-NIN, 2020) has recommended safe intakes of dietary fiber – as 40 g/2000 kcal. Even children in the age group of 1-9 years should consume fiber containing foods that can be in the form of fruits, green leafy vegetables and other vegetables along with whole pulses and whole grain cereals and millets, instead of refined foods.

 

Although there are no negative effects of dietary fiber, but in some people, it may cause abdominal discomfort because of flatus formation. Excessive intake of DF > 60g/d can lead to flatulence, abdominal distension and even diarrhea. Hence fiber intake should be gradually increased giving the gastrointestinal tract enough time to adapt. Drinking plenty of fluids is advisable along with consumption of high fiber diet in order to soften the fiber. Excess dietary fiber may reduce absorption of some minerals like calcium, iron, magnesium, copper, and zinc. Some evidence suggests consumption of fiber along with fluid and some fat is more beneficial as it promotes the smooth flow in the alimentary canal.

Dietary sources of dietary fiber

Ingredients for the healthy foods selection. The concept of healthy food set up on dark stone background.

Any food containing 2.5 g fiber /serving is considered a good source of DG. Animal foods including dairy do not contain any fiber. Fruits (sapota, pears, and oranges), vegetable (corn, peas, jackfruits, and broccoli), pulses (whole Bengal gram, green gram lentils, chickpeas, beans), and whole grains (wheat, maize, millets) are known to contain good amounts of DF. Though spices are consumed in lesser amounts but contain high amount of dietary fiber such as coriander seeds, and cumin seed. Flaxseed is an excellent source of DF containing lignan and used in several diseases. We must remember that milling, peeling and overprocessing the food strip away not only the DF content but the beneficial effect of that food item itself.

EAT WHOLE GRAINS AND RAW FRUITS/SALADS FOR WHOLESOME BODY, HEALTH AND WELL BEING

Bon Appetite through Food Groups

Mother earth has endowed us with an extensive diversity of edible items.  A wide range of cuisines are relished across the globe. There are more than 300 natural foods that are commonly used and each is inherently rich in several nutrients and phytonutrients that we need to include in our dietary regimen for good health and wellbeing. Many of them are therapeutically beneficial and have been used for centuries at household levels, local health centers and have become part and parcel of our traditional systems of medicine. When you dwell deeper into the arena of food groups you will be left muddled and confused as they are vast and diverse.

Food Groups can be understood through nutrition science. Nutrition science can show you the right direction though. The solution lies in teaming up foods and edible items based on their (1) perishability of foods (2) body functions i.e., what are our requirements and (3) nutrients present in the various foods.

(1) Perishability

Eat, drink and be merry with Perishable foods, strengthen your muscles and move your body as much as you want by virtue of a host of nutrients contained in these foods. Many like curd, cow/soy milk are good sources of bioavailable protein lactose, calcium. Many vegetables are good sources of iron, magnesium, riboflavin, folate, vitamin C, beta carotene and other carotenoids, fiber etc. Some fish may provide omega-3 fatty acids.

Satisfy your hunger with Non-perishable foods as these are your staple foods that are important for your survival and give you satisfaction. They contain good amount of carbohydrates coupled with dietary fiber, protein, and good amounts of vitamins and minerals and if you eat whole grains i.e. whole cereals, millets and pulses you will also get phytochemicals that have health benefits.

Semi-perishable foods like pumpkin, fruits and vegetables, onion, sweet potato, spices like ginger, herbs like mint, parsley etc. are good for health and must be included in the diet. So also, should spices. However, one should go slow with foods like biscuits, jams, fruit-based beverages because they are energy dense but poor in important nutrients particularly fiber, vitamins, and minerals.

(2) Body functions – why do we need these foods

Source: Indian Council of Medical Research- National Institute of Nutrition (2011)

Our body requires about 40 to 50 nutrients. It is not easy to remember the sources of these all. Therefore, for convenience, based on their nutrient composition, foods are placed in five groups and all five of them are mandatory as they contribute to a balanced diet. The concept of balanced diet implies that we have wisely included foods from all five groups in the right amounts or proportions.

The Plate shown in the picture was launched on the 50th Anniversary of Indian Council of Medical Research- National Institute of Nutrition in 2018.

(3) Based on the Nutrients present in Foods

As the plate indicates, half of it should be filled with colorful fruits and vegetables.

Fruits and vegetables are easily accessible and affordable; you may buy them in large quantities. In this case, agriculture and marketing may also play role in enhancing the nutritional status of your family members.

Green leafy vegetables contain chlorophyll which carries magnesium in its core molecule. They are rich sources of vitamin A (beta carotene), riboflavin, Vitamin C, iron, folate, and fiber. Darker colour signifies higher nutrient content. Furthermore, they are alkaline in nature and a big support to maintain the acid-base balance in the body. Simple green chutney made with coriander and mint and lemon juice or amla is a good way to add good dose of nutrients and taste in your daily diet.

Rainbow colours like purple, yellow, green, red, orange in fruits and vegetables adds visual appeal and a therapeutic touch, e.g. purple color in red-purple grapes are important in heart health, cognitive development and reducing harmful effects of free radicals.

Cereals like wheat, rice, millets are our staples from which we make a great variety of our favorite foods such as chapati, bhakri, roti, paratha, khakhra, mathri, rice, pulav, and biryani.

All of us, irrespective of community, creed, colour, religion, region, socio-economic status consume cereal products to satisfy our hunger and most of the activities revolve around getting “do vakt ki roti”. Since cereals and millets are cultivated once a year and have low moisture content, they can be stored and used during rest of year. They come under the category of non-perishable items. However, we must remember that cooked products like bread or chapati or rice are perishable. Some food products that are popular are made from refined flour (maida). Refining, milling, polishing (of rice) strip away valuable nutrients like B vitamins, vitamin E, dietary fiber, and certain minerals. On the other hand, use of pesticides, herbicides and inorganic fertilizers has increased the yield and decreased the number of hungry mouths. These herbicides and fertilizers are not good for health and therefore use of organic foods is now gathering momentum.

Indians are quite fond of consuming milk, butter milk, curd, and other milk products like paneer, khoya, milk powder and Indian sweets like kheer/payasam, basundi, rabri, shrikhand, rasmalai, barfi etc.

Vegans refrain from consuming milk and milk products. If you are vegan, it is worthwhile to remember that that each edible food item from the food group categories is important from the nutrition point of view. Milk is an easy and effective supplier of calcium, good quality protein, vitamin B12, riboflavin, lactose (milk sugar), whey protein and immune boosting immunoglobulin. Breast’s milk is considered the best food for the baby till six months. Of course, the milk lacks iron, fiber, and vitamin C.

Pulses Legumes and Nuts are important food ingredients and traditionally in India we use a wide variety of whole pulses/legumes whole as well as decorticated in dal form. We are all familiar with legumes like udad (black gram), mung (green gram) and mung dal, masur (lentil) and masur dal, rajma (kidney beans), chawli (cowpeas), chana ( chickpeas) which includes desi varieties and kabuli chana, horsegram (kulith), different cultivars of field beans (vaal), soybean etc.

They make great nutritional contributions,  providing fiber (in case of whole pulses), protein, carbohydrate, B vitamins, iron, copper, magnesium, manganese, zinc, and phosphorous. In fact, for vegetarians and vegans, they are the major and most important sources of protein. Legumes are naturally low in fat, are practically free of saturated fat, and because they are plant foods, they are free of cholesterol as well. Compared to cereals, they give good satiety and are good for incorporating into weight management regimes. Legumes have a lower glycemic index than cereals and millets.

Nuts are excellent sources of protein and fiber and are good sources of unsaturated fatty acids, vitamin E and minerals. Although their fat content is high, they are sources of ‘healthy’ fats’ that are good for health and nuts like walnut contain omega-3 fatty acid. They are ‘heart healthy’. Nuts that you can include in your diet include almonds, cashew nuts, walnuts, peanuts, charoli/chironji, pistachios, hazelnuts, chia seeds, macadamia nuts, pecans and so on.

They improve cholesterol profiles. The unsaturated fat in nuts helps to lower LDL (bad) cholesterol and raise HDL (good) cholesterol. Nuts aid in preventing erratic heart rhythms also known as arrhythmia, reduce blood clotting, relax blood vessels thus helping blood to flow better and lowering blood pressure, help to control blood glucose, and contribute to satiety. They have a lower glycemic index than cereals because they have much lower carbs content.

If you truly wish to obtain health benefits of nuts, they should be eaten whole with skin and as is (raw) without salt and flavouring and certainly not in the form of chikki, or katri or other sweet preparations.

Fats and oils play a crucial role in our diet. They are used to enhance taste and flavor of the food and make the food more appetizing. They provide more calories as compared to foods containing carbohydrates or protein per gram. Since excessive intake of fat and bad choice of fat is harmful for the body, hence being judicious in selection of food sources is important.

The Indian council of Medical Research-National Institute of Nutrition recommends that a sedentary person should take about 20-30 grams a day. There are of two types of fats in our diets: Visible fat and invisible fat. Visible fat is the one you can see like butter, ghee, hydrogenated fat, vegetable oils. Invisible fat that is present in several food items but it is not seen and not removable (until and unless it is removed by technological processes). Grains, nuts, and seeds contain invisible fat in enough amounts and these are generally good fats as they provide some amount of omega-3: omega – 6 fatty acids. Green leafy vegetables, even curry patta, pulses like whole black urad, rajmah, methi seeds, have good amounts of omega -3. Include them in your daily diet. Visible fat is used in cooking of food and in preparation of snacks and confectionery. After prolonged cooking at high temperature the same fat is very harmful to your health.

Sweets: The tip of our tongue has numerous taste buds that are sensitive to sweet taste; Sugar is a simple carbohydrate and provides only calories and nothing else (we can say it gives ‘empty calories’ i.e. empty of other important nutrients); one tea spoon (5 grams) gives 20 kcal.  So, if I have one cup of green tea with ½ teaspoon of sugar that will give me only 10 kcal and lots of antioxidants.  Problems arise from the amount of sugar added in cold drinks and if soft drinks like cola beverages are consumed, several teaspoons of sugar are taken at a time.

The World Health Organization recommends that only 5% of our total energy intake should come from added sugar. Many persons consume sweets while they do not realize how much they are consuming. We don’t realize the extreme sweetness when consuming cold food products, like ice cream. Over and above this, you should be aware that manufacturers do not always use sucrose but add high fructose corn syrup which disrupts the body’s metabolism. Consumption of high fructose corn syrup containing foods has been found to be associated with weight gain, obesity and heart problems, high uric acid, fatty liver, high triglycerides, etc.

It may be worthwhile to use, dates, raisins, jaggery, maple syrup, honey in limited amounts as sweeteners. If you or your family find it difficult to shun the habit of eating sweets after meals, then use mukhwas or preparations using natural form of sugar rather white sugar or table sugar. Start by trying to reduce the sugar you add to tea/coffee and slowly reduce your intake of sweets gradually.

To sum up, the table given here provides information about the foods and nutrients included in each food group. Included also is the diagram i.e. the pyramid that indicates which foods need to be emphasized and which foods should be included sparingly in our diets.

Food groups Food groups Foods included in each group Nutrient supply by each food group
I Cereals, Millets and Pulses
  Cereals and Millets Wheat, rice, bajra, jowar, maize, corn, ragi, puffed rice, poha Energy, complex carbohydrates, protein, iron, thiamine, niacin, fiber
  Pulses

 

Channa, Urad, Moong, arhar (tur), massor, lobia (rongi or chowli) (with or without skin), peas, rajma, soybeans, dry beans, sprouts Energy, protein, iron, calcium, B-vitamins invisible fat, fiber
II Vegetables and Fruits
  Roots and tubers Onion, potato, yam, sweet potato, garlic Starch, fiber, vitamins and minerals
  Green leafy vegetables Amaranth, spinach, drumstick leaves, coriander leaves, fenugreek leaves etc vitamin A, invisible fats, riboflavin, folic acid, calcium, magnesium, iron, fiber
  Other vegetables Carrots, brinjal, lady finger, pumpkin, gourds, beans, capsicum, cauliflower Invisible fats, riboflavin, folic acid, calcium, iron, fiber
  Fruits Mango, guava, papaya, orange, sweet lime, water melon Vitamin A, B, C and fiber, carbohydrates
III Milk and Animal foods
  Milk

 

Milk– Milk, curd, skimmed milk, cheese, paneer, khoa Protein, fat, vitamin riboflavin, calcium
  Animal foods* Meat, fish, egg Protein, fat, essential fatty acids, vitamin A, D and E and minerals
IV Fats and oils, nuts, and oil seeds
  Fats and oils Butter, ghee, hydrogenated fat (vanaspati), vegetable oils

 

Nuts like almonds, cashew nuts, figs, dates, pistachio,

Energy, fat, essential fatty acids

 

Essential fatty acids, oils, vitamins, and minerals

V Sugar, Jaggery, Honey
  Sugar, jaggery, honey Sugar, jaggery, honey

Jams, jellies, soft drinks

 

Energy, simple carbohydrates

High fructose

Dietary Guidelines for Indians, A manual (2011) 2nd edition National Institute of Nutrition, Hyderabad, India

As you can see using food groups we can select appropriate food items that offer variety in taste and texture and thus help to design a balanced diet. Knowledge about food groups is important to assess anyone’s diet and identify any short comings, as well as they can be used for nutrition counselling.

Proteins and Amino Acids in our Diet – The Crux of Life

What are Proteins?

Protein is found in each cell of our body.  No Protein → No Existence → No Survival. The moment a person makes plans to be healthier, he or she thinks of adding protein in the diet. Let us dwell more into the world of dietary proteins.

Proteins, like carbohydrates and fats, is a macronutrient. They are large, complex molecules that play important roles in our bodies. Proteins are actually long chains of amino acids that are linked together through peptide bonds. In nature there are protein molecules of various sizes depending on the amino acids present in it. The size of the protein molecules and their unique amino acid composition makes them structurally and functionally distinguishable.
Lets dive into the general functions of proteins:

Growth and Development:  The word ‘Growth’  itself implies an increase in number of cells by multiplication and expansion, thereby forming the structure of the body during foetus development, followed by infancy, childhood, and adolescence. Proteins are essential for growh and development in infants, teenagers and pregnant or lactating women. Growth usually ceases by adulthood.

Physical Activity: Physical activity involves actions of our muscles. Movements occuring via contraction and expansion of muscles consumes proteins.  Collagen is another protein that provides strength to our skeletal system which are involved in physical activities.

Maintenance: There is constant wear and tear of the cells in the body while performing myriad biological functions such as breathing by lungs, digestion of food in GI tract, etc. Many cells die and new ones replace them, for which protein is very essential, particularly in adulthood, old age and if there is any injury.

Formation of Enzymes, Hormones, Neurotransmitters, and Antibodies: All the biological reactions occurring in the body need these compounds. Enzymes are specific proteins, that act as catalysts and help in speeding up biological reactions, whereas hormones are our body regulators, made up peptides or polypeptides.

Neurotransmitters are peptides which facilitate the transmission of nerve signals within the body while regulating numerous body functions like mood, appetite, sleep etc., and antibodies are the compounds produced by our immune system to fight infections. Protein is required for the synthesis of the above compounds and is hence highly essential.

Cell differentiation and Cellular Functions: The body is made up of trillions of cells but all cells do not perform the same functions. Proteins also are important for forming different types of cells in the various organs and tissues and plays a significant role in cell development.

Provide Energy: One-gram protein provides 4 kcal. Body uses protein as a source of energy particularly when our carbohydrate intake is insufficient.

Transport of Nutrients: Different proteins confer health and homeostasis in the body. For example, Transferrin transports iron; Haemoglobin assists in carrying oxygen in the blood to all body cells and tissues; Retinol Binding Protein (RBP) that binds and transports vitamin A and lipoproteins signify the concentration of fat in the blood.

Building Blocks of Proteins- Amino Acids

The healthy human body has the capability to synthesize non-essential (dispensable) amino acids whenever they are required in sufficient quantities but aren’t able to synthesize essential (indispensable) amino acids. Therefore, we have to rely on external sources, namely the human diet for this.

It is also very important to ensure that the protein should be of good quality. Protein synthesis in the body depends on three factors (i) the amount and the balance between the different amino acids (ii) the digestibility of the protein and (iii) availability of the amino acids for protein synthesis.

Protein digestibility is the proportion of the protein that has been consumed, which is absorbed after the dietary protein has been digested in the gastrointestinal tract. In mixed vegetarian diet, the protein digestibility is approximately 85%, which is much lower than the reference protein egg, the digestibility of which is 97%.

Inadequate intake of essential (indispensable) amino acids may result in poor appetite, fatigue, slowing down or faltering in growth, stunting (low height for a given age) in children, particularly young children. These are clinical signs of protein malnutrition.

All foods do not contain all the 8 essential (indispensable) amino acids as per our body’s requirements.  However, all are present in egg. Therefore, expert groups throughout the world use regard egg as a “reference protein”. For vegetarians, some amino acids are present in cereals and fruits and vegetables while others are present in pulses, legumes, nuts, oilseeds.

How much protein do we need?

Recently the Indian Council of Medical Research (ICMR) – National Institute of Nutrition (NIN) who gives the recommendations and guidelines for India has published new recommended dietary allowances (RDA) in 2020.

There we can find the recommendations for each subgroup of population, age, gender, physiological status. On an average with a safety margin, 0.83g/kg body weight/per day of protein is recommended for Indian population. (Nutrient Requirements for Indians. (2020).

Adult Man 54 g of protein per day
Adult Woman 45.7 g of protein per day
During Pregnancy 2nd trimester- additional 9.5g of protein per day

3rd trimester- additional 22g of protein per day

0-6 months 8.1 g of protein per day
6-12 months 10.5 g of protein per day
1-3 years 11.3 g of protein per day
4-6 years 15.9 g of protein per day
5-9 years 23.3 g of protein per day
10-12 years Boys – 31.8 g of protein per day

Girls – 32.8 g of protein per day

13-15 years Boys – 44.9 g of protein per day

Girls – 43.2 g of protein per day

16-17 years Boys – 55.5 g of protein per day

Girls – 46.2 g of protein per day

Let’s take a closer look at amino acids:

There are only 20 amino acids, among which 8 are essential and 12 are non-essential or dispensible amino acids. Permutation and combinations of these 20 amino acids results in the myriad proteins that are present in our bodies and responsible for all our life processes.

The Essential (indispensable) Amino Acids:

No. Essential Amino acid Foods sources
1.        Phenylalanine – helps in synthesis of neurotransmitters and skin pigment melanin. Legumes and rice, sesame seeds/til
2.        Tryptophan- helps the body adjust to changes in environment and improves immunity. Though present in all protein foods, high amounts are found in dairy foods
3.        Methionine- reduces oxidative stree, improves DNA sysnthesis and immunity. Cereals and millets
4.        Lysine- helps in growth and tissue repair as well as increases calcium absorption. Kidney bean, chickpea, soy, potato, pea, avocado, pumpkin seeds,
5. Leucine- source of energy for muscle cells and Shows growth-stimulating effects of insulin Jowar, Pulses, Soybean and dairy product
6. Isoleucine- source of energy, stimulates protein synthesis and reduces plasma glucose levels. Soy, cashew nuts, cereals, meat, egg, milk and piyal seeds.
7. Valine- helps in muscle synthesis an absorption of amino acids. Rice, beans, legumes, dairy and mushrooms
8. Threonine- helps in fat metabolism and collagen formation Sesame seeds, dairy products
9. Histidine- helps synthesis hemoglobin, reduces oxidative stress and is good for growth and repair. Legumes and buckwheat

The Non-Essential or Dispensible Amino Acids:

  • Glycine: This simple amino acid repairs cell damage and delays aging by reducing oxidative stress. It is needed for synthesis of proteins like heme, a part of hemoglobin that is present in blood. It is present in legumes and dairy products.
  • Alanine: Alanine is important for glucose metabolism, release of energy from glucose, protein breakdown and helps in production of antibodies for better immunity. It supports utilization and synthesis of B vitamins.
  • Serine: This amino acid helps break down of proteins during digestion process, aids in fat and protein syntheis and production of glucose by the body. It is important for formation of several amino acids and is present in soybean, peanuts, almonds, walnuts, lentil and chickpea.
  • Cysteine: Cysteine is a powerful antioxidant. It protects the body by binding with heavy metals. It is essential for low birth weight infants and hence it is considered to be conditionally essential. It is also important in liver disease.  Good sources include wheat, rice, pea, chickpea, sunflower seeds.
  • Tyrosine: It is needed for synthesis of neurotransmitters that are important for the nervous system. It helps in boosting memory, alertness in stress and for production of proteins that are natural pain relievers and in the treatment of depression and anxiety. It is present in all food protein sources particularly soybean, peas, beans, etc.
  • Glutamate or Glutamic acid: It plays a role in energy production and is especially important for the body’s response during infections, inflammation, and muscle trauma. Glutamate is a component of one of the popular flavour-enhancing ingredient monosodium glutamate (MSG) or Ajinimoto. It helps to maintain the integrity of the gastrointestinal tract. It is found in seeds, beans and buck wheat.
  • Glutamine: Glutamine maintains acid base balance and helps in removing waste products like ammonia. Under physical or physiological (in illness) stress, or when body feels depleted, glutamine needs replacement. Plant based sources can be almonds, peanuts, hazelnuts and beans including soybean. It plays very important roles in energy and protein metabolism.
  • Arginine: This conditionally essential amino acid has an important role in urea formation and in releasing hormones like growth hormone, insulin, glucagon, etc. It is important for immunity and is used to synthesize glutamine by the body. It plays a role in wound healing, immune functions and removing ammonia from the body. It is important during the growing years and in patients with burns. It is also involved in regulating immune system. Good sources of this amino acid are rice, oats, pulses/beans, soy, etc.
  • Proline: Proline is a part of collagen, and is needed to maintain texture of the skin, wound healing, preventing loss of collagen in old age and also strengthens the cardiac muscles. It plays a significant role in antioxidant functions. It is important in growth and development and assumes importance for foetal and neonatal growth. In human colostrum, proline has antiviral activity. It is part of proteins that play a role in neurodegenerative diseases like Alzheimer’s and Parkinson’s diseases. Proline is present in all foods that are plant sources of protein like, cabbage, green leafy vegetables, and whole grains, pumpkin seeds, sesame seeds, etc.
  • Aspartic acid: It aids in synthesis of compounds that are part of DNA and RNA. Like all other amino acids it is also needed for protein synthesis. Its role is linked with liver enzymes and bile acids, is needed for urea formation (waste product of protein and nitrogen metabolism that is excreted in urine) and in energy metabolism. It is present in all legumes including soy, rice, etc. Aspartic acid is also a source for energy and helps us to overcome fatigue.
  • Asparagine: It is crucial in formation of many nitrogenous compunds in the body. Asparagine if combined by reducing sugar at sufficiently high temperature forming acrylamide which is toxic to health. Food sources are potato, legumes, nuts, seeds, soy, asparagus, and whole grains.

Conequences of High Protein Intake

High protein intake (more than 2g per Kg/day) is recommended for high performance elite athletes but not advisable for healthy adults. People who are looking to enhance their performance build stamina or loose body weight often indulge in high protein diet either from dietary sources or protein supplements. High protein intake may increase the nitrogen load in the body and tax the kidney to detoxify ammonia.

Excess of protein intake may show initial symptoms dehydration, fatigue, intestinal discomfort, nausea and weight gain, and after prolonged period of time it may  adversely affect the vital organs like liver, heart and kidney. It may cause increased loss of calcium from bones causing bone related issues.

Adverse effects are more severe when carbohydrate intake is low like in keto diet owing to excessive production of urea and ammonia in the body which may not be released from the body. Hence persons with renal dysfunction and gout are advised to use selective protein sources in limits quantity.

High intake from meat based diet is not healthy over plant based protein foods and may cause certain health issues over a period of time. Undoubetedly animal protein provides all the essential acids and complete protein which is essential for growth but excess of them may lead to inflammation.

Additionally heme iron in meat, may  produce more free radicals that tend to damage the structure of the cell. Animal protein rich foods lack dietary fiber and are rich in saturated fats thus facilitate cholesterol and increase the risk of cardiovascular diseases. On contrary plant protein may lack some of the essential amino acids but contain more nutrients including fiber, carbohydrates, vitamins and health promoting phytochemicals.

 

Importance of Millets in a Diet

Over the past few years there has been a healthy food revolution. Especially, with the increasing health consciousness among people, there has been a rise in the demand of nutrient rich cereals and exotic berries. No wonder why millets have become popular among millennial for its umpteen health benefits

Millets are cereal crops and small seed grasses, which are widely used in African and Asian countries. Since ages, these small crops were used for human consumption as well as a fodder for animals. Majorly cultivated in the semiarid tropical regions of Africa and Asia, around 97 percent of world’s overall millet production happens in these regions.

Health benefits of millets

Since ages millets were commonly used to feed birds and animals, until the health benefits of these super foods were known to the world. However, in various parts of India, millets were used for a variety of dishes. Especially, for their incredible nutrient rich composition.

India is known as the diabetes capital of the world, due to bad eating habits. This has led to the surge in the demand of millets which are low in GI. Moreover, these gluten free millets can play a pivotal role in preventing and curing several health issues. Enriched with the goodness of nature, millets are a rich source of fiber, minerals like magnesium, phosphorous, iron, calcium, zinc and potassium.

Accommodating millets in your daily food routine can be benefitting in many ways.

High in nutrition:

Millets are a good source of nutrients such as copper, magnesium, phosphorus, and manganese. Which are excellent for maintaining a healthy life. A balanced diet full of nutritional properties will also help eradicate the risk of heart problems and other such life endangering diseases.

Low calorie count:

When trying to lose weight, millets are a viable choice to a healthy weight reduction, as their calorie count is very low. Even for the people who are calorie conscious and trying to eat in a manner that will help them maintain their energy levels throughout the day without constantly feeling famished.

Improves immunity:

Weaker immunity can and will be fatal. The weaker the immune system, the more you are inclined towards experiencing health issues time and again. This is due to the serious deficit of protein in the system. Adding millets to your diet on a regular basis will help your body gain back all the protein that your system was short on.

Satiates Hunger:

Many carbohydrates such as rice and wheat are easy to breakdown once consumed, leaving a person hungry within few hours of their meal. This makes people resort to unhealthy eateries to satiate their hunger. Millets have harder structures and does not breakdown easily in the digestive system, keeping you far enough away from unhealthy eating habits.

Reduces Sugar-levels:

Due to its low glycaemic index, millets are an ideal food to consume to pre-empt diabetes from ever occurring in non-diabetic people. It especially aids in keeping type-2 diabetes under control.

Aids heart problems:

Millets contain essential fats, just the right amount to give our body natural fat. This helps prevent excess fat from depositing over muscles which and avoid high cholesterol, heart strokes, and other heart related disease. Millets are the immediate best alternatives to replace with their unhealthy peers, reducing the risk of cardiovascular diseases by a good measure.

Millet is the only grains that contain all the vital nutrients. From proteins to minerals to vitamins, millets have it all. Millets helps you switch to a lifestyle that’s healthy and long lasting.

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Healthy Snacking

Healthy snacks include those that have significant vitamins, are low in fat, added sugars, and sodium. Examples of healthy snacks include: Fruits, nuts and seeds

Resisting the urge to reach for a burger, candy, or potato chips when you’re hit with a snack attack can make a big difference in your health — regardless of your age.

Nutrition really is the key to a healthy lifestyle and a healthy life. It goes a long way toward lowering the risk for heart disease and improving overall health. Eat small meals every three to five hours and that they resist the urge to overeat.

“The easy part is the frequent meals; the hard part is keeping them small. We are used to big meals. “If you can match your intake with your output, you’ll be better off with your weight-control goals.”

Eating small, frequent snacks keeps your metabolism revved up and helps normalize blood sugar. Hunger can throw your body into famine mode, which slows metabolism and makes it easier to pack on the pounds.

Foods like fruits, vegetables, nuts, low-fat dairy products, whole grains, and legumes are satisfying and are packed with the nutrients, fiber, and protein your body needs, and they guard against sugar highs and lows, so you are less likely to succumb to your sweet tooth — or whatever your dietary Achilles’ heel may be.

“I tell people to think about food as fuel,”

Such nutrient-poor, sugary snacks as candy bars are like fuel that runs hot and flames out. They give you a quick jolt of energy that is followed by a crash that can leave you hungry, cranky, sleepy, and unable to concentrate.

Healthy snacks are more like slow-burning fuel that helps you keep going all day. Having several snacks a day helps banish that post meal sleepiness that comes from consuming too many calories at one sitting. If you include protein in your snack, you’ll derive an extra mental boost — protein food like soya, peanut, millets contain an amino acid that increases the production of neurotransmitters that regulate concentration and alertness.

Many of us naturally reach for carbohydrates when we’re feeling down because they help lift our mood by boosting the brain chemical serotonin. While processed foods like plain bagels and cookies give a quick high, it’s followed by a sharp low. Good-for-you fruit sugars, honey, low-fat dairy products, whole grains, and many vegetables lift mood and battle fatigue without the roller-coaster effect.

Omega-3 fatty acids are another good nutrient to include in snacks, for your heart as well as your head. Flax seeds, watermelon seeds, walnuts and some other foods contain omega-3s, which helps to fight with high blood pressure and heart disease, as well as depression and anxiety. The effects of omega-3s are also being studied as they relate to a number of other health conditions, including joint diseases, schizophrenia, and attention deficit hyperactivity disorder.

Eat your fruits and eat your veggies, stay in shape and have less wedgies!

Importance of essential amino acids in day to day life

Amino acids, often referred to as the building blocks of the human body, are compounds that play many critical roles in nutrition. They’re needed for vital processes like the building of proteins and synthesis of hormones and neurotransmitters. Some may also be taken in supplement form for a natural way to boost athletic performance or improve mood. They’re categorized as essential, conditionally essential or nonessential depending on whether the body can synthesize them or they need to be consumed.

What Are Essential Amino Acids?

Amino acids are organic compounds composed of nitrogen, carbon, hydrogen and oxygen, along with a variable side chain group. Your body needs 20 different amino acids to grow and function properly.

Though all 20 of these are important for your health, only nine amino acids are classified as essential.

These are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. 

Food Sources and Recommended Intake

Since your body cannot produce essential amino acids, they must be provided through your diet. Fortunately, many foods are rich in essential amino acids, making it easy to meet your daily needs.

The US recommended daily allowances per 1 kg of body weight for the nine essential amino acids are:

  • Histidine:14 mg
  • Isoleucine:19 mg
  • Leucine:42 mg
  • Lysine:38 mg
  • Methionine (+ the non-essential amino acid cysteine):19 mg
  • Phenylalanine (+ the non-essential amino acid tyrosine):33 mg
  • Threonine:20 mg
  • Tryptophan:5 mg
  • Valine:24 mg

Foods that contain all nine essential amino acids are referred to as complete proteins. Complete protein sources include:

  • Meat
  • Seafood
  • Poultry
  • Eggs
  • Dairy Products

Soy, quinoa and buckwheat are plant-based foods that contain all nine essential amino acids, making them complete protein sources as well. Other plant based sources like beans and nuts are considered incomplete, as they lack one or more of the essential amino acids.

However, if you’re following a plant-based diet, you can still ensure proper intake of all essential amino acids as long as you eat a variety of plant proteins each day.

For example, choosing a variety of incomplete proteins such as beans, nuts, seeds, whole grains and vegetables can ensure that your essential amino acid needs are met, even if you choose to exclude animal products from your die.

Refer the below video link for more details

You can also get more information on “SMART EATING” by clicking on below mentioned link smart eating

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