Re: [pronut-hiv] Nutrient and energy rich foods - nutrient dense foods (5)

["Harry Kanis" <hwkanis@gmail.com>]

Hello Ann and Stella,

Thanks a lot for calling our practical attention again to this vary
important subject of high nutrient dense foods, especially found in fruits
and vegetables from all over Africa.
Even many of my collegues (medical professionals) at least in my country,
The Netherlands, have far too little practical knowledge about this vital
topic.

This subject has great relevance in the prevention and treatment of both
many serious infections (including HIV/AIDS, TB and Malaria) as well as
chronic diseases (like diabetes, cancer and cardiovascular diseases) These
chronic diseases are usually closely associated with an unhealthy modern
lifestyle of affluence and become also increasingly visible in the capital
cities of Africa.

Too little is often known about the great disease fighting powers of many
warm climate fruits and vegetables, in which especially the sunshine
pigments in the edible skin excel in their ability to fight off disease, so
don't throw them away, but eat them!.
Even in the case of established infection, e.g. with HIV, these top quality
foods can often improve the daily quality of life and prolong independence
and delay disease progression.
Some nutrition experts tell us, that up till now about 25.000 (!) different
phytochemicals,  this means chemicals with disease fighting ability in plant foods, are known and daily more of them are being discovered. See especially for many of the latest nutrition research articles about them: "The Journal
of Food and Agricultural  and Food Chemistry" from the USA.

In order to increase more interest in this important subject of nutrient
dense foods, I have created a so called "Garden of Eden" diet page on my
Dutch website.

See: http://hwkanis.googlepages.com/happen

Africa has a great history as far as this "Garden of Eden" diet is
concerned, which contained many of these very healthy top quality plant
foods in the daily diet of our human ancestors in the very distant past.
They were all living in the cradle of mankind in Africa!
See especially the links in this page and in the literature references for
more detailed information.


Harry Kanis
public health physician
The Netherlands



----- Ann Burgess wrote:
>
> Thank you, Stella, for raising the issue of 'nutrient-rich/dense' foods.
> Is this not a rather 'lazy' ambiguous term? Almost 'nutrition-jargon'? When
> I use the term (and I certainly frequently do) what I really mean is that a
> serving of the food should provide relatively large amounts of the
> nutrient/s needed by a particular person/group.
>
> If the list of nutrients includes water and perhaps dietary fibre, are not
> many foods (including sugar!) rich/dense in one or other nutrient?
> Nutrient-rich' is convenient shorthand but when communicating with those
> outside our profession perhaps I (and perhaps we all) should be more
> precise and use more specific terms such as micronutrient-rich, vitamin
> A-rich, etc.
>
> And while on the topic, should we be more careful with the term
> 'energy-rich'? Should we say 'fat-rich'  or 'sugar-rich' depending on what
> we mean?
>
> What do others think? Am I nit-picking??
>
> Ann Burgess
>
> ----- "Kristof & Stacia Nordin" wrote:
>
>
> Hi Stella, yes sort of -
>
> Nutrient dense means that there are a lot of nutrients in a serving
> (Nutrients are Proteins, Fats, Carbohydrates, Vitamins, Minerals, and
> Water).
>
> Energy dense means that there area lot of energy (calories) in a serving.
>
> Both types of foods are available in Africa, but you would need to look
> into
> your own food sources.  Some general tips for finding foods are:
>
> NUTRIENT Dense:
>
> * Dark colors are often more nutrient dense than light colors, for
> example,
> whole grain flour is more nutrient dense than white coloured highly
> processed flours; and dark leafy greens like the African spinach are more
> nutrient dense than whiter leafy greens like lettuce or cabbage.
>
> * Edible skins are often nutrient dense - foods should be cleaned well
> before eating the skin:  sweet potatoe or irish potatoe skins are
> delicious
> and edible; tomato skins; apple skins; cucumber skins, etc.
>
> * Edible seeds are often nutrient dense - pumpkin, sunflower, sesame, etc.
>
> * Edible nuts are often nutrient dense - there are several types of
> African
> Fruits that have an edible nut inside.
>
> * Foods that are not very processed are often more nutrient dense than
> when
> they are processed.  Processing often removes protein, vitamins, and
> minerals, as well as fiber and medicinal properties.
>
> ENERGY Dense:
>
> * Fat has the highest amount of energy and can be found in:  Nuts;
> Oilseeds;
> some fruits like Avocado, Coconut or Olives;  most Animal products (unless
> the fat has been processed out) like milks and milk products, meats,
> insects, and some fish; various oils, margarines and spreads that are made
> from plant or animal oils/fats.
>
> I hope that helps, it is just a general overview.
>
> Stacia
>
> ~~~~~~~~~~~~~~~~~~~~~~
> Stacia Nordin, RD
> GTZ German / Malawi Basic Education Programme
> MoE Sustainable School Food & Nutrition Programme
> GTZ BEP, Box 31131, Lilongwe, Malawi
> Tel:  + 265-(0)1-755-000 or (0) 1-757-358
> Fax: + 265-(0)1-755-000
> ~~~~~~~~~~~~~~~~~~~~~~
> Personal contacts:
> Crossroads Post Dot Net X-124, Lilongwe, Malawi
> Physical Location:  Chitedze Trading Centre, Lilongwe, Malawi (Africa)
> +265  1-707-213  (home)
> +265  9-333-073  (home cell)
> nordin@eomw.net
> www.NeverEndingFood.org (site being built)
> ~~~~~~~~~~~~~~~~~~~~~~
>
> -----  "Mundi Stella" wrote:
>
> Thank you Stacia and Pamela
>   What do you mean by nutrient and energy rich foods - nutrient dense
> foods?
> Are these types of foods available in Africa?
>
>   Stella
>
> ------Kristof & Stacia Nordin <nordin@eomw.net> wrote:
>   Hi Stella - Jane's nutrient needs are higher because of HIV infection
> and
> even higher because of the life stage she is in, breastfeeding (although I
> assume from your message that she has stopped/or is stopping
> breastfeeding?). There may be other things going on increasing her
> nutrient
> needs even further (including clean safe drinking water). Do you have a
> programme you can link Jane to help her access nutrient and energy rich
> foods? Are there local foods which are free through wild harvests that
> Jane
> may be able to get access to? Do you have a nutritionists there that can
> assist you in assisting Jane? What does the one meal consist of, is she
> buying that one meal or growing it or being given it? Is there a way to
> help
> Jane make more nutrient dense food choices with the resources she is
> currently using now? There are many ideas to explore but you'll need to
> know
> the various programmes and people around you to get assistance.
>
> Good luck, I hope Jane is able to get access to the foods that she needs!
> Stacia
>
>
> ----- "Mundi Stella"wrote:
>
>
> Dear colleagues,
> I wrote to this forum a couple of weeks ago looking for guidance on abrupt
> cessation of breastfeeding. I got some help from Ted. The HIV positive
> young
> women (Jane)came to the clinic two weeks ago with her baby for the follow
> up
> visit. The baby was doing very well, but Jane looked very pale and had
> lost
> some weight. Jane did not have any opportunistic infection and was still
> taking iron/folate tablets. The problem is that Jane gets only one meal a
> day. I am a little bit worried about Jane.
> Have you noticed some weight loss in HIV+ women who are breastfeeding?
> What do you do in such situation? What are the recommendations regarding
> the
> care of HIV positive breatfeeding women?
>
> Thank you
>
> Stella
>
>
> ------------------------------------------------
> Ted Greiner wrote: Sure. This means it is not
> worth the time of the health worker to get into complex prenatal
> counselling
> (as per UN guidelines) unless she can tell that a given mother is well
> off.
> I suspect that's what's happening in most African countries. The problem
> then becomes that health workers do not know enough about how to support
> exclusive breastfeeding and mothers need help in the community--otherwise
> mothers in law in particular oppose it.
>
> The sad thing is that counselling definitely is needed to decide when to
> stop breastfeeding and WHO gives almost no practical advice on how to do
> that. We hope to test an algorithm I've designed for this purpose in a
> couple African countries in the near future.
>
> Cheers,
> Ted
>
> Mundi Stella wrote:
> Thanks Ted, this is very useful.
> I agree partially with the recommendation to counsel HIV positive women so
> that they can choose the most appropriate feeding option for their infant.
> >From my experience, only wealthy HIV positive women can make that choice.
> Most HIV positive women attending the antenatal clinic choose to
> breastfeed
> their infant because they cannot afford breastmilk substitute.
>
> Stella
>
> Ted Greiner wrote:
>
> Dear Stella,
>
> Thank you for this question, which raises important issues.
>
> First, if the family cannot afford milk, I do not think it is appropriate
> to stop breastfeeding before about a year of age. With no milk or other
> animal foods (such as liver and eggs) it is impossible to provide a
> nutritionally acceptable diet that will allow an infant to survive and be
> healthy.
>
> Second, the rate of transmission of HIV during exclusive breastfeeding is
> so low that the most recent published simulation study (Piwoz and Ross)
> suggested that it makes no sense to do replacement feeding in a setting
> where the infant mortality rate is likely to be higher than 25/1000 live
> births. (You do not say what country you are writing from but I do not
> believe that anywhere expect possibly wealthier urban areas of South
> Africa
> has such a low IMR in Africa.) Thus stopping exclusive breastfeeding
> before
> six months is hardly advisable in such a case.
>
> Third, in 1998 the Coutsoudis study showing that exclusive breastfeeding
> resulted in a lower HIV transmission rate (later confirmed by data from
> the
> ZVITAMBO study in Harare and the DITRAME study in Abidjan) resulted in an
> inappropriate assumption that mixed feeding after six months of exclusive
> breastfeeding is as dangerous as it was shown to be by those three studies
> in the first three months of life. While no research has been done on
> this,
> I greatly doubt this is true, if only because the infant gut is completely
> different in a newborn compared to a healthy six month old. Honey or
> nitrate-rich water can kill newborns but not older babies; newborns' guts
> are so immature that they can absorb entire proteins instead of breaking
> them into amino acids as six month olds do; until about 8-9 months of
> life,
> some of the lighter proteins in cow milk appear to cause occult gut
> bleeding
> unless the milk is boiled for some time before being fed to the baby--not
> just pasteurized.
>
> Interestingly, infants who were exclusively breastfed in the first three
> months of life in the ZVITAMBO data transmitted HIV at a lower rate during
> the 6-18 month period than those who were mixed fed during the first three
> months (5.6% versus 9.6%), though I was informed that this was not a
> statistically signficant difference.
>
> In most of Africa, the risk of death from not breastfeeding is likely to
> be quite high. Bahl et al, using combined data from Ghana, India and Peru,
> recently found the death rate to be 10.5% higher in the period 6 weeks to
> 6
> months. This is 2-3 times as high as the rate based on old studies in one
> city each in the Philippines, Brazil and Pakistan used in the Piwoz and
> Ross
> simulation. The proportion likely to get HIV during breastfeeding during
> the
> period 1.5-6 mo varies from about 1.5% to 5%, depending on whether the
> breastfeeding is exclusive. Thus stopping breastfeeding would make sense
> only if the infant mortality for that 1.5-6 mo period was under 5/1000,
> which one sees only in industrialized countries.
>
> Another factor to consider is Jane's health and immune status. If she has
> a high CD4 count (or if you do not know it, if she has not lost much
> weight
> in the past year or so), then her chances of transmitting HIV are less
> than
> if her CD4 count is below say 350 (or if her BMI<19 or her weight loss >5%
> recently), when the risk of transmission goes up.
>
> Regards,
>
> Ted Greiner, PhD
> Senior Nutrition
> Director, Ultra Rice Program
> PATH
> 1800 K St. NW, Suite 800
> Washington DC 20006 USA
> +1 202 822-0033
> Fax +1 202 457-1466
>
> Message: 2
> Date: Mon, 17 Apr 2006 07:00:44 -0700 (PDT)
> From: "Mundi Stella"
> Subject: [pronut-hiv] Help with transition to
> replacement feeding
> To: pronut-hiv@healthnet.org
> Message-ID:
> <20060417140044.54298.qmail@web38410.mail.mud.yahoo.com>
> Content-Type: text/plain; charset="iso-8859-1"
>
> Dear colleagues,
>
> I am a midwife in antenatal service in the
> district hospital and will
> be meeting with a 21 year old young woman (Jane)
> who delivered three
> months ago in the maternity. Jane is HIV positive
> and decided to
> exclusively breastfeed her baby.
> I will be meeting with Jane in two weeks to
> counsel her on abrupt
> cessation of breastfeeding and how to transition
> to replacement feeding.
> Jane lives with her parents and does not have any
> income. Jane's parents
> do not know about her HIV status. They cannot
> afford to buy milk. The
> only replacement feeding is available is "family
> foods". I am very
> challenged by Jane's situation. Jane's parents
> may become very suspicious if Jane stops
> breastfeeding their grand child. Family foods may not be
> well tolerated by Jane's baby.
>
> Any idea or suggestion on how to go about this
> situation will be much
> appreciated
>
> Thanks
>
> Stella
>
>
>
>