Guideline to Making Githeri Nutritious

Nutritional components of the two main ingredients maize and beans

 

1. MAIZE

One of the reasons maize is a staple food across the world is its high nutritional value, with high levels of starch and also valuable proteins and oils. Depending on the variety, maize may contain some important B vitamins, folic acid, Vitamin C, and provitamin A (precursor to vitamin A). Maize is also rich in phosphorus, magnesium, manganese, zinc, copper, iron and selenium, and has small amounts of potassium and calcium. Maize is a good source of dietary fibre and protein while being very low in fat and sodium (salt). However, maize is naturally deficient in lysine and tryptophan, which are two of nine amino acids regarded as essential for humans, so it needs to be part of a balanced diet.

Maize has tremendous variation in content and composition of several coloured pigments collectively known as carotenoids. Notably, the carotenoid beta-carotene (or provitamin A) is converted to vitamin A by normal metabolic processes in the body.  Vitamin A is very important to human health, but most especially for vision, and as an antioxidant. Therefore maize can be especially important to people who cannot get fresh vegetable year-round.

Nutrition fact sheet of cereals based on Kenyan food exchange list and the three macronutrients

 

Amount	measure	Protein	Carb	Fat	Calories
20g	2 T-spoons	2g	15g	Neg	70 Kcals

Other nutrition facts on maize-based on Kenyan food composition table include Micronutrients facts which include;

One cup  of maize  contains:

• Calories:177 calories
• Carbs:41 grams
• Protein:4 grams
• Fat:1 grams
• Fiber:6 grams
• Vitamin C:17% of the daily value (DV)
• Thiamine (vitamin B1):24% of the DV
• Folate (vitamin B9):19% of the DV
• Magnesium:11% of the DV
• Potassium:10% of the DV

Though these values differ from one maize type to another, the values are average for all the maize types

2. BEANS  

Beans production for food has been on the rise, this is because of its known nutrition value which surpasses most common traditional foods. Beans are classified as legume and primarily one of the best sources of plant proteins if when prepared and mixed in the required ratio for completion of the protein by value. Some of the common nutrients in beans include protein, folic acid, potassium, iron, magnesium and fibre. It is important to note that despite high protein content, beans are deficient in methionine and tyrosine amino acids which are part of nine essential amino acids required for high biological value protein as such mixing beans with nuts or serials has been a primary solution to obtaining complete protein from plants.

Based on the current Kenyan food exchange list, generally, beans could be group as pulses or legumes with the following nutrition facts on the three macronutrients

 

Amount	Measure	Proteins	Carbs	Fat	Calories
30	3Tspoons	7g	17g	Neg	100kca

 

 

Other nutrition facts on beans based on Kenyan food composition table. Micronutrients facts which include;

1 cup of beans

• Protein: 15 grams
• Fat:1 gram
• Carbs:45 grams
• Fibre: 15 grams
• Iron:20% of the Daily Value (DV)
• Calcium:8% of the DV
• Magnesium:21% of the DV
• Phosphorous:25% of the DV
• Potassium:21% of the DV
• Folate:74% of the DV

Though these values differ from one beans type to another, the values are average for all the  bean  types

MAKING SUPERSTAR GITHERI (MIXING MAIZE AND BEANS)

This has been a long term intervention used for curbing Micronutrients as well as macronutrients deficiencies all over the world, though adopted in various parts of the world, if not done properly it will not aid in sorting out the problem of malnutrition as intended hence the concept of Super Star Githeri.

Githeri is a common food within this region hence need to ensure it is as nutritious as possible, this there for calls for the following five  steps used to ensure the githeri has maximum nutrients

• Whole grain cereals (Maize ) have the benefits of offering vitamins like Thymine and Niacin as well as fibre which are not available in polished grains. These B vitamins are beneficial in energy production and for growth of children as well as new cells in adults. The fibre is beneficial in controlling rates digestion, blood sugar hence key in protecting people from constipation as well as unnecessarily blood sugar related conditions such as diabetes, obesity and overweight. This session, therefore, encourages the use of whole-grain maize in making Githeri.
• To maximize benefits from cereals like maize, there is a need to mix them with legumes /pulses- beans. In this case of Githeri, beans and maize are mixed to give the desired quality before mixing, always ensure the ration of maize to beans is one to one for example when using a tin to measure when you use one tin of maize add one tin of bean. This is because beans have a slightly high amount of protein hence good for bodybuilding but all plant proteins are not complete proteins hence mixing the two products leads to the completion of the protein by getting lacking amino acids from various groups. Most cereals and grains are limited in tryptophan, threonine and a few limited in Lysin.
  Legumes /pulses are limited in amino acids methionine.
  Nuts are limited in amino acid lysine. This mixing helps benefit fully from complete protein with all the essential amino acids. .Once the ration is taken care of soak, the mixture to be cooked the following day overnight before cooking it. Drain out the soaking water to ensure the substance in beans which increases gas and stomach upset it cleared by the water (Since the soaking water contain harmful substances which increase gas and stomach upset do not use it in cooking .Just drain and pour it out ).

Importance of soaking

• Reducing cooking time. Soaked maize takes a maximum of three hours while the standard cooking time is 2-3 hours, unlike un-soaked which can take up to 8 hrs. This spares family time for doing other activities which could increase income in the family.
• Saves fuel, cooking fuel has a lot of direct impact on family finances, whether the family uses firewood, charcoal, gas or electricity. Longer cooking time increases the total amount of fuel used or energy used in cooking hence more money spent on the fuel bills.
• Improve digestibility, Soaking is a mimic of natural sprouting which eliminates digestive enzyme inhibitors, phytates and complex indigestible proteins. This helps in increased the breakdown of complex foods to simple and quickly absorbable nutrients.
• Improve nutrition quality of foods, by eliminating such chemicals like phytates, bio-availability of Micronutrients such as iron and zinc are improved hence easily obtained for the body use.
• Add at least two different vegetables in addition to tomatoes and onions. In Kenyan Food Composition table, vegetables are further divided into three groups. Dark Green leafy vegetable, Vitamin A-rich vegetables and other vegetables.Using this guideline
• Use one dark green leafy vegetable in the meal plan such as kales, amaranth, spinach and among other traditional dark green vegetable. They are good sources of vitamin A, iron.
• Use vitamin A-rich vegetable such as carrots, pumpkin, butternut and orange-fleshed sweet potatoes  to increase vitamin A in your diet
• Other vegetables include onions, tomatoes and pepper (pili pili ) which are all good sources of vitamin C.

The oranges and greens also enhance colour in the food hence increasing palatability and appeal to take more for the children and adults with poor appetite.

• Vegetable cooking is a delicate process since they lose important nutrients like vitamin C very fast. There are therefore two way to ensure you protect these nutrients
• Cook separately and mix at the table. This helps control cooking times including warming time in case a member of the family takes the meals at a later time
• Put the vegetables towards the cooking time to ensure they have shorter total cooking time. This will also protect the vitamins and other volatile nutrients like iodine in the food.
• To increase the value of nutrient like iron by making it bio-available in Githeri please eat githeri with vitamin C rich foods such as pepper, tomatoes, onions, oranges, pawpaws among others. This increases availability of non-heme iron hence increasing absorption.

Reference Materials

• Kenyan Food Composition table 2018
• Food exchange list for meal planning 2014

Michael Ouma Odero

CLINICAL NUTRITIONIST

 

NUTRITION AND CONGESTIVE HEART FAILURE

I have kept my path in clinical nutrition because of the changes in knowledge about the clinical management of the complex cases and how changes in information have transformed the care system for the various patient in the hospital and at home. Two months ago while just taking some routine walk, it happened that I arrived at the gate of a private hospital. The 50-bed capacity hospital happened to have complicated cases wing and when I went in I got the serious attraction to a patient who had a congestive cardiac failure, it was not her first time to be in the hospital, going by the hospital records (in this hospital I learnt that transparent patient a concept I learnt in Academia Engelberg is practised. This gave me ease to interact with the patient’s relatives who were able to trace the treatment record of the patient alluded to had developed CCF diabetes diagnosed in the same hospital some months earlier. The interesting bit of this entire management was the family of the said patient had started taking caution in dealing with their general health, for example, three children of the said patient had started genetic analysis of their conditions and possible exposure to these complications in future.

Congestive heart failure.

This is a condition where gradually, and over some time, the heart muscle becomes weaker than normal thus losing the ability to pump enough oxygenated blood to all body parts to meet the body’s need for supply of both oxygen and vital nutrients required to maintain the system.

 

What does this mean, the rhythmic heart activity results into a small percentage of 55%-60% being pumped out(ejects) of the left ventricle what is called the ejection fraction. In heart failure, left ventricle take out less than 55% thus reduction in ejection fraction. This leads to a low supply of vital ingredients to the tissues including oxygen thus shortness in breath as among the primary signs of heart failure.

The weakening of the muscles can start form either chambers of the heart. The most common symptoms of heart failure include Shortness of breath (maybe all the time, with exertion or at night when lying down), Exercise intolerance, Difficulty lying flat without extra pillows, Increasing fatigue, Swelling in legs, Rapid weight gain, Abdominal distention and bloating.

STAGES OF CHF

There are two common types of CHF which occur in four main stages, the types include systolic; occur when the left ventricle fails to contract normally thus reducing the force to push blood into circulation and diastolic; this occurs when the muscle of left ventricle becomes stiff and can no longer relax thus creating inability to fill blood between the beats. 

The stages of CHF include ;

• Class I; in this stage, a person experiences no symptom at the normal physical activity, only detectable upon analysis of muscle functions of the ventricles
• Class ii; One feels comfortable while at rest but may experience fatigue, palpitations or  shortness of breath while in doing physical activity
• Class iii; one is likely to be comfortable at rest with noticeable limitation in physical activity .mid exercise will cause fatigue, palpitation or shortness of breath.
• Class iv; all likely symptom present even at rest, no amount of physical activity is tolerated.

Heart failure also occurs in both acute and chronic cases which depends on duration of condition, all having almost the same predisposition factors.

ROLES OF NUTRITION IN MANAGEMENT OF CHF 

Nutrition should play role in both prevention unforeseen and treatment of already existing case of CHF.

The use of modern technology in nutrients and genetics, such development in modern medicine as transparent patient should be primary procedures in prevention CHF.

NUTRITION MANAGEMENT OF OF CHF

Nutrition plays key role in management of congestive heart failure but it must be nutrition with specific aims achieve inn order to get results . Primarily it aims of any management is to reduce total pain and restore normalcy in systemic operation.

In Congestive Heart, Failure dietitian have a role in controlling specific nutrient to achieve the main aim of management.

A lot has been done in field of nutrition help in taking care of the cardiac failure patients but most of them are guidelines based on hospital management of palliative care but which focuses on medication and medication. From the analysis of various patients, holistic approach which will give room for social-cultural and lifestyle approach needs to be developed to ease both burdens at the hospital and in palliative care. This approach should be aimed at relieving immediate pain and progressive resolution to the problem at hand.

According to the University Hospitals system of  publication of 2001, the goals of nutrition management should be directed towards ;

• Lowering sodium
• Providing adequate potassium
• Provision of adequate magnesium
• Adequate vitamins C
• Preventing gastric distress
• Restricting (decaffeinate) caffeine in the acute phase
• Maintain adequacy of the diet based on the phase or stage of CHF.

Nutrition Management

Calories intake

Dietary adequacy is very important in any stage of disease management. Diet plays vital roles in healing process as well as cells regeneration.

Amount of energy consumed by CHF patient should be based on age of the patient, stage and other complications associated with the stage of the condition for example in shock, all per oral intakes should be suspended on Congestive heart failure until the shock is fully resolved.

In acute stage four; Total energy intake should not exceed 1000-1200kcals per 24 hrs.The energy intake should be customised for the patient based on how it is tolerated this will inform how other stages are managed.

It is important to note that almost 50% of the CHF patients worldwide suffer from malnutrition associated with their systems inability to take adequate nutrients or caregivers attitude towards patient intake.

The daily energy need of these patients other than those in acute stage four and those in shock should be based on reported leisure energy combined with resting energy expenditure, thus taking care of their possible activity factor. This will provide super adequate energy for the patient.

Fibre Intake

Fibre has a role in controlling blood sugar as wells as total blood cholesterol, fat monitoring is one of thing to monitor in a person exposed to CHF. The total amount of Low-Density Lipo-protein in the blood has a direct impact on coronary system functioning. Fibre amount between 25-35g a day is adequate in the regulation of systemic bad cholesterol a day. This should be proportional for both soluble and insoluble fibre.

Sodium

Lowering salt intake will help you lower the swelling or oedema associated with heart failure.

How much of salt? Averagely a heart failure patient should not take more than 2000 sodium a day. This is equal to less than one teaspoon of salt

• 1 teaspoon salt = 2,000 mg sodium
• 1 teaspoon baking soda = 821 mg sodium
• 1 teaspoon baking powder = 339 mg sodium
• 1 teaspoon MSG = 492 mg sodium

WAYS OF MANAGING YOUR SALT INTAKE

1. Leave the salt shaker off the table and do not cook with salt.
2. Learn to read food labels to avoid foods high in sodium.
3. Purchase fresh and frozen vegetables
4. Use of salt sources with a small quantity of sodium compared to table salt for example baking powder but it is equally important to read manufacturers labelling.
5. Do not add any salt in any food once on the table (I have practised not adding salt in food even if cooked without salt and it has worked perfectly for me in 2years )
6. Order food without salt while eating out
7. Minimize times you eat out per day

• Adequate potassium

Medications for heart failure may affect the level of potassium in your body. Some diuretics cause loss of potassium and so we may encourage high dietary potassium intake. On the other hand, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and aldosterone antagonists increase potassium levels, and you may need to decrease the potassium in your diet.

This guide provides basic information to help you start regulating your potassium level. These are general guidelines that may be tailored to meet your needs. Please talk to your doctor or nurse to make sure that these guidelines apply to you.

An excess of potassium in your blood (hyperkalemia) can have serious side effects and should be treated immediately. Side effects include weakness, general discomfort, nausea, diarrhoea and pain. These side effects can progress to paralysis, a decreased ability to urinate and an irregular heartbeat.

Having a low potassium level (hypokalemia) can also be very dangerous. Symptoms of hypokalemia include muscle weakness, palpitations and muscle aches

• Soak or boil vegetables and fruits in water to help reduce the potassium content.
• Look on labels for symbols listed as (KCl), K+, or potassium and avoid these foods. Potassium may be used in some foods as a preservative or a salt substitute.
• These foods are high in potassium and should be avoided: salt substitutes that contain potassium chlorides such as potatoes, tomatoes, bananas, cooked spinach, bran cereals and sports drinks.

MODERN PREVENTION OF CHF

This drew me to Genome-Wide Association Studies to get insights on association between CHF and possible preventive approach using nutrient-genomic (Nutrigenomics) and in the study it is confirmed and I quote ‘genetic analysis suggest that there may be substantial identified etiologic heterogeneity underlying many common disorders and that this heterogeneity must be resolved if the genetic basis of these traits is to be understood. The research further points at using traditional genetics with higher resolution phenotype implementing tissue-specific functional genomics in an approach called integrative genomics to offer a pathway entry point. This also indicates that new diagnostic resolutions might lead to immediate earlier diagnosis, thus introducing the possibilities of screening for diathesis towards CHF and possible prevention by use of agents such as better-blockers ACE inhibitors or ARBs.

This pathway towards the development of the disease is one such area green to nutrition fraternity but one of the best areas to use as an approach to dealing with CHF in a family lineage associated with the condition or disorder. This is not part of failure in the medical nutrition field since a  little is known yet about the genetics of the CHF despite having a wide coverage on the possible link between heredity and environmental contributors among them human dietetics as a possible link to the occurrence of the disorder. This, therefore, needs an in-depth analysis of the areas of nutrient-genomics of the cardiovascular system and possible hidden causes of injury.

REFERENCES

• University Hospitals system of  publication of 2001
• Elaine K. Luo, MD on August 8, 2018 — Written by Brindles Lee Macon and Kristeen Cherney

Michael Ouma Odero

Clinical Nutritionists

 

 

 

 

 

 

SALT

Dietary Sodium

Two weeks ago a friend who is also a nutritionist gave me a call, she was disturbed that she had one of her clients, the client has some unusual complaints headache, nausea, vomiting, confusion and muscle pain. When the necessary body testes were done, all results were negative except sodium whose range was below the normal range of 135mEq/l-145mEq/l. I was tempted to treat this case as an isolated case since it is a very rare occurrence in nutrition.

A week later, I happened to had met some friends for at least some cup of tea.We were served tea with an option of coffee with bread and boiled eggs. That morning I had taken more than the recommended amount of whole eggs, I, therefore, decided to excuse myself from taking the boiled eggs. This might have triggered some conversation, in the process one of the friends said they no-longer salt in the family since his partner is hypertensive. On the other hand, my other friend comes out to confess that she can never do without salt, her description of the use of salt pointed out at someone who is kind of addicted to using salt. She described her situation as someone who would add salt on food as long as the salt is around. This left me wondering, what could be the effects of the two divergent lifestyles? From the three cases, I got interested in the use of salt and specifically sodium in the salt.

Dietary Sodium

This is a naturally occurring element that is part of the three primary electrolytes required by the body(alongside chloride and potassium ) for proper functioning.

It also occurs naturally in most food through in a smaller amount usually not very enough for the body as per the serving requirements of the specific foods. Sodium daily requirement for an average adult is 2300mg which is equivalent to 2.3 g a value slightly less than 1/2 a teaspoon.

For people with high blood pressure (confirmed cases of hypertension ), the daily requirement should not go beyond 1500mg or 1.5 g value almost equivalent to 1/3 teaspoon.

The blood usual measure of sodium should be valued between 135 mEq\l -145 mEq\l, any value lower than this results into a condition called hyponatremia and any value higher than this range results in a condition called hypernatremia ( as we shall see later in our discussion).

Common sources of sodium in our diet

As I had stated earlier sodium occur naturally in most foods but in a lower quantity not enough to take care of our daily requirements as such the common sources include

• Table salt (added salt )

Then some foods have been grouped to contain a high content of salts due to processes they pass through before getting into our table these form the largest food sources of sodium and they include ;

• Processed, smoked and canned foods like fish, meat, poultry
• Frozen and breaded meats like pizza
• Processed food like cheese,
• Foods preserved through salting
• Roasted meat
• 

Some of the foods with low salt content include foods in natural states like

• Fresh meat, fish and poultry
• Eggs and egg substitutes
• Fresh milk and yogurt
• Fresh vegetables
• Fresh and at times some dried fruits.

Functions of sodium in the body

In general language we say it helps in controlling blood volume and pressure and aiding in proper muscle and nerve functions, then question worth asking is how?

1. Sodium helps in what is called resting potential

For cell membranes to function, membrane potential must be created. This is created through what is called sodium-potassium pump where three ions of sodium are pushed our from the cell through the membrane while two potassium ions are pushed in the cell leaving a net single positive charge across the cellular space. In addition to this a short circuit channel of potassium in the membrane hence close to Nernst potential of potassium across the plasmic membrane.

2. Transport

The export of sodium from the cell through sodium-potassium pump provides a driving force for several secondary active transporter membrane transport proteins, this transports glucose, amino acids, and other nutrients into the cell through sodium gradient.

3. Controlling cell volume

Failure of N+ and K+ pump results in swelling of the cell. Cell osmolarity is the sum of the concentration of various ion species and many other proteins and organic compounds inside the cell. When the is higher inside the cell, the cell draws water inside from the surrounding leading to swelling of the cell. When osmolarity is higher to the outside, the cell will lose water to the surrounding.

4. Function as a signal transducer

Protein-protein interaction plays a very important role in N+ K+ pump mediated signal transduction. For example, the N+K+ pump interacts directly with src protein to form signal receptors complex which is inhibited by the N+K+ pump but upon binding will be released and be activated.

5. Controlling neuron activity state

N+K+ helps in computation in the cerebellum and the brain. Brain neurons can transmit signals using a flow of Na⁺ and K⁺ ions, which produce an electrical spike called an action potential (AP). After an AP, the Na⁺/K⁺ pump resets the arrangement of Na⁺ and K⁺ ions back to their original positions so that the neuron is then ready to relay another AP when it is called upon to do so. So, the Na⁺/K⁺ pump has a “housekeeping” role rather than a direct role in brain signaling.

SIDE EFFECTS OF SODIUM

The side effects manifest in two forms

• Effects of too low sodium

Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. It occurs when blood sodium falls below 135mEq/l.

Common causes of hyponatremia

sodium can be lost through the process which cut across to both losing water fluids and sodium itself, these include

• Diarrhea and vomiting
• Excessive sweating either from extraneous exercise
• Kidney disease, cirrhosis or heart failure
• Conditions which make one drink too much water like polydipsia
• Use of water pills in people prone to low sodium like elderly people.

Hyponatremia treatment is aimed at resolving the underlying condition. Depending on the cause of hyponatremia, you may simply need to cut back on how much you drink. In other cases of hyponatremia, you may need intravenous electrolyte solutions and medications.

Effects of Hyponatremia include signs and symptoms like

• Nausea and vomiting
• Headache
• Confusion
• Loss of energy, drowsiness, and fatigue
• Restlessness and irritability
• Muscle weakness, cramps
• Seizures
• Coma
• Effects of too high sodium

Hypernatremia is a common electrolyte problem that is defined as a rise in serum sodium concentration to a value exceeding 145 mEq/L.

Common Causes of Hypernatremia.

It is commonly caused by activities which result in dehydration which include ;

• Kidney dysfunction
• Dehydration
• Use of diuretics
• Vomiting and diarrhea

Excess levels of sodium/salt may put you at risk for:

• High Blood Pressure
• Stroke
• Heart Failure
• Osteoporosis
• Kidney Disease
• Kidney Stones
• Enlarged Heart Muscle
• Headaches

Your Appearance

Excess levels of sodium may cause, increased Water Retention, Leading to:

• Puffiness
• Bloating
• Weight Gain
• Fasten aging

Common substitutes of the salt include

• Potassium based salt
• Himalayan salt
• Sea salt.

REFERENCES

1. Arganda S., Guantes R., de Polavieja G. G. (2007). Sodium pumps adapt spike bursting to stimulus statistics. Nat. Neurosci. 11, 1467–1473. 10.1038/nn1982 [PubMed] [CrossRef] [Google Scholar]
2. Ashmore L. J., Hrizo S. L., Paul S. M., Van Voorhies W. A., Beitel G. J., Palladino M. J. (2009). Novel mutations affecting the Na, K ATPase alpha model complex neurological diseases and implicate the sodium pump in increased longevity. Hum. Genet. 126, 431–447. 10.1007/s00439-009-0673-2 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
3. Clinical Nutrition Manual 2019
4. Kenya National Guideline for Management of Cardiovascular diseases

Michael Ouma Odero

Clincal Nutritionist

micoushkod@gmail.com /middlehealthsolutions@gmail.com

Nutrition and Peptic Ulcers Disease

Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.Peptic ulcers include:

• Gastric ulcers that occur on the inside of the stomach
• Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin and nonsteroidal anti-inflammatory drugs . Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.

The sore is treatable and therefore you should not worry when diagnosed with PUD .Upon diagnosis the right thing is to seek proper medication aimed at reducing pain and healing the sores .

Several people have been misguided to believe that ulcers is not curable hence misconception of selective use of foods and products once you are diagnosed with PUD .

NUTRITION AND ULCERS

My experience with clients has shown me a different perspective of PUD . My first problem with ulcers in Kenya is both senior and junior nutrition professionals gamble with the concept of ulcers ,giving information which to some extent have contradicted their own practice ethics .

My take as clinical nutritionist is ulcers or peptic ulcers disease (PUD) as it is frequently called does not need any special diet grouped for patients or any particular guideline on what should be added or subtracted in the diet .

The truth is trial and error and elimination methods are the best way to manage a patient nutritionally when they suffer from PUD .Trial and error in this circumstance works for the patient who do not know the exact foods which will trigger pain while elimination method works best for those who have monitored themselves and know so well the foods which affect them .

GENERAL GUIDELINE IN NUTRITION CARE FOR PUD

• Use of energy

This is part of elimination method and the goal is to ensure the foods taken do not affect the patient but promotes healing of the sore or ulceration. For example some lies have been spread about beans , kales and acid producing foods but the fact is our system is made in a way that it recognizes specific food and the food content. This will make one food to produce more acid for an individual but not the other.The same way our systems operate differently while regulating both the temperatures and pH . (One person is different from the other ).

• Use of protein in PUD

During management , high quality protein which would offer essential amino acids for healing must be given .High biological value protein is required for any healing process since it involves tissue rebuilding , repair and some growth . This is not achievable with incomplete protein or protein of low biological value . It is equally important that digestion of protein in the stomach involves release of acid and the source of protein influences acid production , for example plant proteins are harder to digest hence takes longer to digest and absorb as compared to animal proteins , this makes animal protein of great importance in management of ulcers but caution must be taken ,for individuals will react differently with some specific foods from which the protein is sourced .This is because of other components of the food recognized by the body during breakdown.

• Use of oxidative nutrients

Promote oxidative nutrients to help the system defend itself from radicles which could delay healing , foods rich in vitamin c ,selenium , zinc,vitamin K and vitamin E will improve healing process .

Using elimination method always ensure the foods have high quantities of the said nutrients but still do not affect the the patient by causing irritation of any nature .This will work alongside the medication for H.pylori to help in the healing of the sores .

• Use of fibre in peptic ulcer .

There has been a lot of controversies about use of fibre in PUD but what is most ignored is the fact that fibre exist in two groups .That is the soluble fibre and insoluble fibre.The physicochemical properties of fiber fractions produce different physiological effects in the organism. Soluble fibers, found in apple and pears for example are responsible,for example in increasing viscosity in the intestinal content.

Insoluble fibers (for example whole grain cereals ) increase stool bulk, reduce transit time in the large intestine, and make fecal elimination easier and quicker. Fibers regulate the bowel function, which make them vital for the well being of healthy people and in the dietary treatment of many pathologies.

Above all, it is important to monitor patient response to fibre and moderate fibre and connective tissues as per the patients’ need and tolerance .

A diet rich in fibers for individuals with peptic ulcer is advisable (20 to 30 g/day, according to WHO – World Health Organization), because fibers act as buffers, reducing concentrations of bile acids in the stomach and the intestinal transit time, resulting in less abdominal bloating, thus decreasing discomfort and pain in the gastrointestinal tract.

• Use of pepper and garlic in peptic ulcers disease

It is important to note that spices do not cause PUD ,it is caused by H.pylori primarily, it is also important to note that some spices can be nutrient dense to an extent of forcing the gastric system to produce more acid that could cause irritation of the stomach lining . The facts is , spices could also be primary agents in protection as well as healing in PUD. This is based on individual system and how the system responds to the content of the spice or the spicy food .

There is scientific connection between capsaicin in chill and other foods which contain it to reduce the total acid production in the gastric system hence lessening the symptoms of PUD .

• Use of dairy products and Probiotics

For a long time people have been misled that use of milk during treatment of ulcers can reduce the pain by lowering acid production .This is not scientifically true , equally blank accusation of dairy products to offer imaginary results in treatment of ulcers is also wrong . Probiotics are healthy bacteria which can help fight H.pylori in the system . This means foods which give Probiotics could also offer positive results when used alongside management of PUD , the issue is individual system reacts differently to different foods hence giving different results , sample case is in use of yogurt, this is a dairy product and equally it has large content of Probiotics .This means yogurt could be as well used in managing H.pylori but long term use during management is based on the patient’s gastric system reaction to it .Some will tolerate it and get good results while others are not able to tolerate yogurt in PUD .

Conclusion

Peptic Ulcers disease does not need specific management guideline with exclusion of some foods and inclusion of others but it should only follow , the patient based management using elimination method and trial and error in case the patient does not know the exact foods she is intolerant to during the infection .

The exaggerated discussion on dairy products should be rechecked and the right conclusion be made on how to use them during management of PUD .

References

1. Filisetti-Cozzi TMCC, Lajolo FM. Fibra alimentar insolúvel, solúvel e total em alimentos brasileiros. Rev Farm Bioquím. 1991;27:83–99.
2. . Institute of Medicine . DRIs – Dietary Reference Intakes: Applications in Dietary Planning. National Academy Press; Washington, D.C.: 2003.
3. MayoClinic of Nutrition
4. WHO – World Health Organization

Michael Ouma Odero

Clincal Nutritionist

micoushkod@gmail.com /middlehealthsolutions@gmail.com

NUTRITION AND SICKLE CELL ANAEMIA

NUTRITION AND SICKLE CELL DISEASE.

Sickle cell disease is an autosomal recessive condition in which red blood cells become sickle-shaped and fragile. This results in hemolytic anaemia and recurrent vaso-occlusion in the microvasculature due to increased red blood cell adhesion and retention. Acute vaso-occlusion causes severe pain in the musculoskeletal system, abdomen, and other areas. Other acute vaso-occlusive complications include splenic sequestration and/or infarct and the acute chest syndrome associated with pulmonary infarcts. Large vessel stroke occurs in the setting of stenotic blood vessels due to chronic vessel wall injury.

Hemoglobin S (HbS) is characterized by a single change in the amino acid sequence of the β-globin chain and is responsible for creating the abnormal red cell morphology. Individuals who are heterozygous for the HbS gene generally have no symptoms or sequelae of SCD, but they are said to have sickle cell trait; that is , they are carriers of the HbS gene. Their offspring could be affected if the other parent is heterozygous or homozygous for the gene or carries another abnormal hemoglobin gene.

Other sickle cell disease variants include hemoglobin SC, a heterozygous combination of HbS and hemoglobin C, and hemoglobin S and β-thalassemia (hemoglobin Sβ +-thalassemia or Sβ o-thalassemia). These conditions cause sickle cell disease , although the symptoms and complications may be less severe than those in the homozygous condition. .

Acute signs and symptoms may include pain in the hands and feet, fever, serious bacterial infections due to splenic sequestration/infarction, priapism, chest pain, shortness of breath, fatigue, pallor, tachycardia, jaundice, and urinary symptoms. Chronic complications include delayed growth/puberty, retinopathy, chronic lung and kidney disease, cardiovascular disease, avascular necrosis of the hips and shoulders, bone infarcts, and leg ulcers.

Risk Factors

Though genetically passed from two parents with heterogeneous or recessive characteristics ,it is seem more often in Africans and Africa-American as well as Asians more than the original people from West .This could as well be associated to individual characteristic on preventive measure to the disease .(We will look into preventive aspect under treatment and prevention )

Diagnosis

Prenatal screening for sickle cell disease is possible through chorionic villous sampling. Other prenatal tests may be on clinical trials and will be available for our Kenyan health system in future.

Developed nations like United States and United Kingdom have universal newborn screening by electrophoresis (or other diagnostic testing) ,these sophisticated tests are not established in most African Countries including our own Kenya . Sickle cell anaemia is indicated by the presence of fetal hemoglobin (hemoglobin F) and hemoglobin S and an absence of hemoglobin A.

Electrophoretic findings for sickle cell anaemia are:

• Hemoglobin S at 85% to 90% (normally 0%).
• Hemoglobin A at 0% (normally 95%-98%).
• Hemoglobin F at 2%-15% (normally 0.8%-2.0%).

Additional findings are likely to include a normochromic, normocytic anaemia; reticulocytosis; and sickle cells (and other abnormal findings, including polychromasia and nucleated red blood cells visible on peripheral blood smear). Other findings consistent with hemolysis may also be present such as unconjugated hyperbilirubinemia, elevated LDH and low haptoglobin.

Subsequent to diagnosis, patients should undergo periodic testing, which includes complete blood count (CBC), iron studies, liver function tests, and tests of renal function, such as urinalysis, blood urea nitrogen (BUN), and creatinine. These data can be compared with those assessed during exacerbations to guide medical management.

Treatment

In the acute pain setting, analgesics, warm compresses, and oral and intravenous fluids are appropriate interventions.This being an inherited condition ,it is not curable , routine medication, proper nutrition management through healthy diet and at times supplementation (Supplements should be prescribed when justifiable and the moment routine diet only offers long term solution as opposed to acute treatment results required).

Nutrition Management of Sickles Anaemia

1. Total Increase in Nutrient Requirement (Energy need )

During the quiescent phase of the disease , average intake normally go bellow normal , this further drops to more than half during the illness phase requiring hospitalization as such high calories , accompanied with foods dense in nutrients should be the primary goal of the diet formulator.

Children with Sickle cell disease are at high risks of impaired growth and significantly have lower fat and free fat mass as such nutrition care process should over emphasis need to having slightly high free fat mass .This should also be evaluated carefully as adolescents suffering sickle cell disease also develop some margin of obesity and overweight .This calls for evaluation of nutrition assessment standards since resting energy expenditure in sickle cell disease is frequently underestimated leaving room for supplementation though it should be justifiable supplementation .

2. Fluid consumption .

Sickling of erythrocytes increases in sickle cell disease patients who exercise in the heat without consuming fluids, compared with those who maintain well-hydrated status.This calls for adequate fluid intake to maintain hydration and circulation since too low blood and other fluids may increase straining of the incapacitated red blood cells while supplying oxygen to the rest of the body .Thus water and other healthy fluids should be consumed adequately .This should not mean only water is the source of body fluid but other sources including foods with high water content like watermelons ,cabbages among others .

3. Micronutrients.

Blood levels of several vitamins and minerals, including vitamin A and carotenoids,vitamin B 6, vitamin C, vitamin E, magnesium,and zinc, are often low in individuals with sickle cell disease .

These deficiencies cause a significant depreciation in blood-antioxidant status in these patients,and the resulting oxidative stress may precipitate vaso-occlusion–related acute chest syndrome.Studies indicate supplementation of zinc, magnesium, vitamins A, C, and E or treatment with a combination of high-dose antioxidants can reduce the percentage of irreversibly sickle cells. Antioxidant plant phenols, such as flavonoids, may also reduce the oxidative stress in sickle cell disease .

The B vitamins which are primary in blood formation like B12 and B9 as well as iron are also of great importance in this disease .Diet rich in these micros include meat mostly offal meat , dark green leafy vegetables such as spinach , kales , mrenda,amaranthus leaves,legumes / pulses like beans (red-beans ),sea foods and fish like nile perch , sardine , omena .

4. Omega-3 fatty acid supplements.

The serum phospholipids of children with sickle cell disease contain reduced proportions of both the parent (alpha-linolenic acid) and the long-chain omega-3 polyunsaturated fatty acids (eicosapentanoic acid [EPA] and docosahexanoic acid [DHA]), compared with non-sikcler peers .

These long-chain omega-3 fatty acids increase the fluidity of red blood cell membranes, which may prevent sickle cell crisis. In a small double-blind, placebo-controlled study supplemental EPA and DHA had significant therapeutic benefits including reduction of severe anaemia.

As a preventive measure , food rich in these fatty acids including sea foods, like fish and fish products are supposed to be increased in the sickle cell disease beyond the normal levels .This increase storage of excess in the body usable during sickle cell disease crisis .

Preventive Strategies

Comprehensive and multidisciplinary care is essential. Education to both patient and family counseling may help prevent complications of the disease.

Many developed nations are currently exploring genetics ,through genetics testing and counseling for recessive gene and possible phenotyping in their off springs.This is also an individual and couples choices to do the possible tests before marriage and arrangements to get children to ensure they are aware of possible outcomes of their future pregnancies .

References

1. Sickle Cell Disease (SCD): Data and Statistics. Centers for Disease Control and Prevention website. Available at http://www.cdc.gov/ncbddd/sicklecell/data.html . Updated July 8, 2015. Accessed January 25, 2016.
2. Strahan JE, Canfield MA, Drummond-Borg LM, et al. Ethnic and gender patterns for the five congenital disorders in Texas from 1992 through 1998. Tex Med. 2002;98(9):80-6. [PMID:12271912]
3. Yawn BP, Buchanan GR, Afenyi-Annan AN, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA. 2014;312(10):1033-48. [PMID:25203083]
4. Angelucci E, Barosi G, Camaschella C, et al. Italian Society of Hematology practice guidelines for the management of iron overload in thalassemia major and related disorders. Haematologica. 2008;93(5):741-52. [PMID:18413891]

Michael Ouma Odero

Clinical Nutritionist

micoushkod@gmail.com /middlehealthsolutions@gmail.com

Nutrition and Anaemia

Nutrition and Anaemia

 

Blood disorders can affect any of the four  main components of the blood , the disorders are also named based on the component of the blood affected among other specified and non-specified factors .These disorders have different causes ranging from inheritance to disease ,lifestyle to medication .In this article we are interested in blood disorders which affect the red-blood cells and components of the red-blood cells .

Generally the disorder of the red blood cells is called anaemia .Anaemia in lay-language or the patient-patient (non-medics language ) is lack of blood but medically any occurrence which reduces red blood cells capacity to transport enough oxygen to all body parts is anaemia , this occurrences could be in form of damaged red blood cells , red blood cells lower than expected amount (men 4.7-6.1 million cells per micro-litre or non pregnant female 4.2-5.4 million cells per micro-litre ). This is also measured using hemoglobin levels (Hb) with the following ranges for normal men 13.5-17.5 grams per decilitre and female 12.0-15.5grams per decilitre .

Nutritionally all anaemia cases are preventable and treatable , that means  anaemia ,once it  occur it can  be managed  through good medication , good diet or well prescribed nutrition supplements and once can be cure but it can also be prevented through healthy diet  .

In Kenya ,preventable and treatable anaemia among expectant mothers is a public health problem , this is because it is at 55.1%  value higher than 40% cut off point for public health problems according to reports of the Antenatal Attendance in Pumwani Hospital Nairobi County Kenya in 2016 .This is almost the same issue with children under five years  which was graphed  at 73% based on KDHS reports of 2017 while WHO reports indicated limited data on under fives anaemia in Kenya .This is just in reference to one type of anaemia caused by iron deficiency.

 Causes  of  Anaemia

Anaemia occurs if your body makes too few red blood  cells (RBCs), destroys too many RBCs, or loses too many RBCs. RBCs contain hemoglobin,  that carries oxygen throughout your body. When you don’t have enough RBCs or the amount of hemoglobin in your blood is low, your body doesn’t get all the oxygen it needs and this can be accompanied by such symptoms as pale eyes , pale palm , weak body ,general tiredness , breath shortness among others .

Type of  Anaemia

Most anaemia and all treatable anaemia are caused by inadequacy of some specific micro-nutrients in the system or dietary practices which result into inadequacy in utilization of specific micro-nutrients or factors which lead to physical loss or chemical loss of specific micro-nutrients from the body through loss of blood or related body fluids  .These include factors which interfere with normal cells formation processes among others mentioned above .

These types of anaemia include ;

1. Iron Deficiency Anaemia

Iron used by body can only be present in our diet in two forms , heme iron whose sources is majorly drawn from animal food  and it is also biologically very bio-available for the system to utilize while non heme iron  sources include  plants , dairies  and eggs.Non heme iron is  equally good   but it is not as  bio-available as heme iron .

Note. non heme iron comes from both animal and plant sources unlike heme iron which is primarily from animal foods .Non heme iron absorption is further complicated in cases of conditions  like  hamochromatosis.

Iron is stored mostly in the liver in ferritin or hemosiderin.Your body needs iron to make hemoglobin, in RBCs that carries oxygen. The main way you get iron is from food. At certain times ,like during pregnancies , growth spurts, or blood loss—your body may need to make more RBCs than usual. Thus, your body needs more iron than usual.

Iron deficiency anemia occurs if your body can’t keep up with its need for iron.Almost everybody is at risk of iron deficiency anaemia but other people are at higher risks than others ,for example Infants and children, adolescents, and women of childbearing age, People who have certain diseases and conditions such as  kidney failure , People who don’t get enough iron from the foods they eat, People who have internal bleeding or any other type of hemorrhage .

Nutrition Management of Iron Deficiency Anaemia

Based on the cause , nutrition management of iron deficiency will also take into consideration severity of deficiency and risks  with which   the patient life is in  .It is proper to understand that management ranges from provision of readily packed red blood cells with enough irons through blood transfusion as a quick short term remedy to the emergency at hand , supplement prescription as perceived intermediate measure and  long term diet prescription as short acting but  nearing permanent solution to iron deficiency anaemia  . Diet prescription and dietary management is not just long term ,short acting but is also a preventive management towards occurrence or re-occurrence of iron deficiency anaemia .

• Diet Prescription In Management of Iron Deficiency anaemia  

It is important to note that three dietary factors could cause iron deficiency in an individual

• Diet with inadequate iron
• Dietary Practices which increase chances of binding available iron hence lowering its  bio-availability
• Sex ,age and type of diet .

Diet with inadequate iron

Increase foods rich in iron in your diet ,such foods include ;

• meat mostly offal meat like liver
• dark green leafy vegetables such as spinach , kales , mrenda,amaranthus leaves,legumes / pulses like beans (red-beans ).
• Sea foods and fish like nile perch , sardine , omena

The simple way to ensure these foods are taken care of in your diet and maximum iron is found from the diet  , follow up the food groups for example in Kenya there are 15 general food groups but for lactating mothers and expecting ladies  the foods are grouped further to ten while for children 6-59 months the foods are grouped down  to eight . By lactating ,mother taking at least six to seven  groups out of ten a day and the infant taking five out of ten  groups a day the iron sources will be catered for in the diet.

Dietary Practices which increase chances of binding available iron hence lowering its  bio-availability.

These are some of our normal practices and at a time habitual things which in most cases appear relaxing and normal or culturally allowed but scientifically they influence bio-availability of iron in our foods such practices include;

• Taking iron rich food with foods rich in calcium , very common practice is taking milk after meals or milk with main meals .Milk is loaded with calcium and iron but iron in milk is not bio-available (Non-heme ) due to antagonistic effect between iron and calcium ,this is because calcium inhibits iron absorption in a chemical process since it is easily oxidized compared to iron .
• Taking beverages which inhibit iron absorption like tannin,polyphenolic compounds ,caffeine .These beverages in Kenya include tea , coffee among others .It is important to note that non-heme iron is more affected by the compounds compared to heme iron .
• Leaving specific parts of food to some members of the family ,this is actually cultural and it mostly affects women and children negatively for example female at some age are purported and expected not to eat some parts of poultry of which those parts are some of the areas dense in nutrients including iron .
• Mixing all foods while cooking , iron being an earth element it is readily reactive with other forms of chemicals present in the foods we eat hence mixing foods can lead to chemical loss of the nutrient .

Other dietary practices are also helpful in increasing iron bio-availability in diet , these include taking food with iron absorption enhancers such as vitamin C for example taking fish with a little piece of lemon or lemon juice or taking meat with spinach / hot pepper or githeri with kales.

Sex ,age and type of diet

Sex- female are at high risk of developing anaemia due to losses due to menses , this is even more serious in cases of adolescence with  of eating disorders .The need for iron even increases further during pregnancies and lactation hence call for adherence to food groups to prevent any occurrence of iron deficiency anaemia which is one of the complications associated with pregnancies  .

Type of diet has high influence on individual iron stores ,for example total vegetarian  has zero chances of benefiting from heme sources of iron since all plant sources contain non-heme diet .

When designing diet rich in iron based on foods and food groups mentioned above the factor of age ,sex and diet must be looked into to ensure the diet takes care of the population at risks of  iron deficiency anaemia .

2. Vitamins Deficiency Anaemia

B vitamins play major roles in cells formation , as such their deficiencies equally affect the formation process of red-blood cells hence leading to anaemia,such vitamins associated with vitamin deficiency anaemia include vitamin B 9, vitamin B12, all of which are associated with cell formation process and at times vitamin C which plays crucial role in iron absorption . Vitamin deficiency anaemia include include;

• Pernicious anaemia

Vitamin B12 and folate ( B 9 vitamin) are needed to make healthy RBCs. Your body absorbs these vitamins from foods. Pernicious anaemia occurs if your body can’t make enough RBCs because it cannot  absorb enough vitamin B12 from food.Groups at risk include; people who have conditions that prevent them from absorbing vitamin B12 and people who don not get enough vitamin B12 in their diets.

Dietary management of pernicious anaemia

Just as I said earlier management of anaemia nutritionally is based on severity and emergency with which the health workers are dealing with , either way pure dietary management is both preventive and curative as long as the anaemia is purely diet related  .The management  ranges from short term management to restore  red blood cells count to long term management through dietary prevention and cure .In managing pernicious anaemia , it is important  deal with factors prevent adequate vitamin B9 and B12 absorption  before you embark on diet .Foods rich in vitamin B12 and B9 include , whole grains(whole -wheat , rice , maize ) , meat (offal meat) , beans ,spinach , cabbage , broccoli , beetroot

3. Aplastic Anaemia

Anaemia usually refers to a condition in which your blood has a lower than normal number of RBCs. However, some types of anemia, such as aplastic anemia, cause lower than normal numbers of other blood cells, too. Aplastic anaemia can occur if your bone marrow is damaged and cannot make enough RBCs, WBCs, and platelets. The causes of aplastic anemia can be acquired or inherited. Groups at risk include; people undergoing radiation or chemotherapy, exposed to toxins, or taking certain medicines,people who have diseases or conditions that damage the bone marrow

Nutrition Management of Aplastic Anaemia

Depends on the cause of the anaemia. Treatments may include blood transfusions, medicines, blood and marrow stem cell transplants, and lifestyle changes.

4. Hemolytic Anaemia

Normally, RBCs have a lifespan of about 120 days. Your body constantly makes new RBCs to replace ones that die. Sometimes, RBCs are destroyed before their normal lifespan is up. Hemolytic anaemia occurs if your body cannot make enough RBCs to replace those destroyed. Acquired hemolytic anaemia occurs if your body gets a signal to destroy RBCs even though they are normal. Inherited hemolytic anaemia is related to problems with the genes that control RBCs.Risk groups differ depending on the cause and type of hemolytic anemia.

Nutrition Management

Nutrition management and general treatment of hemolytic anaemia depends on the cause of the anemia and may include  blood transfusions, medicines, surgery and procedures, and lifestyle changes.

References

• Baby friendly Community initiative training manual for health workers and CHVs
• Kenya food Composition Table
• NIH Publication No. 11-7629ASeptember 2011
• (n.d.). nhlbi.nih.gov/health-topics/anemia
• Calcium content of common foods. (n.d.).
  org/osteoporosis-musculoskeletal-disorders/osteoporosis/prevention/calcium/calcium-content-common-foods

Michael Ouma Odero

Clinical Nutritionist

micoushkod@gmail.com /middlehealthsolutions@gmail.com 

RENAL DIET

GUIDE TO DEVELOPING RENAL PROBLEM DIET

People with compromised kidney function must adhere to a renal or kidney diet to cut down on the amount of waste in their blood. Wastes in the blood come from food and liquids that are consumed. When kidney function is compromised, the kidneys not filter or remove waste properly. If waste is left in the blood, it can negatively affect a patient’s electrolyte levels. Following a kidney diet may also help promote kidney function and slow the progression of complete kidney failure.

A renal diet is one that is low in sodium, phosphorous, and protein. A renal diet also emphasizes the importance of consuming high-quality protein and usually limiting fluids. Some patients may also need to limit potassium and calcium. Every person’s body is different, and therefore, it is crucial that each patient works with a renal dietitian work to come up with a diet that is tailored to the patient’s needs.Below are some substances that are crucial to monitor to promote a renal diet:

Sodium

Normal sodium intake should be an overage of 2300 mg a day with restrictions in compromised circumstances giving value no more than 1500 mg a day in adults. Normal sodium levels in the blood should be 135 mEq/l – 145 mEq/l. Value below the range is termed hyponatremia with risk factors being age, intense exercise, use of some drugs and some conditions or diseases.

Main source of sodium in Kenyan diets is the table salt where sodium is in the form of sodium chloride.

Role of Sodium in the body .

Sodium is a mineral found in most natural foods. Most people think of salt and sodium as interchangeable. Salt, however, is actually a compound of sodium and chloride. Foods we eat may contain salt or they may contain sodium in other forms. Processed foods often contain higher levels of sodium due to added salt.

Sodium is one of the body’s three major electrolytes (potassium and chloride are the other two). Electrolytes control the fluids going in and out of the body’s tissues and cells. Sodium contributes to:

• Regulating blood pressure and blood volume
• Regulating nerve function and muscle contraction
• Regulating the acid-base balance of blood
• Balancing how much fluid the body keeps or eliminates

Reasons for monitoring sodium in Renal Problem

Too much sodium can be harmful for people with kidney disease because their kidneys cannot adequately eliminate excess sodium and fluid from the body. As sodium and fluid buildup in the tissues and bloodstream, they may cause:

• Increased thirst
• Edema: swelling in the legs, hands, and face
• High blood pressure
• Heart failure: excess fluid in the bloodstream can overwork your heart, making it enlarged and weak
• Shortness of breath: fluid can build up in the lungs, making it difficult to breathe

Sodium monitoring in diet

• Always read food labels. Sodium content is always listed.
• Pay close attention to serving sizes.
• Use fresh, rather than packaged meats.
• Choose fresh fruits and vegetables or no-salt-added canned and frozen produce.
• Avoid processed foods.
• Compare brands and use items that are lowest in sodium.
• Use spices substitute to salt like garlic
• Cook at home and do NOT add salt.
• Limit total sodium content to 400 mg per meal and 150 mg per snack.

Potassium

Normal potassium intake should be in the range of 3500 mg -4700 per day with acute renal problem restriction going to below 2000 mg a day. Normal blood potassium should be between 3.5 mEq/l -5.1 mEq/l. Hypokalemia occur when the blood potassium levels fall below 3.5 mEq/l while hyperkalemia occur in stages of mild 5.1-6.0 mEq/l, moderate 6.0-7mEq/l and severe at above 7.0 mEq/l

Main source of potassium in Kenyans diet include avocadoes, banana, potatoes, spinach, beans, citrus juices and salmon fish.

Role of potassium in the body

Potassium is a mineral found in many of the foods we eat and is also found naturally in the body. Potassium plays a role in keeping the heartbeat regular and the muscles working correctly. Potassium is also necessary for maintaining fluid and electrolyte balance in the bloodstream. The kidneys help to keep the right amount of potassium in your body and they expel excess amounts into the urine.

Reasons for monitoring potassium in Renal Problem

When the kidneys fail, they can no longer remove excess potassium, so potassium levels build up in the body. High potassium in the blood is called hyperkalemia which can cause:

• Muscle weakness
• An irregular heart beat
• Slow pulse
• Heart attacks
• Death

Potassium monitoring in patient with Renal Problem

When the kidneys no longer regulate potassium, a patient must monitor the amount of potassium that enters the body.

Tips to help keep the levels of potassium in your blood safe, make sure to:

• Develop some predictable eating plan
• Limit foods that are high in potassium for example the one mentioned above
• Limit milk and dairy products to not more than two servings a day.
• Choose fresh fruits and vegetables.
• Avoid salt substitutes & seasonings with potassium.
• Read labels on packaged foods & avoid potassium chloride.
• Pay close attention to serving size.
• Develop personalize food diary and eating diary.

Phosphorus

Normal phosphorus varies with age for children of 8 years and below they slightly need more due to bone cementing process which takes place rapidly at this age, 9-18 years intake drops to about 1200 mg per day and adults above 18 years general daily need is an average of 700mg per day. Blood phosphorus levels also vary with age due to use and difference in body need, but an average adult will have their blood phosphorus levels range between 2.5mEq/l-4.5 mEq/l while the younger ages will have slightly higher level.

Common food sources of phosphorus in Kenya include milk ,cheese ,canned fish , carbonated drinks like Coca-Cola

Roles of phosphorus in the body

Phosphorus is a mineral that is critical in bone maintenance and development. Phosphorus also assists in the development of connective tissue and organs and aids in muscle movement. When food containing phosphorus is consumed and digested, the small intestines absorb the phosphorus so that it can be stored in the bones.

Reasons for monitoring phosphorus in Renal Problem

Normal working kidneys can remove extra phosphorus in your blood. When kidney function is compromised, the kidneys no longer remove excess phosphorus. High phosphorus levels can pull calcium out of your bones, making them weak. This also leads to dangerous calcium deposits in the blood vessels, lungs, eyes, and heart.

Monitoring phosphorus in patients with renal problems

Phosphorus can be found in many foods. Therefore, patients with compromised kidney function should work with a renal dietitian to help manage phosphorus levels.

Tips to help keep phosphorus at safe levels:

• Know what foods are lower in phosphorus.
• Pay close attention to serving size
• Eat smaller portions of foods that are high in protein at meals and for snacks.
• Eat fresh fruits and vegetables.
• Ask your physician about using phosphate binders at meal time.
• Avoid packaged foods that contain added phosphorus. Look for phosphorus, or for words with “PHOS” on ingredient labels.
• Keep dietary diary

Protein

Normally, protein function to building new cells and repair of tissues. Protein is built from small units called amino acid hence making it the only macronutrient known in the planet to have nitrogen as element on earth attached to it. Amino acids are grouped into two hence the grouping affects the quality of protein.

1. Essential amino acids

These are nine amino acids which cannot be produced by body hence must be provided by the foods we it they include; lysin, valine, tryptophan, methionine, phenylamine, leucine, isoleucine, threonine and may be Histidine due to its demand in children.

2. Non- essential Amino acid

These are eleven amino acids which can be produced by the body but equally can be provided by the food we eat, they include; glutamic acid, alanine, aspartic acid, arginine, asparagine, cysteine, glutamine, glycine, proline, serine, and tyrosine.Protein intake for normal person should be in the range of 1.0-1.5g per kg body weight or in the range of 10-15% of the total caloric intake but under renal problem restriction of up to 0.8g per kg body weigh is allowed .

Protein breakdown results into nitrogenous waste which must be released from the body since they are harmful and if left could interfere with all the functions of the body for healthy living. The only route to elimination of the nitrogenous waste is through kidney in form of urea.

Note: Low biological value proteins majorly overburden the liver workability hence should be reduced in the renal patients’ diet has much as possible. The low biological value protein majorly originates from plant sources of protein.

Protein is not a problem for healthy kidneys. Normally, protein is ingested and waste products are created, which in turn are filtered by the nephrons of the kidney. Then, with the help of additional renal proteins, the waste turns into urine. In contrast, damaged kidneys fail to remove protein waste and it accumulates in the blood.

The proper consumption of protein is tricky for Chronic Kidney Disease patients as the amount differs with each stage of disease. Protein is essential for tissue maintenance and other bodily roles, so it is important to eat the recommended amount for the specific stage of disease according to dieticians’ prescription.

Fluids

Human total dry weight is 2/3 water, while foods we take are also more than half made of water making elements. Water is important to our lives. We can live surprisingly long without food, but only a matter of days without water. Water is our most urgent nutritional need because we use it constantly. Water is made up of hydrogen & oxygen (H2O) and is the only macronutrient that doesn’t provide energy.

Typically, human body needs at least 1ml of water to utilize one unit of energy .Since average human being do 1900-2300 kilocalories a day , human body equally require close to 2000ml -2500ml to utilize the calories given allowances in other functions .The biggest controversy is the typical suggestion that a human being should take at least two litres of water or eight glasses of water a day .Science has not link any health benefit to this suggestion and equally justifies the need for fluid summed up from all sources including foods eaten with high and low water contents .Over consumption of water is not just bad in renal problem but also in normal health since it can lead to a condition called water intoxication or over-hydration .

Fluid control is important for patients in the later stages of Chronic Kidney Disease because normal fluid consumption may cause fluid buildup in the body which could become dangerous. People on dialysis often have decreased urine output, so increased fluid in the body can put unnecessary pressure on the person’s heart and lungs.

A patient’s fluid allowance is calculated on an individual basis, depending on urine output and dialysis settings. It is vital to follow nutritionist’s fluid intake guidelines.The basic guideline is output plus 1000 (500mls in edema and fluid retention) which is subject to change based on severity of the condition and analysis by the nutritionist .

To control fluid intake, patients should:

• Not drink more than what your doctor orders
• Count all foods that will melt at room temperature
• Be cognizant of the amount of fluids used in cooking

Above all general caloric intake of every human being is important and must be checked whether it influences restrictions during management or not

References

• Casaer MP, Mesotten D, Schetz MRC. Bench-to-bedside review: metabolism and nutrition. Crit Care. 2008;12(4):222. 2.
• McCarthy MS, Phipps SC. Special nutrition challenges: current approaches to acute kidney injury. Nutr Clin Pract. 2014;29(1):56-62. 3.
• Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010;38(1): 1-15. 4.
• Kidney Disease Improving Global Outcomes. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012;2(1):2. 5.
• Valencia E, Marin A, Hardy G. Nutritional therapy for acute renal failure. Curr Opin Clin Metab Care. 2009;12(3):241-244.
• NephCure kidney international

Michael Ouma Odero

Clinical Nutritionist

micoushkod@gmail.com /middlehealthsolutions@gmail.com

PLANT PROTEIN

PLANT PROTEIN.

Plant protein is one of the most mis-prescribed nutrients of all macro nutrients. Other than the genomics of anti-nutrients which results from genetic mis-configuration of available amino acids, several errors have been made in general diet management in patient care. This follows the burden of controversy which come with facts like plant protein if over-consumed could overload the kidney and compromise the normal functioning of the most important waste disposal factory in human system.

The most common errors which all dietitians and nutritionists must do wide range of clinical researches and trials to come up with conclusive reports other than trial and errors include three widely used statements in managing patients with various diseases and conditions.

The three statements

It is error in science when the following statements are made without following fact charts of plant nutrition. These statements include;
1) legumes are plant sources of protein
2) grains / Cereals are not plant sources or rich in protein.

3)cut carbohydrates as source of energy while doing weight management

(This to me ignores the two practical aspects of protein, that after de-amination, the nitrogenous waste (ammonia) is converted into urea less toxic waste for excretion by kidney while the remaining component is use in the body for energy production or stored in the body in form of fats, Marieb, Elaine Nicpon. Human Anatomy & Physiology. 5th ed. San Francisco: Benjamin/Cummings, 2000.)

Practical aspect of Plant protein prescription

Basics of Clinical Nutrition prescription of a diet is Food Exchange List (FEL).
From Latest FEL 30g dry weight of pulses / legumes provides average of 7 grams of protein while 20g dry weight of cereal/ grains (equivalent to a slice of bread) provides 2g of protein.

The Scientific view of plant protein

Plant proteins is incomplete protein, this is because each plant has a specific limiting essential amino acid.
i.e most cereals and grains are limited in tryptophan , threonine and a few limited in Lysin .
Legumes /pulses are limited in amino acids methionine.
Nuts are limited in amino acid lysin.

Mathematical Configuration of plant protein

Legumes + cereal= Complete protein (under specific ratio 1:4)
Legumes +Nut(seeds)= complete protein (under given ratio)
Nut(seeds)+Cereals = incomplete protein limiting amino acid lysin.

One of the most exaggerated plant, soybeans is also limited in amino acids methionine, threonine and lysin.

From this illustration it is clear that plants do not have complete protein hence a single group of plants cannot be justified to be a plant source of protein, secondly quantity of given protein (incomplete protein) differ from one group of plants to another but that cannot make them good sources of protein unless balancing is done using the specific ratios to create a complete protein from various plant groups and sources.

References

1. Guyton & Hall. Textbook of Medical Physiology 10th ed. New York: W. B. Saunders Company, 2000.
2. Marieb, Elaine Nicpon. Human Anatomy & Physiology. 5th ed. San Francisco: Benjamin/Cummings, 2000.
3. Schrier, Robert W., ed. Renal and Electrolyte Disorders. Boston: Little, Brown, 1992.
4. Smith, Michael B.; March, Jerry (2013), Advanced Organic Chemistry: Reactions, Mechanisms, and Structure (7th ed.), New York: Wiley-Interscience, p. 1547

For more information contact

Michael Ouma Odero

0706070306

middlehealthsolutions@gmail.com /micoushkod@gmail.com

Kenyan Food System and Cancer .

Today at the lip of every Kenyan ,the biggest threat and most feared disease /condition is cancer .

According to World Health Organization report of 2018 June ,Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of all deaths globally.
Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 85% of these “premature” deaths occur in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million).

Cancer must be a worldwide concern for it is rated the second killer disease among NCDs.

In Kenya, cancer ranks third as a cause of deaths after infectious diseases and cardiovascular diseases. It
causes 7% of total national morality every year. Although population based data does not exist in the
country, it is estimated that the annual incidence of cancer is about 28,000 cases and the annual
mortality to be over 22,000. Over 60% of those affected are below the age of 70 years.

In Kenya, the
risk of getting cancer before the age of 75 years is 14% while the risk of dying of cancer is estimated at
12%. In many developing countries the rapid rise in cancers and other non-communicable
diseases has resulted from increased exposure to carcinogenic compounds and several other factors but my interests are on food systems as a possible major cause of mutation of genes .

The leading cancers in women are breast, oesophagus and cervical cancers.

In men, oesophagus and
prostate cancer and Kaposi sarcoma are the most common cancers.

Based on 2002 data from the Nairobi Cancer Registry, of all the cancers registered breast cancer accounted for 23.3%, cervical cancer for
20% and prostate cancer for 9.4%.

In 2006, around 2,354 women were diagnosed with cervical cancer
and 65% of these died of the disease.
Despite the fact that noncommunicable diseases such as cardiovascular diseases, cancers, diabetes and
chronic respiratory diseases are on the increase, the health systems in the country have traditionally
concentrated on the prevention and control of communicable diseases. As a result, health and
development plans have not adequately invested in the prevention and control of these diseases.

The silent epidemic of noncommunicable diseases now imposes a ‘double burden of disease’ to the country
which unless it is addressed will over whelm the country in the near future.

This bias in the system has
resulted in weakness in programmes that should be addressing noncommunicable diseases and their risk factors in the country.
According to the regional cancer registry at KEMRI, about 80% of reported cases of cancer are
diagnosed at advanced stages, when very little can be achieved in terms of curative treatment.

Recent happenings in the country might have displayed one factor which has been downplayed by all stakeholder including managers in health , food systems .

As the statistics may be a clear indicator, in Kenya the numbers might even be higher than this , according to one of the local daily newspapers , in 2018 up to 68 Members of Paliament of 290 had confirmed and declared their silence struggle with the killer disease .( These are people with a lot of resources and able to do health checks at anytime ) .What about the “other” Kenyans ? Another important question is why the rapid increase ?

Food Systems verses Cancer .

During my earlier days of life, having grown up in the village , cancer in Kenya was regarded as the “disease of the rich” .

In mid 1990s,the most feared condition in Kenya was HIV infections which today people may regard as part of their life style .

What might have changed ? Am sorry this will appear a bit discriminative but it is the reality .

In early 1990 to early 2000s nutrition and food anthropology of Kenyan Communities was quite different from what we have today .

There were some foods which were associated with a given class of people, for exams in my community a bottle of soda was not for everybody , only a few could afford it (for clarity purposes do not misquote me ,I have not said a bottle of soda can cause cancer ,I just compared affordability then and today ) .

Reason for this was, purchasing power did not allow any layman (Laykenyan ) to put everything on the table .

The duration between 2002 – 2007 came with very rapid economic growth and somehow ease to purchase .

This exposed all Kenyans’ tables to new foods ,new food production methods ,new cooking methods and even more meals .

Researches have shown that our genetical composition could be number one factor predisposing us to cancer (according to Knudson AG . Jr. Birth Defect Orig Artic Ser . 1989).

As a biology student ,with a simple and little understanding of cell division ,any abnormal cell division must be triggered by mutation or fault in genetical composition .

For mutation to take place an external factors may play a role .In Kenya , we have hard a lot ,at one point our consumable sugar was alleged to contain mercury , it came to fruits and vegetables preservation using calcium carbides according to both Standard Newspaper and Daily Nation , sorry milk is also preserved using formalin according to Daily Nation of 30th November 2017 while on the same paper githeri is cooked using painkillers .

Reports have indicated that traditional convectional medicine for TB might be phased out due to resistance . The bacteria resistance to medicine might have come from genetical mutation of the bacterial genes .

As human ,don’t we think that our genes are able to mutate and result into cancer ?

As a nutritionist , my concern is with equation of supplements flooding our markets ,yes a majority could be simplified food components but when are they required in our system ? Sorry I might be stoned for this question by my fellow Nutritionists .

Another question ,the food we eat does it contain the proposition of chemicals as per the guidelines ? Let me bring you to an easy example, in all Kenyan Urban Centres there are mama chapati and baba mandazi ,we are all aware of rancidity ,the oil used in making our mandazis ,chips ,chapatis and fried fish,how pure is it ? How long does it take the oil to undergo oxidative rancidity when exposed to air ? This does not occur to roadside foods only ,who has ever taken time to just peep through kitchens of our five star hotels ? Let me not talk about kibandas ,which are more in our country than our total population .Can’t this be an exposure to consumption of unwanted chemicals hence genetical mutation ?

I don’t want to talk about nyama choma preparation since our own Ministry of Health has shown inability to control chemicals used in preserving fresh meat in food outlets in the country (Thanks to media exposure #RedmeatAlert ) ,they recently confirmed use of sodium metabisulphites in meat preservation .The same Ministry has been unable to control chemicals used in agriculture hence confirmation of drug resistant E. coli in Paultry sold in Nairobi Markets .

Am a part time farmer who does not take a lot interest in it, when you give me tomatoes from open air production and those done in the greenhouse it will only take my tongue thirty seconds to differentiate the two .

The amount of chemical used in the green house can’t it result to mutation ?

Current vegetables production is not the one which left Nutritionists in the olden days with assignment of telling amount of each nutrient per serving,this is because each farmer currently can determine amount of nutrients for his / her produce while in the field .

Who will save Kenyans from this problems ?

Kenya bureau of Standards?A failed organization cannot be trusted with people’s lives anymore .

Kenya Nutritionists and Dietitians institute ? Organization managed and run by people who value their stomach than lives of people is a failed organization. It has only specialised in producing seminar Nutritionists .

Who is here for us Kenyans ? We are here for ourselves but God is for us all .

Michael Ouma Odero

Clinical Nutrition Officer

0706070306 .

Weight management

Weight management has become the most controversial and an opportunity for con-business in today’s health sector .

Majority of us are also stuck in the old thinking of weight loss as a true definition of weight management .

The saddest state of things is the recent evolution of con-business in the name of rapid weight loss. This is where some herbal chemicals or starvation ingredients iñ the name of “supplements” are sold to help you lose weight .

Chemicals in Weight loss

I don’t dispute workability of the supplements as they call them ,my issues are, what standardisation test have been done to qualify their workability ?What is their sustainability in weight management ? Are there any long term effects of using these chemicals “supplements”?

Currently , kidney complications are just any other thing in our hospitals !!!My guess ,if not right but nearly right ,over use of chemicals in the name of Nutrition supplements is also a contributing factor .I also think ,nutrients bound in their natural form “in food” have little or no side effect .Loading the system with simplified chemicals has side effects .

WEIGHT MANAGEMENT

Whenever I see or hear this topic ,I normally think of three possible things ;

1). Adding weight to attain standards

2) Losing weight to attain standards

3) Maintaining weight to maintain standards .

For this discussion, we will focus on number two ,weight loss .

Weight Loss

Currently , obsession with weight loss is beyond measure .It has lost intended purpose .

My take is before we lose any weight ,we need to examine a million factors .This is to avoid failure and Possible complications associated with it .

These factors may include;

a) Diet and physical activity

b) Family History of weighing big

c) Life style and diet

d) Activity factor , present weight ,weight to be lost , available time,life style , among others .

NB: Any methods which will lead to loss of more than 1-1.5kg in a month is a crude method that can lead to complications.

Based on the factors ,an option among the existing orthodox methods of weight loss should be selected.

There are several ways of doing this.

1) Natural weight loss using diet and exercise .

2) Surgical Methods among others .

We will only look at Natural weight loss using diet and exercise.

Weight loss using Diet and Exercise

1) Output -input ratio in weigh management .

Naturally, weight loss will depend on energy consumed verses energy released .

This law is very clear ,

a) If the caloric quantity consumed is higher than that released,we expect excess to be stored in the system hence weight gain .

b) if the input is equal to output we expect a stagnant or constant weight .

c) When input is less than output ,we expect the system to breakdown existing stores thus leading to weight loss.

Please note , regardless of quantity of weight to be lost , caloric restrictions should not go beyond 2/3 of daily need .

Weight Loss Plan

Workout diet plan with the following factors;

– Caloric restrictions not beyond 2/3 of daily need or range of 20- 25 kcal /kg in 24 hrs.

– Increase total fibre intake between 30-40g daily .

– More than 2/3 of total calories from whole mill products .

– Minimize fruit juices and vegetable soups but do whole fruits and vegetables.

-Minimize frequency of weight measurements ,set weekly goals, monthly and annual targets ,learn from your failure and reward your successes .

– trim most fat and do lean .

– Following diet plan is not easy but start slowly and adapt the change consistently.

PHYSICAL EXERCISE

This is a key determinant of outputs but it will only help up to 30%. If diet plan is not followed expect no results .

There are various levels of physical exercise,all depend on several factors among them physical fitness and body activity rates before starting weight loss program.

The levels and their activity factors are key in calculation of caloric needs.

These levels and their activity factors include ;

Sedetary -1.2

Lightly active -1.375

Moderate- 1.55

Very active -1.725

Extremely active -1.9

Extreme excercise has high impact but we have to start slowly as we increase intensity ,also do what you enjoy to avoid boredom.

Excercise is different from physical activity and in this case we are referring to exercise!!

Excercise affects appetite and therefore one must focus on diet plan and avoid impulse eating .

During excercise ensure your fluids are replaced but avoid cold fluids immediately after workout since it can be fatal.

Did you learn a thing ?

Please let me know at micoushkod@gmail.com and 0706070306

Michael Ouma Odero

Clinical Nutritionist..

” Basic things to do as part of healthy eating “

Healthy eating is an individual responsibility while a healthy diet is a collective responsibility.

Eating pattern is an integral part and factor in healthy life ,though it can at times sound funny !

WHO recommends at least three planned meals a day for any adult at normal states of health and at least five planned meals for any adults whose system is compromised by an infectious agent or any form of agent that alters normal state of health .

At normal state of health, people have failed to factor in eating pattern as one of the basic reference point to living a health life .

A day has 24hrs ,though WHO does not recommend what time to take your meals but it should he a common knowledge that the meals should be distributed in a way that allow proper breakdown , absorption and utilization at full potential just for maximum gain from nutrients in the food.

Other basic things should be when should I take my heaviest meal ?Of course in the morning when a lot of energy is required to concur the long day. The strength of your meals should be reducing until we achieve the lightest meal at least 2-3 hrs before bed time .

Basic meal patterns also dictates that the principle of meal planning is applied while preparing these meals just for maximum body nourishment .

Other simple things to check while doing meals include meal time is meal time and water time is water time , variety , physical activity , and time .

Did we learn any new thing ?

Yes ,please , take your lightest meal of the day at least 2hrs before bed time to enable your body to digest ,absorb and utilize nutrients in the food fully .

Healthy eating is individual responsibility but healthy diet is collective responsibility

NEWEST DELICACY IN KENYA

What a sweet food coming in late!

*This question has been asked more than 100 times since this lady was featured doing insect farming.
What is the nutrition value of cricket and cockroach?

Many people have flooded my inbox with the question of how is it made to be food?*

Let me clarify this please .

1) Most insects are of high nutrition value .This is the opportunity most people from western Kenya saw in termite.Termite like any other insect is perceived to be of good nutrition value.

2) Kenyans ,we must stop pretending to have not taken cricket in our entire lives. Most Kenyans do biscuits and cakes when on transit or when hungry. This is not any justification that companies use cricket flour to bake but again who know what goes on in private company kitchens ?

Kenya currently exports cricket flour to developed countries for value addition ,therefore is important to believe that the value addition is doable local ,may be it is done ,just correct my reasoning of we disagree on this .

Nutrition facts that must and should not be forgotten!

Nutrition Anthropology

Societal growth has seen an increase in population to that level that the previously preferred foods would not be at a position to “cure” the rapidly spreading food and Nutrition insecurity.It there fore means human beings must venture into other items culturally not accepted but nutritionally of high value and specifically nutrients dense.This will take care of increased poverty and hunger . We must also appreciate that Kenya is a rich country in terms of culture and there is serious variation in terms of what foods are eaten from one ethnic group to another .

This good gold of culture should mislead us to a level of avoiding technological and climatic changes posed by huge growth in population.

Remember the same size of land owned by less than 600000 Kenyans in the 19th Century is the same size to be owned by more than 80 million Kenyans by the year 2050.

Industrial view of nutrition

Food fortification and nutrient supplementation are two interventions that have been done for more than a century. For instance, in the community where I come from, porridge made from “wimbi” flour would be nutritionally value added through the addition of some fruit juices like “chwa”.

In Kenya ,it is a policy that salts must be fortified with iodine and flour must also be fortified with iron.
I don’t mean insects are used in fortification but just think about the international companies.

Most ,if not all foods manufactured in Kenya are done through multinational companies.

The people who saw the value in crickets long ago have made a lot of products which are healthy and nutritionally proven to good for human consumption.

For instance in Kenya, cricket is processed to flour which has long been used in bakery industries in Europe and U.S.A.

Same products are imported back to our country just like from our raw coffee they make products that are later sold to us in local markets.

This should confirm the fact that more than 90% of Kenyans have at one point taken crickets and other insects of high nutrition value. It is only that we live in denial

Nutrition facts about crickets and most insects.

Crickets are very nutritious, even compared to traditional sources of meat. Crickets boast an excellent nutrient profile, providing a great source of lean protein, vitamins, and minerals. Crickets contain about 65% protein, and other insects can contain up to 80% protein.

Astonishingly, some insects have the same or greater amount of iron than beef.
Though not scientifically proven, there is clear relation shown to exits between protein values of insect; for instance, it is alleged that by taking one cricket, it’s almost more than taking a serving of beef.

According to Keri Gans, proportion of insects’ protein to total calories is the best, for example, that portion that contains 13 grams of protein and 121 calories when compared to equal amount of eggs (about two large eggs) contains the exact amount of protein with slightly more calories (154).

This is the same as equal amount of chicken contains 31 grams of protein and about 200 calories. “It makes sense, because chicken is one of the biggest sources of protein around in the planet .

That is almost the same for all insects and their products. Keri Gans, R.D., author of The Small Change Diet.

Crickets are a good sources complete protein, meaning they contain all of the essential amino acids and that make them appear in the list of the high biological value protein.

They also have omega 3 and 6 fatty acids and are high in calcium and vitamin B12.
As a junior in this field and one with the passion to specialization, have over a long time admired pediatric nutrition and it is a fact that some of the key nutrients looked into when you want wholesome development of children.

“Protein and omega 3 and 6 fatty acids must be the first choices in food value for a healthy growth ”

To cut the long story short,
• ALMOST ALL KENYANS HAVE TAKEN CRICKETS, COCKROACHES AND OTHER INSECTS IN DIFFERENT FORMS.

• CRICKETS, COCKROACHES AND OTHER INSECTS ARE HEALTHY FOODS IF USED WELL.

• KENYA WILL NOT ACHIEVE BIG FOUR AGENDA WITHOUT VENTURING IN NEW FOOD SOURCES AND FOOD GROUPS .

Michael Ouma Odero
Clinical Nutritionist

NUTRITION AND LIBIDO

LIBIDO
Sexual activity, drive or desire to coitus is influenced by several factor .These factors include:

1) Biological factors,

2) Social factors or and work factors),

3) Psychological factors (personality and stress factors)

4) Medical factors,

5) Lifestyle and relationship.

Nutrition gets into this space as a key biological factor.

It means one has to check his or her psychological and social factors and add nutrition in the biological factor to achieve the required outcome.

BIOLOGICAL FACTORS
This purposefully deals with sex hormones and associated neurotransmitters .

Some of these primary hormones include;

a) Testosterone and,

b) Dopamine .

The two are primary regulators of human libido . Nutrition is vital in formation of some of these hormones.How does nutrition come in ?

Good nutrition play vital role in stamina, moods and wellbeing of all human beings .

Generally ,stamina ,mood and just good health is highly needed for healthy sexual performance .

Some foods contain vital co-enzymes and vitamins which increase circulation, stimulation and production of hormones which are required to optimize sexual drive.
Some of these specific food and the nutrients include;

1. BANANA
Potassium; is required in the production of testosterone in male. This hormone is a booster of human libido and dictates time for sex.

Amino acid tryptophan; is one of the essential amino acids, it helps in the production of serotonin hormone, this hormone is key in lifting moods thus improving sex drive.

Magnesium and manganese; for a strong prostrate function in male these two minerals are needed. Magnesium deficit in male due to demand from other body functions do happen as such eating foods rich in the two is very vital .

One of their common source is banana ,spinach ,peanut , cashewnuts, brown rice .

2. WATERMELON
Watermelon has citrulline, this a chemical is used by the body to produce amino-acid arginine. Arginine amino acid is one of the non-essential amino acid found in majority of foods . It can also be produced by the body .

The amino acid is a precursor for nitric acid which helps in blood vessels dilation. Though it is hard to specify what quantity of watermelon ,10 slices of watermelon (4 servings ) can give up to 150mls of citrulline which is required to have a Viagra effect .

This does not mean taking watermelon once will improve your sexuality, this will be like a drop of blood in Lake Victoria.

It must be a practice . These foods must form part of your diet .

It is also dangerous to take one food at the expense of the others in the name of improving your sexuality.Generally doing variety is important.

3. DARK CHOCOLATE

Most chocolates contain L-arginine . We did see in previous discussion that arginine amino acid is a non-essential amino acid found in majority of foods and can also be produced by the body .

The amino acid is a precursor for nitric acid which helps in blood vessels dilation. This increases blood flow to several organs thus improving sexuality.

Chocolate also has a lot of phenyl ethylamine (PEA), this is commonly used in manufacture of sex supplements and Viagra, this chemical normally induce euphoria.

When it is released by brain, one gets desire for sex, and then it functions as neurotransmitters of dopamine, one of the important sex hormone which enhances the feeling of wellbeing, joy and having that pleasure.

4. PUMPKIN SEEDS
Phosphorous, this is a very important mineral in bone life second to calcium. Other than that obvious function, it also plays key role in maintaining body PH, while in sex life it has a function in energy generation and utilization, this plays key role in boosting energy needed during coitus or sexual intercourse.

Zinc –Zinc a micronutrient is very important in men .For a man to produce quality and healthy sperms. It is also required in the motility and count of these sperms; he needs these minerals in large numbers. Zinc also has effect on production of testosterone in males. Zinc also has influence on hormones that increases sex desire in ladies.

Vitamin E and Selenium-They are all antioxidants , this is a good function in protecting arteries and other blood vessels in general .

This helps in blood flow that improves sexual excitement, for example,in male main sex organ is only usable at full erection that implies that it functions only when blood flow is at maximum in the vessels which cover the organ .

Lubrication in ladies –pumpkin seeds also contain a lots of omega 3 fatty acids which can act as antioxidant but a part from that fats are known to be active lubricant thus it help in production of lubricant in adequate quantity that reduces the need for application of manmade lubricants .

It also has calcium, niacin, arginine and potassium all needed for sexual desire.

5. HOT PEPPER CHILLY

It has a chemical called capsaicin, this is what brings the heat in chilies.

The higher the concentration of this chemical, the hotter the pepper.
This chemical when taken in, it normally creates some heat in the system that makes the metabolism go up , that is , having metabolic effect .

When metabolism goes up the cardiovascular system gets jumpstarted to supply the body with more nutrients and oxygen while also eliminating waste from the body .This results into thermogenic effect and also endorphin activation (this increases pleasure induction and pain suppression )hence regulating pleasure and pain thus increasing drive or desire to do it more and increasing lasting time for sex.
Spices and mostly hot spices like hot pepper, ginger can also do the same function by creating burning sensations in females’ genital regions which can cause sexual arousal.
In male, cardiovascular system working in full force due to that hot feeling can lead to vasodilation of the blood vessels , this is important for sexual activity. When the blood vessels are wide and full erection occur in genital region .

6. AVOCADO
This food has gotten publicity for good reasons in a range of area.

Avocado is one source of healthiest fat ever seen on Earth.It also has important nutrients required for general development of sex life;

Vitamin B6 –This is among the B-complex vitamins which have a lot of benefits in dealing with depression, fatigue, heart diseases, stress, brain health, and high cholesterol .They also play key role in increasing testosterone hormone.

Potassium – is required in the production of testosterone in male. This hormone boosts libido and dictates time for sex. Potassium also has control on functioning of thyroid gland which influences most body hormones. This is very important in female sexuality.

Folic acid –this is valued nutrient in the heart health and energy generation

7. GARLIC

This miracle herb has gotten a lot of publicity in regard to blood health, especially when combined with onion. It normalizes blood flow especially towards the sexual organs due to allicin compound found in it .This helps in enhancing erection in men.

8. PEANUT
This is a great source of L-arginine amino acids. Arginine amino acid is a non-essential amino acid found in a majority of foods and can also be produced by the body .The amino acid is a precursor for nitric acid which helps in blood vessels dilation.

9. SALMON FISH
These are such fish like herring or omena and sardine mostly found in the coastal water .These contain omega 3 fatty acid which are key in brain functioning , they also fight depression and improve mood ,memory and brain power .

10. SPINACH
Magnesium and manganese; for a strong prostrate function in male these two minerals are seriously needed. Magnesium deficit in male due to demand from other body functions do happen as such eating foods rich in the two is very vital.
Other foods which produce similar effects for a good sex include Ginger, Eggs, Vanilla ice cream, Beetroot, cheese.
Taking these foods once in a day or twice a week does not guarantee any sexual improvement it requires continuous use of these food, variety and using them a alongside other foods of the same benefits .Caution should be taken not to over use one food at expense of the other .It is also important to take care when planning your meals to ensure they cater for nutrient needs holistic and prevent such like foods which can cause unnecessary weigh gain. Desired weight and muscular strength is needed for good sex.

In conclusion , various foods have effect on general sex life but they must be used alongside management of the factors to achieve maximum results .

Micheal Ouma Odero

Clinical Nutrition Officer

micoushkod@gmail.com

0706070306 .

HOW TO ENSURE VEGETARIAN DIET IS HEALTHY AND BALANCED

A lot of things have been said about the vegans and types of diet they use .

Some statements might be true while others are myths.

The aim of this work it to demystify the ambiguity surrounding the adequacy of the vegans’ diet and deal with general myths about the vegans’ diet .

Generally people speak about balanced diet and think that it is a healthy diet.

Others also think that healthy diet must contain both plants and animal products .

It is important to state that diet can be healthy and balanced without including animal products and equally understand that balanced diet is not a healthy diet but a healthy diet can be a balanced diet .

To achieve a healthy diet with vegans , the most essential bit is to work on the principles of meal planning and come up with appropriate plant products which can take care of all macro-nutrients and micro-nutrients required for the body to function well .

The food within our locality and our preferences should be considered while checking on the variety along side other factors
Objective
• To understand the vegetarian diet
• To understand ambiguities surrounding vegetarian diet
• To determine nutrition adequacy of the diet

1) Understanding vegetarian diet.

This should not be misinterpreted to taking vegetables and fruits or cereals and other plant products only. Vegetarian diet is a complex diet that could contain plant products only or have certain animal products not forming more than 20% of the total diet when compared to non-vegeterian diet .

Primarily, the diet is made of plant and plant products .

Some do plant products only, those are called total vegans (total vegetarians) while other do plants with a little of specific animal products, those are called semi-vegans (partial vegetarians)

2) Understanding ambiguity surrounding the vegetarian diet
• What is a semi vegetarian diet?

Semi vegetarian diet is tha which primarily is made of plants and various plant products but also has a little of animal products and other seafood occasionally. For example there are vegetarians who do not take any kind of animal products except eggs,such are called ovo-vegetarians . Some also do both eggs, milk and milk products they are called Lacto-ovo-vegetarians.

• What is total vegetarian diet?

Total vegetarian diet does not include any animal products or seafood.

It is wholly made of plants and plant materials .It excludes stew made out of animal products or seas food ( seafood do not form part of total vegetarian diet).
• Reason for being a vegetarian.

There are several reasons as to why a person can decide to do plants products only or primarily with a little of animal products. These include;

1. religious factors,

2. intolerance and allergies,

3. metabolic problems,

4. cultural aspects,

5. diseases among others .

• Is it healthy to be a vegetarian?

Vegetarian diet is a special diet driven from basic and local plant products.

It is as healthy as any other diet but with a few consideration mostly on principles of meal planning .

It only take into intervention of a qualified dietitian to come up with a healthy vegetarian diet .

It is important to note that at some point the diet if not well planned can be unhealthy due to such factors as complex protein waste from plant protein, too much fibre offering bulk with less caloric value among other factors .

In other words, everything has to be done in a procedural way to make the diet be as healthy as any other diet.

• Is it advisable to take raw food in vegetarian diet as means of getting maximum nutrients?

In nutrition we say eat hot food hot and cold food cold .This refers to correct temperature when eating the food .

It is important to note that cooking may destroy nutrient due to temperature but safety of the consumer of the food is also paramount as such only foods safe to be taken raw should be taken raw .

If there is food that can be taken raw or cooked, the safety of the person should be among the factors considered before taking it,for example carrots can be done both cooked and raw and still maintain nutrient values .

The most important thing to check is how safe is it considering its hygiene .

• What are the benefits of being a vegetarian?
Any properly planed diet will satisfy all the nutritional needs of a person as required, putting into consideration individuals’ daily requirement or recommended daily allowance and condition of the person .

All and above that, plants have phytosterols which are healthy unlike cholesterol produced by animals which are associated with coronary system problems. Other than phytosterols, plants are also known to have phytochemicals and antioxidants which are stated to be healthy chemical products from plants.
The ratio of polyunsaturated to saturated fatty acids is also high enough; this explains the perceived thought of reduced coronary system problems in vegetarian.
It is also important to note that phytochemicals and antioxidants reduce possibility of arteriosclerosis and other heart diseases.

In vegetarian diet full use of medium chained polyunsaturated fatty acids is attained .

These type of fatty acids are known to reduce the low-density lipoprotein (bad cholesterol ) in the system while increasing the high density lipoproteins hence increasing healthy cholesterol in the system.

• Do vegetarians need supplements?
If properly planned vegetarian diet can provide all the required nutrients .

It is also important to consider the fact that some of the micro-nutrient might not be taken care of if the diet is not well planned .Supplementation should only be a last option in situations when specific nutrients needed in body cannot be provided by the available diet .Emphasis should be made such that the first thing to prioritize is ,the diet to offer required nutrients and if it does not offer , an alternative supplement should be sought to boost what is not available in the diet.
3) Adequacy of a vegetarian diet
As long as a diet is well planned putting in to consideration all the factors considered when planning a diet that is; Adequacy, Balance, Variety, Moderation, Nourishment, all diets whether vegetarian or normal diet can be adequate . it is also important to put into consideration some specific areas in micro-nutrient which might be very hard to provide in a vegetarian diet unless specific plant foods are used.
Example of such nutrients which must be planned for include Vitamin B12 , the vitamin is found in abundance in most animal products but only a few plants have a little of the vitamin ;soy products ,fortified cereals , fortified amold milk ,nutritional yeasts (best source) vegan protein powder will provide a little B12 .
Another such micro-nutrient is iron whose major sources are animal products but can be found in other plants such as Legumes: lentils, soybeans, lima beans, Grains: fortified cereals, brown rice, oatmeal, Nuts and seeds; pumpkin, squash, sunflower, cashews, unhulled sesame, Vegetables; tomato sauce.
Calcium is another culprit in vegetarian diet as such when planning the diet variety should include Kale, Carrots, and Sweet potato among others. It is important to note that exercise strengthens bone , as such may lower total calcium requirement .This means active vegans may have a little calcium requirement as opposed to inactive vegans .
Vitamin D can also be a matter of concern in vegan’s diet but it is unrealistic for one to suffer vitamin D deficiency in tropical regions .This is due to abundance of sunlight that one only needs exposure for fifteen minutes to cater for the next forty-five days. It is also unrealistic for one to meet their need with the use of sunlight but still dietitians can identify sources such as fortified cereals and soy products such as soymilk to provide the need from diet .

NEVER WORRY ABOUT WHAT YOU EAT JUST PLAN YOUR MEALS AND CONSULT DIETITIANS TO FIND IT RIGHT .

Michael Ouma Odero

Clinical Nutrition Officer

micoushkod@gmail.com

0706070306.

The Journey Begins

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Michael Ouma Odero

Clinical Nutritionist