Nutrition and Health

A survey of 2165 Londoners in the 1960's found that only 5% of people were without complaints. This compares with a previous London survey of Pearse and Crocker in 1943 where 12% were free of complaints. At Cambridge final plans are being laid for a further national random household survey of health attitudes and behaviour.

Breast milk, like the milk of all mammals, is matched to the requirements of the growing young. The fat content is lower than that of cow's milk and varies greatly throughout suckling, providing from 30 to 55% of the baby's energy requirements. The unsaturated fatty acid percentage is twice that of cow's milk, while the lipase level of the milk provides for the digestion of the fat before the infant gut lipase develops. The lactose level is much higher than in cow's milk, meeting the human need for more galactose. The protein structure is matched to the digestive requirements of the human infant gut particularly in the way curd formation takes place. Lactoferrin and lysozyme in the protein fraction control gut flora development, suppressing pathogens, being assisted by the immunoglobulins which provide anti-infective action until the infant immune system develops. Thus breast feeding provides protection against infection and a fully balanced diet.

Development of the child during the fetal and infantile stages is affected by mutual responses following birth. The nurture of the intelligence and the facilitation of the stages of growth are involved. Just as imprinting takes place with chicks so the human infant instinctively bonds to its mother by eye to eye and skin to skin contact in the 45 minutes following birth - if and when it is allowed to do so. The consequences of frustrating these instinctive processes are discussed.

Over the past two decades Britain, like many other countries, has developed a system of special care units for sick and preterm babies. These, together with the intensive care units which some of them incorporate, now admit between 15 and 20% of all newborn babies.

Admission to these units and the employment there of a growing range of invasive treatments has led to a profound change in the neonatal environment for these babies and their parents. Some of these changes have provoked anxiety about their possible consequences for the development of these children. This, article describes some of the aspects of the environment of the preterm baby that have given rise to concern and some of the ways in which we may reduce the potential risks.

“Inhibition of action” is a concept introduced by Laborit and could account for the genesis of what one commonly calls the diseases of civilisation. It corresponds to the only possible behaviour when one cannot face an adverse experience either by struggling or by fleeing. After a medically controlled birth, the newborn baby is usually in a highly pathogenic situation. The effect of this situation is especially powerful at an age when the hypothalamo limbic system is still establishing its set point level. Close contact between mother and baby after a physiological delivery is an important element of the prevention of most of the diseases of civilisation, which are the first disregulations of the hypothalamo limbic system. They are so common nowadays that we have to face a real collective and cultural disorder

The endocrine system is sensitive to nutritional status. The hypothalamus reacts to poor nutrition by reduced secretion of hormones which normally stimulate the release of pituitary hormones essential for fertility of male and female, for embryonic development and by secretion of hormones which inhibit the release of other hormones controlling growth and lactation. The secretion of hormones by the pituitary, ovaries and liver is also directly inhibited by different degrees of nutritional inadequacy on varying timescales. The hypothalamic-pituitary system is inhibited by caloric restriction, and by deficiencies of vitamins such as pyridoxine and folic acid, and by deficiencies of minerals such as zinc and magnesium. Extensive epidemiological data from Europe in times of food shortage show that maternal malnutrition around the time of conception is much more damaging to the outcome of pregnancy than maternal malnutrition during the last two trimesters. The embryo during the first eight weeks of gestation, before the development of the placenta and fetal biosynthetic capacity, is dependent on a supply of essential nutrients in the right concentration and on a balanced supply of hormones and biochemical precursors from maternal blood.

Present typical body burdens of the cumulative neurotoxic pollutant lead are now believed to be some 100–1000 times greater than those in pre-technology man. The effects of these seriously elevated levels on brain development and function in children are reviewed. All such effects so far discovered are adverse, and in conjunction with social factors and defective nutrition they can act to prevent a child's mental development reaching his or her true genetic potential. Most aspects of mentation, except possibly mathematical ability, appear to suffer dose-related disturbance at levels now typical for urban children, but impaired intelligence and deficits in the normal inhibitory control of behaviour appear to be prominent. Lead intoxication is therefore a phenomenon relevant to such important problems as educational underachievement and anti-social conduct disorders of the hyperactivity type characterised by a deficiency of inhibitory function in the central nervous system.

Individual allergic sensitivities, and allergic sensitivities between family members are described in ten allergic families. Allergic sensitivities were diagnosed by clinical histories, food and water sensitivity analyses, and skin prick tests. Intra-family allergic sensitivity occurs as a consequence of introduction of human allergens between family members. Such sensitisation follows transfer of food antigens across the placental and mammary barrier, occurs during and following intercourse, and can be produced as a result of repeated skin contact within a family. Hand-holding provides a simple clinical challenge test which reproduces the allergic symptoms characteristic of intra-family sensitivity and those which occur during intercourse. Auto-Immune Buccal Urine Therapy desensitises family members to intra-family allergic challenge equally effectively whether the challenge is produced through breast-feeding, intercourse or skin challenge. The clinical and social consequences of intra-family allergic challenge are discussed.

Maternal food intakes were assessed for one week in each trimester of pregnancy in 100 mothers from two socio-economically contrasting areas of London. There were significant differences in energy, fat and protein intakes as well as in many of the micro nutrients. There was also a significant difference in the mean birthweights with 11.8 per cent of the birthweights below 2500g and 50 per cent at or below 3000g in the lower socioeconomic group.

In comparison with older children and adults, infants under 2-3 months of age are physiologically less well adapted to digest, absorb and metabolise certain nutrients. This may lead to clinical problems, which are most important in infants born before term. These problems are aggravated by the requirements for very rapid growth in the young infant. Particular difficulties may occur in the digestion and absorption of dietary energy, mainly due to problems of fat absorption, in Vitamin D and calcium nutrition, in the handling of protein and sodium, and occasionally in trace element nutrition. Human breast milk, though usually ideal for full-term babies, may be inadequate for some premature infants for reasons which are discussed. The nutritional problems of preterm infants are potentially very important because of the vulnerability of the immature organism to nutrient deficiency. Full term infants may also suffer from inadequate maternal milk production, the misguided use of cult diets or from ignorance about the correct composition and use of cow's milk formulas.

Selected Canadian experiences directed to the improvement of maternal health and better birth outcome through nutritional enhancement are outlined. These experiences range from a pioneering food supplementation program in a clinical setting first reported from Toronto in 1942 to a combined pregnancy and pre-conception program about to begin in Calgary. The long-standing Canadian program for legislated food enrichment, the strategy of physician education by means of the adoption of an official position paper by organized medicine, and a trial use of television media supported by the issuance of a free attractive publication, are all described.

Intensive educational programs using computerized nutritional analysis in Vancouver designed to complement clinical care, outreach programs in urban and rural settings, using non-professional staff selected from immigrant groups and low income sectors of society, are described as useful and effective strategies and a new program planned for Calgary, Canada, is outlined embodying all the foregoing strategies.

If a new mother is to be able to nurture her child, she herself needs to be nurtured. She is not just a baby-producing apparatus, but a person with emotional and social needs of her own. A facilitating environment for becoming a mother is one in which pregnancy and birth are recognised as personal and intimate experiences. The woman should be enabled to act as an adult, taking on responsibility for a new life, not a passive patient undergoing a medico-surgical crisis. Western society fails to provide such an environment and nursing routines function to impose a ceremonial order on the individual and have the effect of reducing her to the status of a child and also of de-sexing her. The new mother needs to be able to take on responsibility and make decisions. Care in childbirth needs to be changed radically if women are to be equipped for the major challenges that follow after.