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Fish oil or omega-3-fatty acid
Fish oil has been studied for many potential health benefits and some populations who eat a lot of fish products have lower rate for heart disease. You may hear that fish oil is good for many medical conditions but not all of them have been proven by scientific studies. However, we know for the fact fish oil or omega-3-fatty acids have effect on high cholesterol and high blood pressure. Many studies were done on laboratory animals and some were done on humans for high cholesterol. Studies concluded that fish oil reduces triglycerides (a type of cholesterol) level by large amount in patients with high triglycerides. It may also raise HDL (good cholesterol) level by small amount. It is recommended to consume at least one or two servings of oily fish a week. Fish with lots of omega-3 include tuna, salmon, mackerel, mullet, anchovy, trout, sardines, halibut and herring. You can also get omega-3-fatty acids from flaxseed oil, canola oil and soybean oil. If you do not like to eat fish, you can take fish oil supplement (1 gram daily). Talk to your doctor if you are concerned about your daily dose of fish oil supplement along with your other medicines. Fish oil supplements may contain small amount of vitamin E. You should not take more than the recommended dosage.
We know that fibers are good for your intestines and it can help prevent colon cancer. Studies showed that soluble fibers in psyllium, wheat, celery, oatmeal and oat bran can reduce LDL cholesterol (bad cholesterol) level. You can also get fibers from eating fruits. Therefore, it is recommended to have 5-10 grams of fibers a day.
Studies showed that walnut has effect on lowering total cholesterol and LDL cholesterol (bad cholesterol). Similar effects are found from almonds and pistachio as well. You should try to consume a handful of nuts a few times a week. Make sure to get the ones which are unsalted or not sugar-coated. Some studies indicated that people who consume nuts more than two times a week may benefit from lowering the risk of heart disease.
Others with small effect on cholesterol level
There are a few studies done on green tea on cholesterol level and researchers found that drinking unsweetened green tea can reduce LDL cholesterol in a small amount. In addition, soy products are rich in unsaturated fats and fibers compared to protein from meats. Studies showed that soy protein improves cholesterol level and blood pressure.
Contributed by Patricia Hsiao M.D.
Sources: ncbi.nlm.nih.gov/pubmed, nlm.nih.gov/medlineplus, mayoclinic.com, uptodate.com
What are the recommended servings for carbohydrates, protein, fruits, vegetables and dairy in pregnancy?
The recommendations may vary slightly depending on what sources you are looking at. Generally, about 9 servings of carbohydrate, 3 or more servings of protein, 2 or more servings of fruits, 3 or more servings of green vegetables, and 4 servings of dairy products are recommended during pregnancy. Limit fat consumption to about 2 servings per day and try to drink 8 glasses of water a day.
Do I need extra calories during pregnancy?
Yes, women need to consume more calories to support the growing baby during pregnancy. Daily calorie intake needs to be increased by 300 kcal per day in second trimester (4-6 months) and over 400 kcal per day in third trimester (7-9 months).
How much weight do I need to gain during pregnancy?
The amount of weight you need to gain during pregnancy varies and it depends on your weight before pregnancy. Check with your obstetrician about how much weight you should put on in your pregnancy. The following is a recommended weight gain for general population:
BMI before pregnancy Recommended weight gain during pregnancy
Underweight (BMI of less than 18.5) 28-40 pounds
Normal weight (18.5 and 24.9) 25-35 pounds
Overweight (BMI of 25 to 29.9) 15-25 pounds
Obese (BMI of 30 or greater) 11-20 pounds
Why should I monitor my weight gain?
We encourage women to have better control over their weight gain during pregnancy to prevent large infant, preterm birth and post-term birth. Overweight and obese women are at higher risk for developing gestational diabetes (high blood sugar during pregnancy) and preeclampsia (high blood pressure in pregnancy). Babies are also at higher risk for birth defects and birth-related injuries.
What foods should I eat to get the extra calories?
The extra calories should come from various food sources such as carbohydrates, protein and low-fat dairy products. You can get carbohydrates from whole grain products, cereal and starchy vegetables. Protein is also essential nutrient for fetal growth and development especially in the second and third trimester. Your diet should include more lean meat found in poultry and fish (certain types), tofu, dried beans and peas. Protein can be obtained from dairy products such as egg, milk, yogurt and cottage cheese as well.
What are good sources of protein if I am a vegan?
Soy products, beans, peas and peanut butter are rich in protein.
What is folic acid?
Folic acid or folate is vitamin B that prevents neural tube defects (defects of brain and spinal cord). Brain formation occurs as early as four weeks after conception. You can find folic acid in fortified cereals, green vegetables (spinach, broccoli, asparagus, okra and brussel sprouts), dried beans, peas and citrus fruits (orange, grapefruit, papaya and strawberry).
Can I take folic acid supplement?
Yes, you can take 400 to 800 mcg (micrograms) of folic acid daily. Some prenatal vitamins contain folic acid but the amount varies among different brands. Let your doctor know if you are taking medications for seizure, diabetes, asthma, lupus or inflammatory bowel disease. You may need a higher dose of folic acid. You will be given a higher dose of folic acid if you had a baby with brain or spinal cord defect or you have a family member with spinal bifida. In that case, the doctor will prescribe you 4000 mcg of folic acid daily, which is ten times higher than the normal dose.
When should I start taking folic acid supplement?
Even when you are just planning to get pregnant, you should start eating healthy foods and take multivitamin with folic acid (400 to 800 mcg daily). Brain and spinal cord form very early on in pregnancy before most women find out they are pregnant. On the other hand, neural tube defects are very much preventable with folic acid during pregnancy.
What other vitamins and minerals do I need during pregnancy?
During pregnancy, women need increased amount of iron, calcium and vitamin D. If you are a vegan, you may also need vitamin B12 supplement as well as iron, calcium and vitamin D.
What is iron for?
Iron is part of the red blood cells and red blood cells carry oxygen to the brain, organs and tissues. Your body demand for iron is higher in pregnancy since your baby also produces his or her own blood supply.
What is anemia?
Anemia is a condition where you do not have enough red blood cells to carry oxygen to the organs and tissues. During pregnancy, iron-deficiency anemia is more common and it is due to inadequate iron to make red blood cells. Common symptoms include fatigue, weakness, pale skin and headache.
What types of food are rich in iron?
Iron is found in meats, iron-fortified cereal, spinach, beans and nuts.
How much iron do I need daily?
You need 27 milligrams of iron daily and most prenatal vitamin supplements contain iron.
What are calcium and vitamin D for?
Calcium and vitamin D are needed for bone formation and to strengthen bones.
What foods are rich in calcium and vitamin D?
You can get calcium and vitamin D from milk, yogurt, cheese, eggs, spinach, asparagus, broccoli, cereal and fortified orange juice. Vitamin D is also from sunlight through your skin.
How much calcium do I need daily?
You need 1000 milligrams of calcium daily. If you are a teen mom, you need 1300 milligrams of calcium daily.
How much vitamin D do I need daily?
You need 600 IU (international unit) of vitamin D daily.
Can the daily requirements of iron, calcium and vitamin D be fulfilled by taking prenatal vitamins?
No, prenatal vitamins are supplement to your diet. You still need to eat nutritious foods to meet your daily requirements of iron, calcium and vitamin D. Most of them do not contain 1000 milligrams of calcium.
Are there any foods I must avoid during pregnancy?
Yes, there are certain categories of food you must avoid during pregnancy. Those include fish with high mercury content, raw meat, some seafood, unpasteurized milk and cheese products.
What types of fish are high in mercury?
Fish with high mercury content are found to be associated with central nervous system damage and those include swordfish, tuna steaks, mackerel and shark.
What fish are safe to eat during pregnancy?
It is safe to eat canned light tuna, salmon, tilapia, catfish, crab and shrimp up to two times a week.
What other seafood do I need to avoid?
You should avoid oysters and clams as well as sushi that are made with raw fish.
Can I eat organ meats?
No, because they contain too much vitamin A, which are toxic for the fetus.
What foods should I avoid to prevent myself from bacterial food poisoning?
You can get bacterial food poisoning from raw, undercooked meat and poultry and it can be harmful to your baby. If you eat processed deli meats and eggs, make sure they are cooked thoroughly. It may be wise to avoid eating raw sprouts such as clover, radish and alfalfa because it is impossible to wash out the bacteria inside the seeds.
What other hygiene should I adapt to prevent myself from food-borne illnesses?
Always rinse the vegetables and fruits thoroughly before eating. Make a good habit of washing your hands before and after handling foods.
What is listeriosis?
Listeriosis is a condition caused by bacteria called listeria. While it causes mild-flu-like symptoms such as headache, fever, nausea and vomiting in a mother, it is more fatal to the fetus. It can cause miscarriage and stillbirth.
What foods should I avoid to prevent myself from listeriosis?
You must avoid unpasteurized milk or juice, soft cheese, foods that are made from unpasteurized milk, raw or undercooked meat, poultry and smoked seafood. Soft cheese includes Camembert, feta, Brie, blue cheese and Mexican-style cheeses (fresco, queso, blanco and panela).
Can I have caffeine during pregnancy?
Some studies suggested that too much caffeine is associated with miscarriage and preterm birth but not enough evidence to support it. However, it is recommended that pregnant women should consume less than 300 mg of caffeine, which is about two cups of coffee a day.
Are herbal products safe to consume during pregnancy?
We have limited data to support whether herbal teas and products are safe to consume or not. Thus, you should stay away from herbal products during pregnancy.
What other lifestyle modifications do I need to adapt in pregnancy?
As we all know that alcohol causes fetal alcohol syndrome (mental retardation and developmental problems), pregnant women must avoid all alcoholic beverages including wine. In addition, quit smoking if you smoke. Try to exercise for 30 minutes a day as many times as you can in a week.
Contributed by Patricia Hsiao M.D.
Sources: acog.org, ncbi.nlm.nih.gov , mayoclinic.com, ghc.org, uptodate.com
Scientists do not know the exact causes of PCOS yet. Nevertheless, it is found to be associated with imbalance of several hormones including estrogen and progesterone (female hormones), androgen (male hormone), LH and FSH (from pituitary gland in the brain) and insulin. Insulin is the hormone that regulates blood glucose. In a normal menstrual cycle, LH, FSH, estrogen and progesterone play a role in oocyte (egg) development and ovulation, which is the released of the matured egg for fertilization.In PCOS, too much insulin is produced but the body cells are resistant to insulin uptake. Therefore, blood glucose remains high. In addition, it causes increased production of androgen (male hormone) in the ovaries. Too much androgen interferes with ovulation. Thus, fertility problem, excess body hair and irregular menstrual cycle are common among women with PCOS. Some women may also develop multiple cysts in the ovaries.
There is a variety of symptoms associated with PCOS and it varies from one woman to another. Most women experience irregular periods where they have less than 8 periods per year. Period may be heavy and prolonged when they have it. Many women with untreated PCOS have difficulty getting pregnant. Because of too much androgen (male hormone), women develop male-like features such as hirsutism in which excess hair growth on the face, chest and belly. Furthermore, they may experience hair loss or male-pattern baldness and deepening of the voice.
Some women develop acne from oily skin due to androgen and they may notice dark patches of skin around the neck, groin area and under arms. Insulin impairment causes weight gain and obesity, which is common among women with PCOS. Some women develop type II diabetes. Both obesity and diabetes increase the risk of heart disease and many women also suffer from sleep apnea in which your breathing stops briefly during sleep. People with sleep apnea experience fatigue and increased daytime sleepiness.
There is no specific test for PCOS. It is often diagnosed by taking a complete medical history, blood tests and pelvic ultrasound. The doctor will ask you about your period and other symptoms you may have. You do not need to have all the symptoms mentioned above to make a diagnosis of PCOS. He or she will do a physical exam and pelvic exam to check for abnormalities. The doctor will order blood tests for pregnancy test, fasting blood glucose and cholesterol, androgen hormone level and thyroid-stimulating hormone. Some doctors will do glucose tolerance test where your fasting blood glucose and blood glucose after drinking a sugary drink are measured. You may be asked to have a pelvic ultrasound to check for cysts in your ovaries.
PCOS is treated by managing or reducing the symptoms with oral medications. For women who are not planning to get pregnant, your doctor will prescribe birth control pills to regulate your menstrual period. Birth control pills decrease the production of male hormone so it is effective for reducing facial hair growth, deepening of the voice and male-pattern baldness. It can also help clear acne. You may experience nausea, bloating and breast tenderness from birth control pills but those often resolve in a few months. Laser hair removal is an option if you have a lot of excess hair on the face and other parts of the body.
If you are not a candidate for birth control pills, another medication called spironolactone (Aldactone) is an option. It is a medication to reduce androgen hormone production as well as lowering the blood pressure. It is effective for treating excess hair growth, male-pattern baldness and acne problem. However, it can cause birth defects if you become pregnant.
Metformin (Glucophage) is a diabetes medication to improve insulin function and it is given to regulate blood glucose. Metformin also helps regulate menstrual period. Unlike other diabetes medications, metformin does not cause weight gain. The doctors will also recommend lifestyle changes such as diet and exercise if you are overweight or obese. Losing a few extra pounds can lower your blood glucose and keep your periods regular.
There are fertility medications available if you are planning to get pregnant. PCOS causes infertility by blocking ovulation. Clomiphene (Clomid and Serophene) is an oral medication that stimulates ovulation. Studies showed that 50 percent of women with PCOS become pregnant after getting treated with clomiphene. You will need to lose a few extra pounds if you are overweight. If you still do not ovulate with clomiphene, gonadotropin therapy (FSH and LH injections) is recommended. Some doctors may refer you for in vitro fertilization (IVF) treatment. It is a more expensive fertility treatment and it has increased chance of multiple births.
Contributed by Patricia Hsiao M.D.
Sources: ncbi.nlm.nih.gov, pcos.northwestern.edu, mayoclinic.com, womenshealth.gov, uptodate.com
Thyroid gland is located in front of the neck below Adam’s apple. Thyroid hormones production is controlled by another endocrine gland in the brain called pituitary gland. Thyroid hormones regulate body’s metabolism which affects many organs including heart, digestive tract, muscles and etc. Diabetes is due to lack of insulin production in the pancreas or body cells are resistant to insulin. Insulin is a hormone that regulates blood glucose. Pancreas is one of the endocrine glands (hormone producing gland) located behind the stomach.
Type I diabetes occurs when the body’s immune system destroys insulin-producing cells in the pancreas. Similarly, thyroid disorders can be due to immune system attacking thyroid gland. That is one of the reasons for thyroid disorders being more common in type I diabetes. For thyroid disorders, you can either have hyperthyroidism (too much thyroid hormones) or hypothyroidism (too little thyroid hormones). The symptoms differ in these conditions. A person with hyperthyroidism may complain of rapid or irregular heartbeats, anxiety, irritability, weight loss despite normal or increased appetite, diarrhea, tremors in the hands, muscle weakness and heat intolerance (sweating more than usual). Women may experience irregular menstrual period.
On the other hand, a person with hypothyroidism may experience fatigue, shortness of breath with exercise, weight gain despite normal appetite, cold intolerance, thin or coarse hair and constipation. Women may have menstrual irregularity. Both hyperthyroidism and hypothyroidism can interfere with your diabetes management. If you are diabetic and develop hyperthyroidism, your blood glucose will be high even when you are taking insulin or oral medications regularly. Medications or insulin could not stay in the bloodstream long enough since your metabolism is faster. Also, hyperthyroidism may be confused with signs of hypoglycemia (low blood glucose) such as sweating, racing heartbeats and tremors because both conditions present with similar symptoms. Having hypothyroidism can affect your blood glucose as well. Individuals with diabetes may experience repeated episodes of low blood glucose because medications or insulin will stay longer in the bloodstream. In addition, hypothyroidism will raise your LDL (the bad cholesterol) and triglycerides levels.
In diabetics, thyroid symptoms can be a bit difficult to diagnose because of the similarity. Therefore, serum TSH is recommended as a screening tool. When you are first diagnosed with type II diabetes, TSH should be done at that time and it should be repeated every few years. If you are diagnosed with type I diabetes, your doctor will check for antibodies (specific proteins) against thyroid hormones as well as serum TSH. If antibodies are found, TSH screening will be done every year. In conclusion, thyroid disorder should be treated promptly especially in diabetics because it will improve blood glucose management greatly.
Contributed by Patricia Hsiao M.D.
Sources: journal.diabetes.org/clinicaldiabetes, spectrum.diabetesjournal.org, thyroidscience.com, ncbi.nlm.nih.gov, uptodate.com
What is aspirin and how does it work?
Aspirin is one of the medications in NSAIDs (nonsteroidal anti-inflammatory drugs) group. It has been used for pain relief and to reduce swelling. In recent years, low dose aspirin is used to prevent heart disease. Heart disease includes heart attack, stroke and peripheral arterial disease in which poor circulation in the legs. At low dosages, aspirin prevents platelets from clumping. Platelet is one of the blood cells and they play a role in blood clotting. Without platelets, you can bleed to death when you cut yourself or have an injury to your tissues and organs. At the same time, platelets can form clots in the coronary arteries that supply your heart and can cause decrease in the blood flow. When there is insufficient blood supply to the heart, it results in heart attack due to the death of heart muscles. Also, reduced blood flow to the brain can result in stroke. Therefore, the role of low dose aspirin is to prevent platelets from clumping and keep the normal blood flow in the arteries.
Who should take daily aspirin?
You should not take daily aspirin unless prescribed by the doctor. Your doctor may put you on daily aspirin if you belong to this group of people.
The criteria in this group include:
• If you have a history of heart attack
• If you have a history of ischemic stroke or transient ischemic stroke (TIA)
• If you have stable or unstable angina
• If you have had a coronary artery bypass graft (CABG procedure)
• If you have had angioplasty
• If you have atrial fibrillation (A-Fib)
• If you have heart valve disease
Your doctor will decide what dosage is right for you. Some people may get baby aspirin (81 mg) while others may get a regular strength (325 mg). If you take ibuprofen or other NSAIDs for chronic conditions such as arthritis, chronic pain or back pain, talk to your doctor. They can reduce blood clotting like aspirin so you are at increased risk for bleeding.
People who do not belong to the above group:
You are at a higher risk for heart disease if you have diabetes, high cholesterol, obesity and high blood pressure than general population. But it does not mean you should start taking daily aspirin on your own. Many studies have been done on men and women who did not have heart disease and who are over 55 years of age. Aspirin like many other medications comes with side effects. Side effects of aspirin include bleeding more than usual when you have a cut. Some people experience stomach bleeding especially if they have ulcer. Another concern is hemorrhagic stroke which is bleeding in the brain. Aspirin also causes stomach upset such as nausea, vomiting, heartburn and stomach pain. It can also interact with ibuprofen (another NSAID). Therefore, many studies have been conducted to see whether the benefit of aspirin on heart disease is greater than the risk of side effects.
Many studies concluded that whether you should be on daily aspirin must be determined by individual’s risks and benefits from aspirin. Some people may benefit more from aspirin while it may cause more harm to others. Hence, the decision should be made by your primary care doctor who knows about your detailed medical history.
Contributed by Patricia Hsiao M.D.
Sources: mayoclinic.com, nlm.nih.gov/medlineplus/news, ncbi.nlm.nih.gov, uptodate.com