ADVANCED DIPLOMA IN PRINCIPLES OF NUTRITION

@ShawPhotoTomCourse Educators: Thomas Woods, William Eames

BY AMANDA BRODERICK BSc ANutR

BSC HONS Sports Biomedicine and Nutrition

BY AMANDA BRODERICK LESSON: 2

Course Educator:

Amanda Broderick Course Educator

B.A. (Hons.)

Semester 1: Nutrition through the LifecyclePractical Lesson 3

@ShawNutritionA amandabroderick@shawacademy.com

Nutrition for Teenagers

Practical Lesson 3 Learning Outcomes:

Menstruation

Premenstrual syndrome

Case study

Menstruation

• Menstrual cycle: time between the 1st

day of period through to next period.• Menstruation or menses- period

• Day 1- first day of period• Day 14- ovaries release an egg

(ovulation)• Day 28- uterus begins to shed if

pregnancy has not occurred

Menstrual Cycle- An Explanation

• Typically follows a 28 day pattern

• During the menstrual cycle, hormones that fluctuate significantly are:

• Follicle-stimulating hormone (FSH)• Luteinizing Hormone (LH)• Oestrogen• Progesterone

Menstrual Cycle

Follicular Phase (proliferative) days 1-14Ovulation (Not a phase) usually day 13-14Luteal Phase (secretory)-Days 15-28

Low body fat % to weight Strenuous and consistent exercise Extreme dieting Menopause Illness Pregnancy Polycystic ovaries High stress Undiagnosed gluten sensitivity, coeliac disease or

malabsorption Undiagnosed autoimmune syndrome/disease

Common Cycle Disturbances

Premenstrual Syndrome

• Premenstrual syndrome (PMS)- occurrence of physiological and/or psychological symptoms during the luteal phase of the menstrual cycle and which are relieved by the onset of menstruation

Common physical symptoms:Bloating, Weight gain, Mastalgia (breast tenderness), Lack of energy, Headache

Common psychological effects:Depression, irritability, anxiety, tension, aggression, feeling overwhelmed

Most women experience at least mild symptoms 5-8% of women experience severe symptoms

which can disrupt normal life Length of symptoms- a few days to 2 weeks Symptoms are worse 6 days before menstruation Symptoms peak 2 days before menses starts Anger and irritability are the most severe

complaints Symptoms usually fade on first day of period but

can linger into the next menstrual cycle Anxiety disorders also occur at a higher rate in

women with PMS

Prevalence of PMS

Diagnosis: daily charting of symptoms over 2 menstrual cycles

Women with PMS should be investigated for depression, dysthymic disorder, anxiety disorders and hypothyroidism

Medication for PMS: Use of progestogens e.g. progesterone Antidepressants e.g. selective serotonin-reuptake

inhibitors (SSRIs)

Prevalence of PMS

Premenstrual Dysphoric Disorder

Calendar method is easiest way to chart cycle

Day 1 is 1st day of bleed Day 14- ovulation Day 14- oestrogen and luteinizing hormone

peak during ovulation Day 20-28- oestrogen peaks a 2nd time with

progesterone….this is when the majority of PMS symptoms peak during the luteal phase

Chart Your Cycle< Jul 2014 >

Sun Mon Tue Wed Thu Fri Sat

1 (15) 2 (16) 3 (17) 4 (18) 5 (19)

6 (20) 7 (21) 8 (22) 9 (23) 10(24) 11(25) 12(26)

13(27) 14(28) 15 (X 1) 16 (2) 17 (3) 18 (4) 19 (5)

20 (6) 21 (7) 22 (8) 23 (9) 24(10) 25(11) 26(12)

27(13) 28 (O) 29(15) 30(16) 31(17)

Adjust diet to help reduce symptoms Oestrogen may also increase the efficiency of

insulin causing hypoglycaemia-sugar/carbohydrate cravings

Most women with PMS feel great during the follicular phase or after the start of menses-oestrogen and progesterone along with luteinizing hormone are at their lowest levels

LUTEAL PHASE- balanced nutrition, sleep, exercise and stress management are most important during this time

Chart Your Cycle

Plentiful fruit and veg Increase complex carbohydrates- Low GI diet- raises

levels of tryptophan (pre-cursor of serotonin and other neurotransmitters)

Plenty of fluids Avoid Caffeine Reduce sugar intake Avoid alcohol Reduce salt

Achieve a healthy weight- BMI positively associated with PMS

Get regular exercise- aerobic exercise preferable Get plenty of sleep CBT

Stop smoking-increases risk of PMS

Healthy Lifestyle To Treat PMS

Calcium carbonate-1,200mg/day…good evidence Vitamin D- 400mg IU/day Vitamin B6-neurotransmitter formation and

influence on mood- up to 100mg/day…no conclusive evidence,

Doses >200mg/day can cause neuropathy

Dietary Treatment of PMS

Vitamin B1 (thiamine)- 1.1-1.9mg/day…2-3 servings of fortified cereals, legumes, nuts and red meat

Vitamin B2 (Riboflavin)- 1.1-2.5mg/day…1-2 servings fortified cereals or 6-7 servings riboflavin rich foods such as cows milk or soy milk, spinach, red meat

Better to obtain Vitamins B1 and B2 through food than supplements

Vitamin E- up to 600IU/day, although limited belief Magnesium- up to 500mg/day…mixed evidence, may

improve mood and decrease water retention Manganese Zinc- lowers risk of PMS Iron-high intake non-haem iron associated with

decreased PMS, >20mg/day may be helpful Potassium- may actually worsen PMS, more studies

needed

Dietary Treatment of PMS

Other Supplements Chasteberry supplement- anti-prolactin effects….may have benefit Evening primrose oil-Ƴ-linolenic acid (GLA), usually taken in the

form of evening primrose oil or starflower oil, can improve symptoms of breast tenderness, probably as a result of its effects on prostaglandin production – 500-1,000mg/day

Chaste tree extract- 30-40 mg/day, few adverse effects St. John’s Wort- no controlled trials evaluating use for PMS, long-

term effects unknown, a small pilot study showed efficacy in PMS St. John’s Wort has known interactions with SRIs and other

medications Natural progesterone- shown to be ineffective in controlled trials Gingko- no controlled trials, potential for drug interactions Kava- no controlled trials, potential for hepatotoxicity Dong Quai- no controlled trials, unsafe in pregnancy, should not be

used by patients on anticoagulants Black cohosh- stimulates oestrogen receptors, used to treat anxiety,

breast pain, no controlled trials

Katie is a 15 year old elite-level gymnast.

She is concerned about her weight as she

recently gained 2kg in weight which will

affect her athletic performance.

She is weighing herself every morning

Skipping breakfast

Ends up snacking on junk food

Starving in the evening and eats huge

portions

What would you advise her??

Case Study

Not concerned overly about health at this point in life

Body shape- many think they are too heavy and exhibit body dissatisfaction

Body image- important contributor to choosing food

Parental control Age Gender Media influences Peer pressure Personal issues during puberty Dieting Food knowledge

Factors Affecting Adolescent Food Choice

Not meeting macronutrients requirements-carbs, fats and protein

Not meeting calcium and iron requirements Snack choices-high in fat, e.g. potato crisps and

chocolate Evening meals- prepared with high fat cooking

techniques Eating late in the day-resulting in lack of energy

and inability to recover after training Skipping breakfast

Assessment of Katie’s diet

Consider: Food preferences- what foods does she

like/dislike? Food constraints- are the meals suitable for her

parents to cook for the family? Can she bring an extra portion to school?

Practicality- the suggested changes must not pose too great a burden in terms of time, effort or complexity – we know she is very busy

Healthy snacks must be included It is important to assess Katie's diet and establish

her needs, problems and usual eating habits

Considerations

Increase: Fruit and veg consumption Include dairy in the diet or other forms of calcium to prevent

osteoporosis- 3 portions Vitamin D - 400-800IU/day Increase iron intake - may need a supplement Adequate calcium Long chain omega - 3 polyunsaturated fatty acids Adequate protein - 2 portions Fat - include oil rich fish 1 to 2 portions per week Increase fluid intake

How Can she Improve Her diet?

Breakfast- 2 slices wholegrain bread with a boiled eggs, low fat natural yoghurt and fruit (approx. 500calories)

Mid-morning snack- handful nuts and an apple (approx. 150 calories)

Lunch-1 cup wholegrain rice, steamed vegetables (2 servings) and salmon (approx. 350 calories)

Mid afternoonChopped vegetables (2 servings) and low fat natural yoghurt (150 calories)

Dinner-Wholegrain rice, grilled chicken and sautéed vegetables (2 servings)Mixed fruit salad (approx. 400 calories)….total 1550 calories

6-8 glasses of water in the day

Fruit-3Vegetables- 6Olive oil- cookingDairy products- 2Carbohydrates-wholegrainOily fish and lean poultry

Use calorie counting websites or apps to help you to become

familiar with working out calories

Meal Plan for Katie

Try attend all of the sessions live and see your knowledge grow

Lesson 4 will cover Optimising Nutrition as we Age

Recordings are uploaded within 24 hours of the completion of each live session

Further reading links are available if you wish to learn more

Next Steps

Further Learning

To expand upon the subjects covered in todays lesson:

• Basic nutrition- Diploma in Nutrition

• Weight loss- Ultimate weight Loss Programme

Advanced Course Resources

• Free Short Videos• Topical Items that Pop Up Frequently• Easy way of communicating that free content is

available without spamming you!!!!

Facebook: www.facebook.com/shawacademyTwitter: @shawacademy, @ShawNutritionA

Before we begin let us gauge your experience level

www.shawacademy.com

amandabroderick@shawacademy.com

Contact us anytime on:

UK: +44 (0) 207 022 6483