angie jefferson rd consultant dietitian...fermented by gut bacteria helpful for cholesterol &...
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Angie Jefferson RD Consultant Dietitian
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Constipation & Haemorrhoids are two of the most common problems experienced by pregnant
women Incidence increases dramatically 40% women reported to become constipated
>320,000 women every year & 25-35% develop haemorrhoids
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Women Constipation & haemorrhoids both incredibly uncomfortable & affect quality of life
Health Care Professionals should care: Patient wellbeing Straining can damage pelvic floor musculature
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Dietary fibre is the edible parts of plants or analogous carbohydrates that are resistant to digestion and absorption in the human small intestine, with complete or partial fermentation in the large intestine. Dietary fibre includes polysaccharides, oligosaccharides, lignin, and associated plant substances. Dietary fibres promote beneficial physiologic effects including laxation, and/or blood cholesterol attenuation, and/or blood glucose attenuation.
(ref. American Association Cereal Chemists)
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Soluble fibres dissolve in water to form a gel Fermented by gut bacteria Helpful for cholesterol & blood sugar control Found in legumes, oats, some fruits & vegetables
Insoluble Fibres – bulk forming Absorb water and swell to form soft mass Increase faecal mass & soften stools Speed transit of food and waste materials Ease defeacation Found in cereals e.g. wheat bran, nuts & seeds, some fruits & vegetables, esp. skins
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The time taken for food to travel from the mouth through the digestive tract & out the other end! Ideal < 48 hours UK average 70+ hours
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Difficult to define as means different things to different people
Bowel habits vary a lot People have different ideas about what's normal. A change from your regular pattern of bowel movements is often the best way of telling if you're constipated Mild constipation due to low fibre intake is common Are you finding it more difficult or
uncomfortable to pass stools?
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Usually use Rome III criteria Must include two or more of the following:* • Straining during at least 25% of defecations • Lumpy or hard stools in at least 25% of defecations • Sensation of incomplete evacuation for at least 25% of defecations • Sensation of anorectal obstruction/blockage for at least 25% of defecations • Manual manoeuvres to facilitate at least 25% of defecations (e.g., digital • evacuation, support of the pelvic floor) • Fewer than three defecations per week • Loose stools are rarely present without the use of laxatives • Insufficient criteria for irritable bowel syndrome
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
World Gastroenterology Organisation Constipation; A global perspective (2010)
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Constipation & Haemorrhoids
Increased hormone
levels Physical
in-activity
Pressure growing uterus
Iron supplements
Pressure of
growing foetus
Increased straining
Adequate Fibre & Fluid intake vital for good bowel health for ALL
WOMEN!
blood volume
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Satiety – prevent excess weight gain ? risk Pre-eclampsia
Blood glucose control incidence gestational diabetes insulin requirement in Type 1 Diabetes
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1. PREVENT with good advice
2. & TREAT with good advice
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Trimester 1 Trimester 2 Trimester 3 Post-birth
UK 35% 39% 21% 17%
Spain 30% 19% 22% 25%
USA 24% 26% 16% 24%
Derbyshire et al 2006, Bradley et al 2007, Ponce et al 2008
Problem throughout the whole of pregnancy Advise on prevention (wheat bran & fluids) at first contact
Incidence of Constipation by trimester
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NICE GUIDELINES Antenatal care for uncomplicated pregnancies. Clinical Guideline 62 (2016)
1.4.3 Constipation Women who present with constipation in pregnancy should be offered information regarding diet modification, such as bran or wheat fibre supplementation. 1.4.4 Haemorrhoids In the absence of evidence of the effectiveness of treatments for haemorrhoids in pregnancy, women should be offered information concerning diet modification. If clinical symptoms remain troublesome, standard haemorrhoid creams should be considered.
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Wheat bran is one of the most effective fibres for stool bulking
Fibre Increase in grams
Wheat 5.4 g
Fruits and Vegetables 4.7 g
Psyllium 4.0 g Cellulose 3.5 g Oats 3.4 g Corn 3.3 g Legumes 2.2 g Pectin 1.2 g
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• Wheat bran fibre contributes to an increase in faecal bulk
• Wheat bran fibre
contributes to a reduction in intestinal transit time
EU permitted Nutrition & Health claims
* Based on 10g Wheat Bran Daily
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0
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4
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BRAN STICKS CEREAL WHOLEMEAL
PASTA BRAN BISCUITS BRAN FLAKES
WHOLEMEAL PITTA WHOLEMEAL
BREAD
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New recommendation (2015) is for 30g fibre/day
No increase for pregnancy
Average female intake ~ 17g/day Need to increase fibre intake by around 13g/day
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Don’t be fooled by labels Wholegrain does not automatically equate to fibre Look for:
wheat bran source fibre (≥3g/100g) high fibre (≥6g /100g)
Read Nutrition panel
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Choose a cereal rich in wheat bran or high in fibre Switch to high fibre snacks
Recipes: www.allbran.co.uk
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Find on British Nutrition Foundation website RCM accreditation Access free of charge from Kellogg Alliance Partner hub on RCM website
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Reference materials in delegate bags Visit the Kellogg’s stand & Spin the Wheel Info & Resources on RCM Alliance partner – Kellogg webpage Info & Resources on www.kelloggsnutrition.com For recipes see www.allbran.co.uk