UCSD Lactation Educator Program Nutrition Assignment

1. List and explain 3 reasons why a Lactation Educator should know about the nutritional status of the breastfeeding woman. (Does not need to be referenced) The nutritional status of the mom can affect the nutritional status of the breast milk and the baby. Some women are self-conscious of their weight after giving birth and may choose to restrict Calories in order to lose weight, which can affect the baby she is feeding. If a mom has a nutrition related disease, like diabetes or hypertension, it is important to know this so you can either refer her to a more qualified person (like a Registered Dietitian) who also has lactation knowledge. Discuss 3 common fallacies/myths regarding food and food sensitivity in the breastfeeding mother and infant. State the fallacies or myth and then state your response to the client/participant/patient. (Does not need to be referenced) There are certain foods a mother should avoid while breastfeeding all foods are okay to eat while breastfeeding, as long as they do not make the baby upset/gassy. Some babies are allergic to their mothers breast milk if a baby shows sensitivity to mothers breast milk, it is usually related to a protein the mother has ingested. For example, some babies are sensitive to cows milk proteins that pass into a mothers breast milk from her diet. A mom needs to drink milk to make milk a mom needs to have liquids to make breast milk, but does not need to drink cows milk. In fact, cows milk protein that passes into the breast milk has the potential in some infants to cause gas/upset stomach. Weight Loss: Please reference your answers Describe the weight loss recommendations for the breastfeeding mother after 3 months postpartum. State what you would say to a client/participant/patient when they ask you about breastfeeding and dieting. Remember to include minimum number of calories; at least 2 strategies for calorie reduction; and at least 2 ways for a breastfeeding mother to get exercise. It is important to remember that you gained your pregnancy weight over months, so your expectation of losing the weight should be similar1. Since a breastfeeding moms Calorie needs will depend on her height, weight, activity level and age/size of her baby, it is important to first calculate your needs (you can use an online needs calculator by searching for breastfeeding needs calculator) and then subtract roughly 3000-500 Calories/day to see a 1 pound weight loss/week. Some easy ways to reduce Calories from your daily diet include cutting out liquid Calories (regular soda, sugary coffee, frappuccinos, too much juice/fruit punch, etc) and replace them with water, diet drinks, unsweetened tea, black coffee; or increase the amount of fruits and vegetables on your plate at each meal, this will fill you up and you will eat less of the other foods. Two ways for a breastfeeding mom to get more exercise are to take your babies out for daily walks (possibly with other moms and babies) or choose a gym where they have a childcare, so your baby can be close, just in case she gets hungry while you are working out. Discuss at least Weight Watchers and 1 other commercial or advertised breastfeeding diet plan. Weight Watchers: If you are a breastfeeding mom ready to lose weight, with Weight Watchers PointsPlus program you can adjust your points to account for breastfeeding and still lose weight. It is important to take your weight loss slow and steady to make sure you retain all the nutrients both you and your baby need. Please remember, it is always important to talk to your care provider prior to starting a weight loss routine.2

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UCSD Lactation Educator Program Nutrition Assignment

Medifast for Breastfeeding Mothers: Medifast for Nursing Mothers is designed for the nursing mother whose baby is over two months of age. This nutritionally balanced program allows for gradual weight loss. It is designed to support your bodys nutritional needs and encourage optimal growth in your nursing child. Once your babys food intake is less than 30% breast milk, you can continue this plan or move to the Medifast 5 & 1 Plan, which provides a lower amount of calories and carbohydrates, and may increase your rate of weight loss3. Discuss breastfeeding and vegetarian diets. Be sure to include the vitamin a breastfeeding mother must have in her diet. A vegetarian diet is completely safe while breastfeeding, however, there are a few things to be aware of. Remember, your breast milk is comprised of the nutrients taken from your own diet and body stores. Therefore, it is important to eat a well-balanced diet full of lean protein, healthy fats, whole grains and fruits and vegetables. Many vegetarians have a hard time getting ample protein. Your best sources of protein will be eggs (if you eat them), legumes/beans (including soybeans and tofu), whole grains (quinoa is the highest in protein), nuts/nut butters and low-fat dairy products. Healthy fats include liquid fats like olive oil, peanut oil, vegetable oil and avocado, as opposed to fats that are solid at room temperature, like lard, butter and Crisco always using fats sparingly. Whole grains include brown rice, barley, quinoa and breads/pasta that are labeled 100% whole grain (or whole wheat). With fruits and vegetables, variety is important. Get a variety of colors including red, green, orange, purple, yellow, white and more! With regards to vitamins and minerals, most doctors will recommend that you continue to take your prenatal vitamin. All other supplements should be discussed with your medical provider prior to beginning a new regimen. Remember, most of the time, what you consume, your baby consumes! If you follow a strict vegan diet, be sure your medical provider is aware of your dietary choices, as there are some nutrients that are hard to consume without any animal sources in the diet. The hardest is vitamin B12, an essential vitamin, which is only found in animal products including meat, eggs, milk, cheese and yogurt, among others. Vitamin B12 should be supplemented with vitamin B12 shots or fortified foods if you are following a strict vegan diet. Consult your medical provider as soon as possible. (I am not referencing this information because it is all common knowledge to me and no outside sources were used for this question). 4. Give your recommendation for the use by lactating woman of the following: (Dont do it, is not an appropriate answer and DO NOT COPY and paste from the Internet Based on a reference source what would YOU say to the client).

Please reference your answer.

Alcohol (Include minimum 2 points covered in class) 1. As long as it is within a reasonable amount (the recommended alcohol intake for a woman is no more than 1 drink a day), a mom can continue breastfeeding. Baby may be sleepier, but mom does not need to pump. Simply avoid breastfeeding for 2 hours after consuming a drink. 4,5 2. Timing is everything. Feed your baby before you drink and if you decide to drink more than what is recommended, store pumped milk to be fed to the baby while your milk has alcohol in it.5 Marijuana (Remember to include your advice to the once a week user)

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UCSD Lactation Educator Program Nutrition Assignment

1. Regular marijuana use can cause sleepiness in baby, increase risk of SIDS, can lead to slower weight gain and possibly slow overall development. 2. If you are smoking once a week, be sure to feed your baby before you smoke, wear a covering over your normal clothes to keep your clothes from absorbing the smoke and wash your face and hands before handling your baby again.6 Cigarettes (Include minimum 3 points covered in class) Breastfeeding is still best if you are smoking. Please take the following precautions: 1. Feed your baby before you smoke. 2. You and anyone else in your household should smoke outside the home 3. You and anyone else in your household should wear a jacket over your clothes while smoking and take it off before returning inside.5 4. Be sure to have anyone who has smoked wash their hands and face before coming into contact with your baby again. Caffeine (Be practical in your advice, how will a mom know what amount is ok and what should she do?) The amount of caffeine that passes into a mothers breast milk varies from mother to mother and the effect it will have on a baby also varies from baby to baby. Caffeine is okay to be consumed in moderate amounts, but what that amount is for each mom will vary. Moms can have some caffeine each day. Try to breastfeed right before having the caffeine, choose beverages that are low to moderate in caffeine (green tea, black tea, home brewed coffee). Look for signs of caffeine sensitivity in your baby, like wakefulness (more than usual) and colicky behavior.7 NutraSweet Due to its rapid breakdown in the mothers body, aspartame is rarely detected in a mothers breast milk and appears safe for consumption, unless the baby suffers from the rare metabolic disorder called phenylketonuria.8 Chocolate (Look up Theobromine) (Be practical in your advice, how will a mom know what amount is ok and what should she do?) Consuming chocolate should be treated similarly to other caffeinated substances. Both caffeine and theobromine, a substance in chocolate which has a similar effect to caffeine, may affect baby. Use the same advice as you would for other caffeinated substances.9 Prescription Medications Check with your physician before taking any prescription medications. You may also use a new web resource as a guide, LACMED, at http://toxnet.nlm.nih.gov/cgibin/sis/htmlgen?LACT.10 Recreational drugs Recreational drugs should be avoided during breastfeeding. If you are having difficulty quitting a recreational drug, please contact your physician or seek alternative help. Refrain from breastfeeding your baby if you are currently using a recreational drug.

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UCSD Lactation Educator Program Nutrition Assignment

Diet analysis: List your own 24 hour intake of food and beverages. Table 1: 24 Hour Intake11 Kylee Scholar
FOODS Breakfast Great Value - Buttermilk Buscuits, 1 Buscuit Eggs - Scrambled (whole egg), 1 large Cheese Organic American, 1 slice (1 oz) Trader Joe's - Veggie Sausage Patties, 1 Patty Lunch Bananas - Raw, 1 medium (7" to 7-7/8" long) Trader Joe's - Valencia Peanut Butter With Sea Salt, 2 tbsp Milk - Reduced fat, 2% milkfat, 1 cup Kale - Raw, 1 cup, chopped Dinner Lentils - Cooked, boiled, without salt, 0.5 cup Squash - Zucchini, includes skin, cooked, boiled, drained, without salt, 0.5 cup, sliced Rice - Brown, long-grain, cooked, 0.5 cup Tomatoes - Red, ripe, raw, year round average, 0.25 cup, chopped or sliced Cheese - Cheddar, 0.25 cup, shredded Onions - Raw, 0.25 cup, chopped Oil - Olive, 1 tablespoon Trader Joe's - Rustic Multi Grain Bread, 1 slice Butter - Salted, 1 tbsp Snacks Oranges - Raw, navels, 2 fruit (2-7/8" dia) Mangos - Raw, 1 cup, sliced Homemade - Chocolate Chip Cookie, 1 cookie TOTAL: grains protein dairy protein 190 101 105 70 25g 1g 0g 2g 8g 7g 9g 5g 3g 7g 6g 6g 5g sugar none none preservatives 1 1 1 1 Food grp Cals Carbs Fat Protei n Added sugar/ additives Servings

5.

fruit Protein Dairy Vegetable Protein/ vegetable Vegetable

105 190 122 34

27g 7g 11g 7g

0g 16g 5g 0g

1g 8g 8g 2g

None Salt None None

1 1 1 1 1 1

115 14

20g 4g 22g 2g 0g 4g 0g 14g 0g

0g 0g 1g 0g 9g 0g 14g 1g 12g

9g 1g 3g 0g 7g 0g 0g 3g 0g

None None None none None none None None Salt

Whole grain Vegetable

108 8

1 0.5

Dairy Vegetable Fat Whole grain Fat Fruit Fruit Sweets/fat

114 17 119 80 102

0.75 0.5 1 1 1 2 1 1

137 107 100 1,938

35g 28g 19g 228g

0g 0g 8g 95g

3g 1g 2g 70g

None None None

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UCSD Lactation Educator Program Nutrition Assignment

Evaluate this list as though you were a BF woman that is 3 months postpartum and make a recommendation, to balance this intake I want to preface this with saying that my intake is probably much more clean and will balanced than the average person and my intake is fairly high related to being pregnant. With that being said, there are still some changes that could be made and I will discuss as if I were breastfeeding and wanting to lose weight. The above list is very well balanced with good amounts of protein, fat and carbohydrates. Although fat is a bit high, I would not be too worried since a majority of it is unsaturated and none of it is trans. With the following recommendations, we would see the saturated fat that is present, decreased significantly. The reason we would want to decrease saturated fat is that it increases LDL cholesterol (the bad cholesterol) and we would want to see no trans-fat is because it not only increases LDL cholesterol, but also decrease HDL cholesterol (the good cholesterol). I would recommend cutting the 1 tbsp butter with tbsp, or possibly some avocado or hummus (to reduce saturated fat and Calorie intake). I would recommend trying a reduced fat cheddar cheese, 1% milk and replacing the American cheese with a park skim mozzarella to reduce saturated fat. I might also recommend replacing one of the 4 pieces of fruit with a vegetable, maybe for one of the snacks (perhaps cucumber, carrots or celery with hummus) to reduce the sugar (even though the sugar in fruit is natural, there is a lot less in vegetables). Please reference your answer this is what I do for a living, so all the information given is my own, minus the program I used to analyze my diet which is referenced in the table provided. Include the following information: See above for all the following: i. Calories total ___ Grams of fat ___ ii. State food group ___ Number of servings ___ iii. Carbohydrates ___ Proteins ___ Additives ___

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Be sure to use at least one text reference AND one internet reference and clearly list them at the end of the question. You MUST include this in the assignment!!! See references below.

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UCSD Lactation Educator Program Nutrition Assignment

References 1. http://www.llli.org/faq/diet.html, accessed on February 13, 2013. 2. http://www.weightwatchers.com/util/art/index_art.aspx?tabnum=1&art_id=4561&sc=3010, accessed on February 13, 2013. 3. http://www.medifastmedia.com/shared/docs/nursing_mothers_guide.pdf, accessed on February 13, 2013. 4. Gini Baker. UC San Diego Lactation Educator Counselor CLEC Program 2013. Gini Baker RN, MPH, IBCLC. 5. Jack Newman. More and More Breastfeeding Myths. Revised 2005. Taken from UC San Diego Lactation Educator Counselor CLEC Program 2013. Gini Baker RN, MPH, IBCLC. 6. http://kellymom.com/bf/can-i-breastfeed/lifestyle/marijuana/, accessed on February 13, 2013. 7. Judith Lauwers and Anna Swisher. Counseling the Nursing Mother. A Lactation Consultants Guide, fifth edition. Jones and Bartlett Learning, LLC, 2011. 8. http://www.drugs.com/breastfeeding/aspartame.html, accessed on February 13, 2013. 9. http://www.llli.org/faq/caffeine.html, accessed on February 13, 2013. 10. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT, accessed on February 13, 2013. 11. http://www.myfitnesspal.com/, accessed on February 17, 2013.

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