A lifelong concern


cartoon woman with salad

The idea that food is medicine has been widely acknowledged for centuries, so it’s no surprise that pharmacists should be called upon to offer advice on optimal nutrition at all life stage

By Leanne Philpott

“Nutrition plays an important role in health at all stages of life, but over the years scientific progress has allowed us to develop a greater understanding of the vital nature of nutrition, particularly during the first 1,000 days of life,” a spokesperson for Danone tells The AJP.

They advise, “Adequate nutrition during infancy and into toddlerhood can have a profound effect on an individual’s long-term health status. For example, excessive weight gain in infancy or being overweight as a young child has been linked to obesity and noncommunicable diseases in later life. Nutrition can influence other systems including organ growth, such as brain development, and our immune system, which in turn can be connected to the progression of allergies and chronic conditions, such as diabetes and heart disease.

“There are phases of life when specific nutrients become particularly important, such as folic acid in pregnancy and long chain polyunsaturated fatty acids and vitamin D during infancy growth, for example. Yet the most important thing is to have balanced, complete and age-appropriate nutrition.” 

Aloysa Hourigan, senior nutritionist, Nutrition Australia, says, “If you look at the amount of information about nutrition that’s communicated through media and social media, it’s probably hard for people to truly forget about the importance of nutrition for health and wellbeing. However, there are two issues that can detract strongly from people taking action to improve their nutrition through better food choices.

“Firstly, life is so busy and often stressful for many people, that nutrition is not their number one priority (although it could help them to manage the other areas of life more effectively).

“Secondly, there are a lot of confusing messages about what is ‘good nutrition’ out in the public domain.  People are unsure what ‘healthy eating’ and ‘good nutrition’ mean.

“Pharmacies are often the first port of call when people are feeling a bit below par, which means pharmacists are well-placed to remind their customers about the importance of healthy eating and can direct them to sound sources of information or perhaps suggest they seek help from an accredited practising dietitian (APD) or other appropriate health professional.

Hourigan says, “The Australian Dietary Guidelines are an excellent point of reference for basic healthy eating advice that pharmacists can refer to, especially if their clients seem unsure or want to know more about healthy, nutritionally balanced eating.

In this regard, it is important that pharmacists are familiar with the Guidelines and the Australian Guide to Healthy Eating – so that their advice is consistent with these.”

Nutrition and disease state management

Nutrition affects many aspects of patient care and wellbeing, from wound healing and the likelihood of infection to liver function, obesity and the risk of type 2 diabetes.

Hourigan says, “Improving nutritional intake, will mean there is a better balance of the macronutrients (protein, fats and carbohydrate, fibre) and the micronutrients (vitamins, minerals and other phytochemicals, for example antioxidants).

“This will assist people in achieving and maintaining a healthy weight, which helps to minimise risk of type 2 diabetes, hypertension and cardiovascular disease. Heart health is optimised when we have the right balance of different types of fats in our diet. For instance, poly- and mono-unsaturated versus saturated, plus omega 3 versus omega 6 fatty acids.

“Ensuring we choose carbohydrate-based foods that are higher in fibre and with a lower glycaemic index (GI), and minimising intake of added sugar helps to successfully regulate blood glucose levels.

“Eating enough vegetables and minimising intake of low nutrient ‘discretionary’ foods is one of the best things people can do for their health and wellbeing. This will help to protect against chronic disease such as type 2 diabetes and heart disease.

“In addition to this, pharmacists can help people to understand the interactions that can occur between medications and nutrients, and can also provide the advice people need regarding appropriate nutritional supplements. An APD might suggest a certain supplement, but the client may need reassurance from the pharmacist about the appropriate dose, when to take the supplement and if it might interfere with other medications they take, plus any possible side effects.

Nutritional know how

According to Hourigan, key advice points to discuss with customers purchasing nutritional supplements or meal replacements include:

  • Ensuring they are also implementing moving to an overall healthy lifestyle pattern that they think can be sustainable.
  • Identifying if they have a health issue or are on medication for a health problem, which may contraindicate use of the supplement they wish to purchase.
  • If using meal replacements, it is best that they are using these with medical supervision, as there are some health risks associated if the suggested protocols are not followed closely. A key message for people using meal replacements is that they need to ensure an adequate overall fluid intake (especially enough water) and should be encouraged to also include non-starchy vegetables as well as their meal replacement shakes. For example, eating salad, stir-fried or steamed non-starchy vegetables with a meal replacement shake at lunch and/or dinner.
  • Encourage them to seek advice and support from a dietitian or nutrition professional.

It’s not just what you eat, but how you eat

Tim Cassettari from The Mind & Body Coach is a nutrition consultant who says the way in which we eat is just as important as eating nutrient-rich foods. This is because the body’s physiology changes according to its emotional state.

He says eating in a stressful state can have a myriad negative effects on the body including:

  • Up-regulating the hormones that promote weight gain,
  • Increasing our appetite, which can encourage cravings and overeating
  • Impacting, in a negative way, the actual metabolic effects foods have on our body,
  • Reducing absorption of nutrients,
  • Damaging our healthy gut bacteria, likely impairing our immune function and body weight regulation, and even
  • Increasing our likelihood of developing intolerances to nutritious foods.

“When we approach food and nutrition with a different mindset, we can help to undo these physiological effects. Research shows that eating more mindfully and with self-compassion—being aware and attentive to our eating, without judgment—is a healthy way to eat.”

He explains, “Mindful eating is about letting go of those judgments, and you can help to do this by focusing on listening to what’s going on inside of your body instead of listening to what’s going on inside of your head. 

“An easy step to start is to consciously scan your body before eating, including how hungry and full you feel in your stomach area from a scale of 1 (extremely hungry) to 10 (very full).

“Try to aim for at least one time a day where you focus only on your eating. Slow down, savor the taste and chew your food thoroughly. Many people find that they experience a richer flavor and greater satisfaction from the food than they would do normally.”

He says being more mindful about what and how we eat brings health benefits that go beyond the digestion and absorption of nutrients.

Eating well for early life

“Eating well during pregnancy helps to ensure healthy growth and development for the baby and good health and wellbeing for the mother too,” says Hourigan.

To help achieve this, pharmacists and their staff can encourage women who are pregnant to:

  • Enjoy a wide variety of nutritious foods
  • Select foods mainly from the Five Food Groups and limit intake of ‘discretionary’ foods and drinks that are high in saturated fat, added sugars and added salt, such as cakes, lollies, biscuits, potato crisps and soft drinks
  • Include plenty of vegetables and fruit in different types and colours. The recommended daily intake is: 5 serves vegetables plus 2 serves of fruit
  • Increase consumption of grain (ideally wholegrain) up to 8-8.5 serves (for women aged 19-50 years who are not pregnant the recommended intake is only 6 serves per day)
  • Choose foods from the meat and alternatives group that are high in iron, such as lean red meat or tofu. During pregnancy, you need 1 serve more than the usual recommended amount for adult women.

Additional nutritional needs during pregnancy include:

Folic acid

Hourigan says, “This can be achieved by eating plenty of green leafy, red and yellow vegetables and high-folate fruit (bananas, oranges, berries, rockmelon). If you have a female who is planning to get pregnant it is recommended to take a folic acid supplement of at least 400 micrograms every day one month before and three months after conception. There are some medications where folate supplementation may be contraindicated so it’s always best to suggest they check with their doctor beforehand.”

Iodine

Hourigan advises, “While iodine is important, it is best to test urinary iodine to see if a pregnant woman is iodine deficient. If a pregnant woman has a thyroid problem they should not take an iodine supplement unless it has been recommended by their doctor.”

Calcium

“Suggest drinking milk, eating hard cheese, yoghurt or calcium enriched alternatives, and choosing reduced fat varieties if possible. However, if you have a pregnant woman who doesn’t like dairy foods or the calcium-fortified alternatives, they may need to check with their doctor as to whether they need to take a calcium supplement. If a woman is already known to have heart disease or there is a strong family history, it may be risky to take a calcium supplement, so they should check with their doctor first,” says Hourigan.

Infant nutrition

According to the Infant Nutrition Council, among others, breast milk provides the best nutrition for infants and is a key factor in an infant’s health and wellbeing.

The nutrients in breast milk are readily absorbed and bio-available. As such, it is recommended that infants should be exclusively breastfed to approximately six months of age; if exclusive breastfeeding is not possible, infant formula can be used.

The National Health and Medical Research Council’s Infant Feeding Guidelines state that ‘when infants are not breastfed, infant formula is the only suitable and safe alternative to meeting their primary nutritional needs.’

Although healthcare workers, including pharmacists, have a responsibility to promote breastfeeding first, it’s important to provide parents who choose to use infant formula with the information and support they need to prepare, store and use feeds correctly. This will help ensure that babies get the right amount of nutrients.

Guidelines for the correct preparation of infant formula advise:

  • Always wash hands before preparing formula and ensure preparation takes place in a clean area
  • Bottles, teats, caps and knives should be washed carefully and sterilized by boiling water for five minutes or by using an approved sterilising agent (such as submersion in 50 ppm hypochlorite for 30 minutes)
  • Use fresh water that has been boiled and allowed to cool for 30 minutes
  • Ideally prepare one bottle at a time, just before feeding
  • Always read the instructions and check the correct amount of water and powder, as shown on the feeding table—which can differ between formulas
  • Add water to bottle first, then powder
  • Always measure the correct amount of powder, using the scoop provided
  • Fill the measuring scoop and level off
  • Any formula left in the bottle at the end of a feed should be discarded
  • Formula that has been at room temperature for less than 1 hour can be stored in the fridge for up to 24 hours (after 24 hours it should be thrown away)

Despite there being multiple formulas on the market, there is no evidence that one formula is better than another. Often it will come down to personal preference, unless the infant is at risk of allergy or has been diagnosed with cow’s milk allergy. In this instance there are special formulas that pharmacists can talk through.

Hourigan says, “Pharmacists can help parents make an informed choice on infant formula. They can also encourage mums to check their infant is growing and developing well and to urge them to seek help from their doctor, a child health nurse or an accredited practising dietitian if they feel they are having problems maintaining adequate nutrition.”

 

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