The Importance of Nutrition During Pregnancy for Brain Development

The Lifelong Importance of Nutrition in Pregnancy for Brain Development

Susanne D. Rooij

How drastic is the effect of nutrition during pregnancy on infant brain development? -JR

The importance of a healthy diet for proper functioning of the brain is increasingly being recognized. Week in, week out studies appear recommending a high intake of certain foods in order to achieve optimal brain function and prevent brain diseases. Although it is definitely no punishment for the most of us to increase our chocolate consumption to boost brain function, the most important period during which nutrition affects our brain may already be behind us.

Nutrition affects the brain throughout life, but it is potentially most important during the critical prenatal period, during which the lion’s share of our brain development takes place. During the time we spend in the womb, our brains undergo dramatic changes. The fetal nervous system from which the brain and spinal cord progress is one of the first systems to develop. Its foundations are laid down during the very first days of pregnancy. At the end of pregnancy, the brain has grown exponentially and is capable of learning and forming memories. It is actually not very hard to imagine that to lay a good foundation for the brain it is of utmost importance to receive the best building blocks through proper nutrition of the mother.

A very dramatic illustration of the consequences of not receiving adequate nutrition was shown in a study from the seventies in which Zena Stein and colleagues investigated the effects of prenatal exposure to the Dutch famine on the development of babies. The Dutch ‘Hungerwinter’ was a period of severe famine that struck the Western part of the Netherlands at the end of World War II. There was so little food available that even pregnant women suffered from severe undernutrition. Stein and her colleagues found that babies that had been exposed to the famine during the first trimester of pregnancy had increased rates of birth defects of the central nervous system.

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Common issues that hurt your sleep

This article discusses common issues that hurt people's sleep, and tells you what to do about them.

You might remember a time when you could drift off to sleep in an instant and remain in a state of blissful slumber well past lunchtime the next day. Now your sleep is more likely to be lighter and more fitful, and when you wake up in the morning you don't always feel refreshed.

A lack of good-quality sleep could be a natural consequence of changing sleep-wake patterns after menopause. It's also likely that the issue is physical--and fixable. Many conditions can disrupt your rest, and they can be treated. It's important to address these issues. Lack of sleep does more than make you drowsy. Chronic insomnia has been linked to a variety of health problems, including obesity, high blood pressure, heart disease, diabetes and depression.

Go through this list to see whether you might have one of these sleep-stealing conditions. Also check your medicine cabinet. Some medications, including corticosteroids, beta blockers, cold and flu remedies, and certain antidepressants also can interfere with sleep.

1. Sleep apnea

The conventional image of sleep apnea is of the overweight man who snores, but women of any size can also develop these repeated pauses in breathing while they sleep.

"A woman who has a narrow jaw or a change in muscle tone can get apnea," says Dr. Julia Schlam Edelman, clinical instructor in obstetrics and reproductive biology at Harvard Medical School and author of "Successful Sleep Strategies for Women and Menopause Matters: Your Guide to a Long and Healthy Life." Either of these anatomical issues can block oxygen from reaching your lungs (and subsequently the rest of your body) while you sleep. Snoring might not be your main symptom if you do have sleep apnea, but you will notice that you're especially sleepy during the day.

Solution: See a specialist for a sleep study. You may be able to relieve apnea with a few lifestyle adjustments, such as sleeping on your side or losing weight. Your doctor might also suggest an oral appliance or a CPAP machine that blows air into your airways to keep them open at night.

2. Diet

What you eat can affect your sleep. Spicy foods can contribute to painful heartburn. Big meals leave you uncomfortably full, and over time can contribute to obesity--a well-known risk factor for sleep apnea. Too much caffeine could keep you wide awake, even if you finish your coffee in the morning.

"It takes six hours to clear half of the caffeine from your body. If you have enough caffeine, it's still in your body at 4 in the morning," says Dr. Edelman. And though a glass of wine or two with dinner will make you feel relaxed or even sleepy, it won't help you sleep. "You can fall asleep, but once you're asleep you can't sleep deeply," she says.

Solution: Eat dinner at least a couple of hours before bedtime, and keep the meal light. Avoid spicy, fatty foods, as well as alcohol and caffeine. Also, don't drink too many fluids before bed. Having to constantly get up to go to the bathroom can disrupt your sleep, too.

3. Lack of exercise

Sleep and exercise complement each other. Working out regularly can help you sleep better, and conversely, you're more likely to exercise if you get a good night's rest.

Solution: Exercise every day if you can, ideally in the morning. Doing a high-energy aerobic routine too close to bedtime can have the opposite of the intended effect, making you too energized to sleep. A gentle yoga stretch before bed probably won't hurt, though. It might even help you relax.

4. Pain

Arthritis aches or any other kinds of pain don't make for restful slumber. Conversely, a lack of sleep can increase your pain. Researchers believe that a lack of sleep may activate inflammatory pathways that exacerbate arthritis pain. Poor sleep can also make you more sensitive to the feeling of pain.

Solution: In addition to the pain remedies your doctor recommends, try using a heating pad or taking a warm bath before bed to soothe achy joints or muscles. Lying against a body pillow can put you in a more comfortable position while you sleep.

5. Restless legs syndrome

Women are twice as likely as men to have restless legs syndrome (RLS)--a condition that causes a creepy, crawly feeling and uncontrollable movements in the legs at night. It's often linked to hormonal changes early in life and during pregnancy, but RLS can continue as you get older. RLS isn't just miserably uncomfortable--researchers at Harvard have linked this condition to an increased risk for heart disease and depression in women.

Solution: Try simple interventions first. Exercise every day, take a hot bath before bed, massage your legs, and cut back on things that can make you jittery--like caffeine and tobacco. If these measures don't work, your doctor may recommend one of several medicines that reduce RLS symptoms--including ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro), or gabapentin enacarbil (Horizant).

6. Depression

"Depression is a common compromiser of sleep, and it's much more common in women than in men," Dr. Edelman says. Women who are depressed may sleep more than usual, but their sleep isn't restful. Some of the antidepressants meant to counteract depression, particularly SSRIs, can also interfere with sleep.

Solution: See your primary care doctor, psychologist, psychiatrist, or therapist for help, which may include medications, talk therapy, or both. If your antidepressant seems to be keeping you awake, ask your doctor to switch you to another drug.

7. Stress

It's impossible to sleep when the weight of the day is pressing on you. Finding a sense of calm before bed isn't easy, especially when you can't unplug from the demands of your day.

Solution: Establish wind-down time. Do a quiet, relaxing activity before bed that doesn't involve a screen. Talk to a friend or family member, sew, or read a real book--not one on a backlit tablet device.

"Just allow yourself to have quiet time," Dr. Edelman adds. And don't sleep with your smartphone on your bedside table.

8. Poor sleep habits

Sometimes insomnia stems from long-ingrained behaviors, like staying up too late or engaging in stimulating activities before bed.

Solution: Follow a few basic sleep hygiene strategies. Go to bed and wake up at the same times each day. Keep your bedroom cool, dark, and comfortable. Use your bed for sleep and sex only. If you can't fall asleep within 15 minutes, get up and leave the bedroom. Read or do another quiet activity for 15 to 20 minutes until you get sleepy.

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Natural treatment for ADHD symptoms

Natural treatments to remedy ADHD, such as fixing sleep issues or monitoring screen time, may help reduce symptoms of ADHD.

I call it the September phenomenon. My practice fills with children getting ready for school, college students grabbing their last-minute prescriptions and everyone questioning whether they should refill their ADD/ADHD medicine of choice.

It is always interesting to see the diversity amongst my ADD population. Many young children and adolescents love the feeling of being "hyper-focused" and are able to accomplish massive amounts of work in a short period of time. Others stare at me, looking pale and fatigued, wanting off their medications.

Medications for ADD have come under increased scrutiny, with recent statistics showing that use of these medications has increased by 50 percent in the last six years. Abuse of Ritalin, one of the most commonly used ADHD medications is also rampant on college campuses. Research continues to debate the effectiveness of the medications for improving grades and helping students "study."

I am always trying to help my patients understand the cause and options for treating their ADD/ADHD. While some patients do need medication, we have seen attention and hyperactivity improve with alternative regimens. Spending time educating patients about prevention of inattention and hyperactivity has proven to be effective in our practice.

ADD and ADHD are the result of neurotransmitter and neuroendocrine imbalances. The four main imbalances include high norepineprine and cortisol, dopamine dysfunction, serotonin deficiency, and insulin irregularity. Each of these imbalances are rooted in nutritional deficiencies that with correction, improve symptoms of hyperactivity and inattention. Food allergies and intolerances also contribute to malabsorption of nutrients.

While my practice goal is to identify each patient's unique ADD/ADHD type, there are general patterns that seem to be consistent for the majority of patients.

Correct Irregular Sleep Cycles

Children with inattention, as well as adolescents, need more sleep than their non-ADD counterparts. Most children require at least 10 hours of uninterrupted sleep. I have noticed that many children become wired at night, fighting sleep and bedtimes. Creating a calming sleep routine that is consistent helps children with ADD/ADHD relax. Reading, journaling, guided imagery tapes and yoga are great pre-bed activities. Warm baths with Epsom salts may also help.

Keep Insulin Stable

Teaching children and parents tips to keep blood sugar and insulin levels stable improve inattention and hyperactivity symptoms. Many children leave their homes with a high-sugar breakfast, followed by sugary snacks and unhealthy lunches. Emphasizing the importance of protein and decreasing total sugar consumption daily to under 40 grams is critical for children with ADD/ADHD. Small servings of protein should be eaten at regular intervals. Convenient protein sources include nuts, yogurt, hummus, protein bars and protein smoothies.

Correct Nutritional Deficiencies

Nutrition is often underplayed in ADHD management, but there are nutritional deficiencies that appear in my patients repeatedly. These deficiencies are also important in neurotransmitter balance. The most common nutritional deficiencies we see in practice include low B vitamin levels, low magnesium, and low levels of amino acids. If you or your child may have ADD/ADHD, have your physician or nutritionist evaluate your potential nutritional deficiencies, prior to supplementation.

Morning Exercise

For many children, serotonin imbalance is the cause of ADD. Beginning a quick morning workout before heading to class gives the brain a serotonin boost. Try running up and down the stairs five times or 10 jumping jacks. A brisk morning walk may also help "wake up" your serotonin.

Create an Electronic Budget

Children and adults with ADD/ADHD often find their symptoms worsen with constant stimulation from iPhones, iPads and other electronics. Most children should have an "electronic budget" that limits use of TV, video games, phones and other gadgets to one hour per day. Adults need an electronic budget as well. While jobs may force us all on the computer for long periods of time, having "electronic-free" hours can help build focus and attention. Turn off your electronics by 10 p.m. and keep four hours at least one day per week gadget/electronic-free.

Although many patients will still need ADD/ADHD medications, trying natural alternatives can keep us all less medication dependent and living healthier. Focus on alternatives in beating your ADD/ADHD, naturally.

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Autistic Children at Risk for Feeding Issues and Nutritional Deficits

A study on the nutritional habits of children with Autism shows that Autistic children are much more likely to have a feeding problem which may result in decreased growth.

Healthy eating not only promotes growth and development, but also provides important opportunities for children to socialize during meals. A new, comprehensive analysis of feeding behavior in children with autism spectrum disorders (ASD) indicates that these children are five times more likely to have a feeding problem, including extreme tantrums during meals, severe food selectivity and ritualistic mealtime behaviors.

Researchers at Marcus Autism Center and the Department of Pediatrics at Emory University School of Medicine conducted a comprehensive meta-analysis of all published, peer-reviewed research relating to feeding problems and autism. Examination of dietary nutrients showed significantly lower intake of calcium and protein and a higher number of nutritional deficits overall among children with autism.

The results are reported in the Feb. 1, 2013, online early edition of theJournal of Autism and Developmental Disorders.

"The results of this study have broad implications for children with autism," says William Sharp, PhD, a behavioral pediatric psychologist in the Pediatric Feeding Disorders Program at Marcus Autism Center and assistant professor at Emory University School of Medicine. "It not only highlights the importance of assessing mealtime concerns as part of routine health care screenings, but also suggests the need for greater focus on diet and nutrition in the autism community."

Chronic feeding problems increase a child's risk for poor medical and developmental outcomes, including malnutrition, growth retardation, social deficits and poor academic achievement. Emerging evidence suggests the feeding problems and dietary patterns associated with autism may place this population at risk for long-term medical complications, including poor bone growth, obesity and other diet-related diseases (e.g., cardiovascular disease) in adolescence or adulthood.

While parents of children with autism frequently express concern regarding how few foods make up their child's diet, the systematic review and meta-analysis led by Sharp and colleagues represents the first attempt to combine outcomes from studies providing empirical evidence about levels of feeding problems and nutrient intake in children with autism compared with peers.

"Despite the risk of long-term medical issues, as well as frequent caregiver concern regarding the quality of their child's diet, feeding problems are often overlooked in relation to other areas of clinical and research concern in the autism population," says Sharp.

"Our findings have immediate and important implications for the work of practitioners serving children and families with autism, who in the absence of such information, may struggle to address parents' concerns, or, worse, may fill the void with alternative treatments that may be ill-conceived or even harmful to children and families."

One important example is the highly prevalent adoption of elimination diets as a form of treatment for autism, which, the data appear to suggest, could further exacerbate the nutritional risks for children with autism. With this in mind, Sharp and colleagues used this information to develop autism-specific recommendations to guide future clinical and research activities in this area.

These recommendations included screening for feeding concerns and nutritional deficits/excesses in addition to measurement of gross anthropometric parameters as part of routine medical evaluations for children with ASD. They also suggest healthcare providers review the potential consequences of pursuing an elimination diet with consideration of the child's unique feeding and nutritional presentation.

"This study is the first of its kind to quantify the impact of feeding disorders in the autism population," says Sharp. "We hope that our work helps guide clinical practice, as well as provides a roadmap for future research in this area."

Now that the magnitude of the feeding disorders in the autism population has been defined, Marcus Autism Center is now using these findings to expand the research program for children with autism and feeding disorders seen through its Pediatric Feeding Disorders Program.

Future areas of research include the more detailed analysis of the health burden associated with atypical dietary patterns, such as prevalence of obesity and obesity related disorders, as well as determining the social implications and family stress associated with chronic feeding problems in this population.

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