Sunday, February 15, 2015

Healthy eating tips


We were all brought up to finish the food on our plates, but sometimes it’s more than we really need. These days larger portion sizes are also more readily available, which does mean that it’s very easy to eat too much.
Try our simple tips to get you and your family into great healthy eating habits.

Some special tips to help keep the kids’ portions under control

Lots of the tips above will help the whole family, but try these special ideas to help you make sure you’re giving your kids the right amount of food and help them understand why you’re doing it.

Me-size bowls

Plates and bowls are bigger these days - a child-size portion may not look like enough. So try getting child-sized ones for the kids; it’ll make it easier to tell if they’re getting the right amount.

Snack time

Set a regular healthy snack time for mid-morning and afternoon when the kids are home. It helps train their bodies to think regular food is coming, making them less likely to overeat at meal times.
 

Get the kids involved

Let the kids watch you serve the meals. This way they’re more likely to understand the different portion sizes for different ages.

Start small

Give them less to start with - they can always ask for seconds. You’ll have less waste and they won’t eat too much.

Just a mouthful

If you’re worried about picky eaters not getting a balanced diet, encourage them to try a mouthful of everything on the plate, rather than all of it. You might find they try more things that way.

Clear plate conundrums

Don’t worry if they don’t clear their plate. If they say they’re full, the chances are, they are full!

Water regularly

If the kids say they’re hungry while you’re cooking, try giving them a glass of water or juice to fill the gap rather than a snack that could ruin their appetite.

Tips for getting five portions of fruit and veg each day


Fruit and veg are a source of vitamins, minerals and fibre which may help reduce the risk of diseases like heart disease and some cancers. We all know that it’s important for us to eat a variety of at least five portions of fruit and veg each day, but how many of us actually manage it?
Luckily, it can be easier than you think to get your 5 A DAY. The great thing is that you don’t need to make a big change to your diet or do without the foods you love.

It doesn’t have to be expensive!

It doesn’t have to be expensive. You can keep the costs down by buying canned fruit and veg, which doesn’t go off as quickly. Choose canned fruit in its own juice – it’s healthier than fruit in sugary syrup. Or try canned veg in water with no added salt or sugar.

Frozen is even handier, as you can use what you need and put it back in the freezer! And buying fresh fruit and veg when it’s in season is usually cheaper too. Local markets can be great places to pick up fresh and tasty produce at really good prices.
Just add a portion of veg here, sprinkle a portion of fruit there – and you’ll hit your 5 A DAY before you know it!

Where does the fat we eat go?


Ever wondered where the fat in foods goes? Here's more about what it does in our bodies....

1. Brain

When arteries get clogged up this can stop blood getting to the right parts of our brain and can cause strokes.

2. Heart

Arteries carry blood around our bodies. Over time, too much saturated fat can clog up our arteries and restrict the blood supply to our heart which can cause chest pain (angina) and if completely blocked heart attacks.

3. Pancreas

Eating too much fat can make us put on weight. Being overweight or obese can stop our pancreas from producing enough insulin and cause type 2 diabetes.

4. Bowel

Being overweight increases our risk of getting bowel cancer - but a diet high in fibre and low in saturated fat keeps our bowel healthy and reduces the risk.

5. Body

If we eat too much fat we store the fat in our bodies which can lead us to put on weight.

My kids love outings to fast food restaurants but I know the food is bad for them. Is there a healthier alternative?

Kids do tend to love visiting fast food restaurants but some food choices can be high in fat, salt and sugar. Some restaurants do have nutritional information on their menus but it can be very difficult to get kids to choose salad over chips! So the best advice is to visit only once in a while.
You can also make your own leaner version of burgers at home, with turkey mince, fresh lettuce and tomatoes - check out our homemade turkey burger recipe.
To add more fun, try turning your kitchen into a fast food restaurant instead of going out. Make some menus, and serve homemade burgers, potato wedges and smoothies. Then just add plastic cutlery and colouring books. Better than the real thing - and cheaper!
 

My wife always gets us fish and chips on Friday nights because she doesn’t like to cook at the weekends. I’m worried that this is going to make us fat. What swaps can we make?

Fish and chips is a great traditional dish – but a portion can contain up to 1,500 calories. On average, women should eat around 2,000 calories each day, and men 2,500. So fish and chips can take up a big chunk of that – and that’s before all your other meals, snacks and drinks have been taken into account that day.
You could try sharing a portion and add some salad, baked beans, bread or mushy peas to fill you up instead. Or try having a kids’ portion, if they do it. Have it every other week or try making your own oven baked version at home instead. And watch the salt - if you want salt, it’s best to add a small amount yourself.
 

Cut back fat

- simple ways to reduce saturated fat

We all know too much fat is bad for us. But we don’t always know where it’s lurking. It seems to be in so many things we like, it can be difficult to know how to cut down.
There are two kinds of fat in the foods we eat – saturated and unsaturated fat. We need a bit of fat in our diets to help our bodies absorb vitamins and stay healthy. But we shouldn’t have too much saturated fat – this type of fat can build up in the body, leading to serious problems like a heart attack or stroke. Eating too much fat can also make us more likely to put on weight, because foods that are high in fat are also high in energy (measured in calories).
Saturated fat is in things like butter, cheese, cakes, biscuits, pastries and fatty meats like streaky bacon and sausages. To help you spot it – this kind of fat tends to be solid at room temperature.
The good news is that you don’t have to stop eating these altogether. You can still enjoy the foods you love, but you can make some healthy changes and food swaps to make sure that you cut back.

Saturated and unsaturated fats

Saturated fat – “bad” fat

Saturated fat is the “bad” type of fat and the one that we really need to watch in our diets. It can build up in our bodies, eventually leading to high blood cholesterol and increasing the chances of developing heart disease.

Unsaturated fat – “good” fat

Having unsaturated fat instead of saturated fat can help lower blood cholesterol. Try to cut down on foods high in saturated fat and replace them with foods that are rich in unsaturated fat.
Read more about saturated fats on NHS Choices
Don’t worry, there are plenty of ways to go easy on the fat. These include: simple food swaps, changing the way we prepare and cook food, and comparing food labels. You can find more tips for cutting down on saturated fats below.

Ideas for reducing saturated fat

Here are some simple ways you can start cutting back on fat right away:

Easy breakfast fat swaps

  • Milk: use 1% fat milk on your cereal. It has about half the saturated fat of semi-skimmed.
  • Sausages: compare nutrition labels on the packs and choose the ones lower in saturated fat. You can spot these by looking for the amounts of fat "per serving" or "per 100g". Remember, servings may vary so read the label carefully. You can also try grilling sausages instead of frying.
  • Bacon: choose back bacon instead of streaky bacon and cook by grilling instead of frying.
  • Eggs: prepare eggs without oil or butter. Poach, boil or dry-fry your eggs.
  • Swap pastries for thin pancakes with fruit, or crumpets with a thin layer of jam.
  • Toast: have sliced banana on whole grain toast instead of white toast and butter.

Ways to reduce the fat at lunchtime

  • Potatoes: make your Sunday lunch roast potatoes healthier by cutting them into larger pieces and using just a little sunflower or olive oil.
  • Cheese can be high in saturated fat – check the label and choose cheese that’s lower in saturated fat. Grating it, rather than slicing it, will make it go further. If you choose a strong-tasting cheese, such as mature cheddar, you can use less of it because the flavour will go further.

Dinnertime fat swaps

  • Spaghetti Bolognese: use a leaner mince. It’s lower in saturated fat. If you aren't using leaner mince, brown the mince first, then drain off the fat before adding other ingredients.
  • Fish pie: use reduced-fat spread and 1% fat milk to make the sauce.
  • Chilli: use leaner mince to reduce the saturated fat content. Or try it vegetarian-style for a change by adding beans, pulses and vegetables instead of mince.
  • Chips: choose thick, straight-cut chips instead of french fries or crinkle-cut. At home, choose oven chips. If you’re making your own chips from scratch, cook them in the oven with a drizzle of sunflower oil, rather than deep-frying.
  • Mashed potato: use reduced-fat spread instead of butter, and 1% fat milk or skimmed milk instead of whole or semi-skimmed milk.
  • Meat: trim the visible fat off meat such as steak.
  • Pasta: try a tomato sauce on your pasta. It’s lower in saturated fat than a creamy, cheesy or meat sauce.
  • Pizza: choose a lower-fat topping, such as ham, vegetables, fish or prawns, instead of pepperoni, salami or extra cheese.

Dressings

Mayonnaise can be really high in saturated fat. It can turn a healthy looking meal like a salad into a less healthy one in just a couple of dollops! Keep an eye on the salad dressings too – try using low fat options, or using less than usual.
  

I’m trying to save money by making a packed lunch each day. What makes a good low-fat lunchbox?

Homemade sandwiches, bagels, pittas and rolls are great lunchtime options because bread is not high in fat – you just have to be careful what you use as a filling. Be sparing with a lower fat spread, put in plenty of salad and then a thinly-sliced low fat meat like chicken. Or you could try drained tinned tuna, mackerel or salmon with a tasty salad. You can mix in some egg mayonnaise, as long as the mayo is low fat. There are loads of great sandwich options, so just experiment! In the winter, how about a flask of homemade vegetable soup?
You can pack a pasta salad - as long as the sauce isn’t a creamy one. And don’t forget to add plenty of fruit, chopped up veg sticks, and some nuts and raisins to snack on too.
 
 
  

Watch the salt

- avoiding salt in the foods that we eat

Many of us enjoy a bit of salt on our food. And you might think you don’t eat much salt, especially if you don’t add it to your food. But don’t be so sure.
What we don’t realise is that salt is hidden in everyday foods that don’t even taste that salty! Things like bread, breakfast cereal, ready meals, sauces, baked beans and pizza. In fact, three quarters of the salt that we eat is found in the foods we buy.
It means that most of us are eating much more salt that than we realise, and that’s before we add any salt while cooking or at the table.
The bad news is that too much salt can raise your blood pressure, which means we are more at risk of getting heart disease or having a stroke.

How much?

To stay healthy, our goal should be to eat no more than 6g of salt a day for adults– that’s around a teaspoonful, which isn’t very much at all. That’s why it’s so important to watch the salt – both how much we add to food and how much is in the foods that we buy.
It’s not just adults that need to watch the salt – if you’ve got kids, you need to keep an eye on it for them as well. If they're under 11, they should be eating less salt than you – that’s even less than one teaspoon.
  • Kids aged one to three: 2g salt a day (0.8g sodium)
  • Kids aged four to six: 3g salt a day (1.2g sodium)
  • Kids aged seven to 10: 5g salt a day (2g sodium)
  • Kids aged 11 and over: 6g salt a day (2.4g sodium)
Try not to give them a taste for salt right from the beginning – have a look at the tips on our sister site, Start4Life, which has advice for parents with babies and children under 2.
Luckily, by keeping an eye on what we eat, we can keep a check on the salt. 

Relationship Between Prenatal Alcohol Use and Fetal/Infant Death


Pregnant woman drinking an alcoholic beverage
Researchers identified an association between prenatal alcohol exposure and fetal death more than 20 years ago. The likelihood of miscarriage increased directly with alcohol consumption. Risk was twice as high in women consuming 1 ounce of absolute alcohol as infrequently as twice a week.35 More recently, fetal mortality was found to be 77 percent higher when alcohol was consumed during pregnancy.36 Prenatal alcohol exposure is also associated with a higher rate of infant death.37
A related research finding was that siblings of children with FAS had increased risk of death due to infectious illness and sudden infant death syndrome (SIDS) compared with controls. A diagnosis of FAS is an important risk marker for mortality in siblings of an individual with FAS even if the siblings do not have FAS. Maternal alcoholism appears to be a useful risk marker for increased mortality risk in diagnosed cases and their siblings.37 In some populations, such as Northern Plains Indians, binge drinking (four or more drinks in about two hours) in the first trimester was associated with an increased risk of SIDS.38

Effects of Alcohol on the Developing Brain, Continued


Effects of Alcohol on Specific Brain Function

Alcohol can affect specific parts of the brain in ways that impair several functions.33,34
Specific parts of the brain impaired by alcohol, such as the frontal lobes, hypothalamus, cerebelum, basal ganglia, hippocampus, and corpus callosum
  • Corpus Callosum. The corpus callosum connects the two hemispheres of the brain, allowing the left and right sides to communicate. Prenatal alcohol exposure can cause abnormalities such as thinning or complete absence. These have been linked to deficits in attention, intellectual function, reading, learning, verbal memory, executive function, and psychosocial functioning. 34
MRI images of brain
Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.
  • Hippocampus. The hippocampus is involved in memory, but its precise function is uncertain. Alcohol can change the fibers and cause cell reduction. Some persons with prenatal alcohol exposure have deficits in spatial memory and other memory functions associated with the hippocampus. The hippocampus also acts as a mood control center. Damage to the hippocampus can affect the ability to respond appropriately to emotions, such as anger. 34
  • Basal Ganglia. The basal ganglia are nerve cell clusters involved in motor abilities and cognitive functions. Heavy prenatal alcohol exposure can reduce basal ganglia volume. This can affect skills related to perception, such as the ability to manage time or inhibit inappropriate behavior. 34
  • Cerebellum. The cerebellum is involved in both motor and cognitive skills. The cerebellum tends to be smaller in people with an FASD. Damage to the cerebellum can cause learning deficits and problems with motor skills, such as balance and coordination. 34
  • Frontal Lobes. The frontal lobes control executive functions, such as planning and problem solving. They also control impulses and judgment. Frontal lobes can be smaller in individuals prenatally exposed to alcohol. Persons with an FASD may have poor impulse control and self-monitoring. They might engage in risky or illegal activity to fit in with peers. 34-36

Effects of Alcohol on the Developing Brain

Competency 1: Introduction to FASD

Effects of Alcohol on the Developing Brain

Alcohol can damage the developing brain when it crosses the placenta. Since the brain develops throughout pregnancy, alcohol exposure at any time can cause brain damage. Prenatal exposure to alcohol can change the brain structurally in ways that can be viewed and measured, including:
  • Small head (microcephaly), usually below the 10th percentile.
  • Damage to, or absence of the corpus callosum, an area of the brain that contains nerve fibers that bridge the two hemispheres of the brain. MRIs have shown completely missing areas of the brain in some individuals with an FASD.31,32
  • Abnormal cysts or cavities in the brain.
  • Neurologic problems, such as seizures, tremors, and poor fine motor skills.
  • Patterns of dysfunction on psychometric tests.
Prenatal exposure to alcohol also can change the function of different parts of the brain, leading to deficits in executive functioning, memory, word retrieval, concrete thinking, cognitive flexibility, sensory integration difficulties, and sleep disturbances. The damage can lead to developmental delays, learning disabilities, and behavior problems, such as:
  • Mental retardation
  • Problems with attention
  • Hyperactivity
  • Poor impulse control
  • Problems in social perception
  • Speech and language delays or deficits
    • Poor capacity for abstract thinking
    • Specific deficits in math skills
    • Poor judgment
    • Problems with cause and effect
    • Problems anticipating consequences
    • Problems changing behavior or response in different situations

Effects of Alcohol on Developing Embryo

Competency 1: Introduction to FASD

Effects of Alcohol on the Developing Embryo and Fetus


Alcohol is a teratogen, a substance that can harm a fetus. Research has established that maternal alcohol consumption is the leading preventable cause of birth defects and childhood disability in the United States.
When a pregnant woman drinks, alcohol easily crosses the placenta and enters the bloodstream of the fetus through the umbilical cord. When this happens, the blood alcohol level of the fetus can be higher than the mother’s level. The fetal blood alcohol level remains high longer because the fetus cannot break down alcohol the way an adult can. 24
Researchers do not know the amount or timing of alcohol consumption that damages the fetus. There is no known threshold amount. As few as one standard drink per week has been shown to be adversely related to child behavior at age 6 and 7. 25 Higher levels of alcohol consumption increase the risk of fetal damage. Binge drinking, four or more drinks in about two hours, can be especially harmful. 26 Maternal metabolism and alcohol's interactions with other drugs also affect the amount of damage the alcohol can cause to the fetus.
The only statement that can be made with complete accuracy is that zero exposure equals zero risk. Therefore no woman should drink at any point during her pregnancy. Women who consumed alcohol before knowing they were pregnant should stop drinking immediately. Doing so can reduce the risk of fetal harm.
Source: Moore, K.L., and Persaud, T.V.N. 1993. The Developing Human: Clinically Oriented Embryology. Philadelphia: W.B. Saunders.
FASD occurs after fertilization and is not caused by sperm. The only cause of FASD is maternal alcohol consumption during pregnancy. By definition the father cannot cause FASD.
However, scientific research has suggested that male alcohol use before conception may affect both conception and the fetus. While some studies show no discernible effects 27, others show that sons of fathers who drank alcohol, prior to conception, have memory deficits, hyperactivity, and other neurologic problems. 28,29 Some research suggests that male alcohol use can affect the motility of sperm. 30 The only way to completely avoid the risk of damaging a fetus is for both parents to be alcohol free prior to conceiving a child and for the mother to abstain from drinking alcohol throughout her pregnancy.
While men cannot cause FASD, they can help prevent FASD by helping the women in their lives remain alcohol free throughout their pregnancies. They can encourage women not to drink during pregnancy. They can also support and respect a woman’s decision not to drink. Men can also be role models for their significant others. By not drinking themselves, they are modeling the safest behavior for pregnant women. Men can help women get alcohol treatment and follow their treatment plans.

Saturday, February 14, 2015

Don’t gamble SEXUAL health •WHY A CHECK UP IS IMPORTANT



Introduction 
Most infections caught through having sex can be treated easily and painlessly. If you are worried that you have put yourself at risk, you should go to your GP or your local Genito Urinary Medicine (GUM) clinic. Not all genital infections are caused by sexual contact, but they may still need treatment.




Embarrassment is probably the most difficult thing they have to treat.Reasons to have a check up
 • it will help put your mind at ease;
 • anyone who has vaginal, anal or oral sex can catch or spread sexually transmitted infections (STIs);  • not everyone will develop symptoms;
 • if not treated early, some STIs can do permanent damage to your health;
 • if not treated early, you risk spreading the infection. Remember most STIs are easy to treat.

If you think you have an infection you should not have sex until you have had a check up. Both you and the person you had sexual contact with should go to your GP as soon as possible.

For women 
What to look for:
• discharge from the vagina or anus;
• pain or stinging when passing urine;
• itchiness, soreness or redness around the vulva or anus;
• swelling of the vulva; • blisters, ulcers or warts around the genital area or mouth;
• sore throat (after oral sex);
• bleeding after sex;
• abdominal pain. Often women have no symptoms - that’s why it’s important to have a check up if you have taken a risk.

For men 
What to look for:
• discharge or pus from the tip of the penis or anus;
• pain or a burning feeling when passing urine;
• itchiness, soreness or redness around the penis or under the foreskin;
• blisters, ulcers or warts around the genital area or mouth;
• sore throat (after oral sex).

Men should try not to pass urine for at least four hours before attending the clinic for a check up. This will help with tests to find out if there is an infection.

What do Sexual Health clinics provide? 
• a clinic where you do not need to be referred by another doctor, but in some cases you may need to make an appointment;
• confidential testing and treatment for sexually transmitted infections, including HIV;
• medical, nursing and social support for people with HIV infection;
• vaccination for Hepatitis B;
• confidential advice and counselling on sexual health issues;
• information on contraception;
• safe keeping of your records within the department.


 What happens at the clinic? 
 The doctor will ask you about any particular problems and then may:
• examine your genital area;
• take swabs to check for infection;
• ask you for a sample of urine;
• take a blood test (to check for Syphilis, HIV or Hepatitis B/C);

NB. Unless you tell the doctor otherwise, the blood sample taken from you will be tested for HIV. Treatment Most STIs are easy to treat. Treatment for each infection is different. It may include lotions, tablets or injections. It is important that the course of treatment is completed. You should follow any advice given by the doctor about not having sex during treatment.

Prevention
The spread of most sexually transmitted infections can be reduced by:
• using a condom every time you have sex;
• limiting your number of sexual partners;
• having regular check ups.Some common STIs Chlamydia Chlamydia is one of the most common STIs. Symptoms include a discharge from the vagina or penis or stinging when passing urine. Often there are no symptoms - that is why it is good to have a check up if you have taken a risk. If left untreated it could lead to infertility. 

Non Specific Urethritis (NSU) NSU is an inflammation of a man’s urethra (the tube for passing urine). It can be caused by a number of germs. One of the most common is chlamydia.

Symptoms may include a discharge from the tip of the penis or a burning feeling when passing urine. Gonorrhoea Gonorrhoea may cause a discharge from the vagina, penis or rectum, pain when passing urine or a sore throat. There may be no signs, especially when infection is in the throat or rectum.

 Genital Warts 
Genital warts are caused by a virus and are passed by skin to skin contact. They may appear as little lumps or spots on the skin or may cause an itch. Not all lumps or spots on the genitals are warts. However, if you are concerned, it’s important to have a check up.

Warts may appear anytime from two weeks to a year after contact with the virus. There is a link between genital warts and cervical cancer. Women who have had warts should have a regular cervical smear.

This test can help to find cell changes of the cervix usually years before cancer develops. These cell changes can be cured.

Genital Herpes 
Herpes is caused by a virus. There are two types of virus - the first causes sores around the mouth and nose (cold sores) and the second causes sores in the genital area. Both are passed on by oral, vaginal or anal sex with someone who has sores at the time.

There is a very small risk of passing the virus on when there are no sores present.HIV Human Immunodeficiency Virus or HIV is found in the blood, semen and vaginal fluids of an infected person. It can be passed on through unprotected penetrative sex, sharing needles to inject drugs and from a mother to her baby before or during birth, or by breastfeeding.

All pregnant women in Northern Ireland for example, are now routinely tested antenatally for HIV. Contact with STIs increases the risk of contracting HIV.

A discharge or broken skin around the genital area make it easier for the virus to pass from an infected person to an uninfected partner.

Syphilis
Syphilis is spread during sex, including oral sex. Although half of those infected show no symptoms, painless but infectious sores may appear. These may clear up on their own but symptoms such as a rash may develop later.
Syphilis can be easily diagnosed and treated with antibiotics. If left untreated it can lead to serious health problems, eg damage to the heart, brain and nervous system.

Thrush
Thrush is a very common minor infection caused by a fungus. It often occurs during pregnancy or after a course of antibiotics. It can also be passed by sexual contact. It can cause a thick, white discharge from the vagina, itchiness or redness around the vulva, penis or anus. It can also cause pain during sex or when passing urine.

 Bacterial Vaginosis (Gardnerella)
Bacterial Vaginosis is a common cause of vaginal discharge, related to an excess growth of bacteria in the vagina. Symptoms include a fishy smelling discharge which may be more noticeable after sex or during a period. Male partners do not get any symptoms. However, if they are also treated it may reduce the risk of the discharge returning to their female partner.


Please find help as soon as possible.

Drinking During Pregnancy: Is it Really Okay?

I am a member of several different listservs for clinicians, researchers and teachers of psychology and mental health topics. A hot button issue spurring a lot of discussion on one of these listservs is the group's reaction to a recent ABC News video segment (and published story on their website). 

This video segment depicted two women in their 30s who are 8 months pregnant with their first child. One woman has made the choice to not drink at all during her pregnancy, while the other drinks a glass of wine 4 or 5 days a week. In theory, I assume the story was supposed to present the pros and cons of drinking alcohol during pregnancy. In reality, the "take home message" of the story was that moderate drinking (of an unspecified amount) during pregnancy is okay.

This is an issue that draws an emotional reaction from many people- from pregnant women and their spouses; to parents in general; parents of children who have been affected by fetal alcohol spectrum disorders (described below); researchers/scientists, and health care professionals; and finally, "people on the street" who see a pregnant woman drinking. Clearly, the reactions may not always be based on the best available medical and scientific information, but rather, get intertwined with other emotionally charged ideas of self-sacrifice, personal freedom, and privacy issues.

Unfortunately, the ABC video segment did not provide the audience with additional research-based medical/scientific information that could help pregnant women make a more well-informed decision. Rather than presenting different viewpoints and data, the reporter interviewed only one "expert" (Dr. Moritz) during this story. This expert may be a wonderful practicing physician, but he made 2 statements that cloud the issue. The first statement was false, while the other was (hopefully) unintentionally misleading because it omitted crucial facts.

Problematic Point #1:

Dr. Moritz acknowledged that The American College of Obstetricians and Gynecologists and the March of Dimes recommend zero alcohol consumption during pregnancy. However, he went on to say that these recommendations are "very, very strict" .... and resulted from the fact that "there are no studies done."
This first point is problematic because we do have studies suggesting that alcohol can damage a growing fetus. It would be more accurate if Dr. Moritz had said that we don't have experiments of the double-blind placebo-controlled variety that would allow us to specify exactly how much (or how little), and when alcohol can be safely be consumed during pregnancy. Obviously, it would have taken a bit of airtime to tease out the meaning of this expanded sentence, but at least it would have been more accurate.

So, what exactly does my new longer sentence mean? A double-blind placebo-controlled experiment is a rigorously designed and tightly controlled type of study that is the gold standard in medical research. "Double-blind" means that neither the pregnant women or the scientists collecting the data would know the level of alcohol that participants received during the study. Being "blind" in this sense is important, particularly when the doctors and women go on to rate their babies and children on scales of emotional. social, and behavioural development. We want to know whether prenatal alcohol exposure causes long term problems (described more below), so we will be examining these kids across time using parent reports, doctor reports, etc. Across time, moms and doctors may unintentionally subtly bias their ratings if they know that the child being discussed was subjected to a little or a lot of alcohol prenatally. Even subtle biases can create problems in studies that can lead to making incorrect conclusions.

"Placebo-controlled" means that among the different groups of women being studied would be one group (again, both experimenters and participants would be "blind" to this fact) who received a placebo, or non-alcoholic version of whatever substance they were using as the "treatment". This is an important component of an experiment that allows a researcher to more precisely determine whether it's truly the alcohol and not something else that's causing the effects on children. If women in the placebo group (who drink no alcohol) have children who are identical to children coming from women who drink several alcoholic beverages per week, then it's awfully hard to conclude that alcohol is causing the problems!

In addition to the double blind placebo control, a "true experiment" would have to be designed as follows: 1) the experimenters would need to find a large group of women who agreed to participate 2) the potential participant pool would need to be as identical as possible before starting the study (women at the same stage of pregnancy, similar body weights, similar history of previous alcohol use, similar diets, etc.), 3) the participants would need to be randomly selected from the pool by a computer program (or another means) to ensure that everyone had an equal chance of being included in the study 3) selected participants would need to be randomly assigned to different study groups that would only differ with regard to the amount of alcohol they were consuming, 4) The method of giving the women alcohol would need to be tightly controlled and not be obviously different across groups (keeping participants and experimenters "blind"). In other words, it would be pretty clear what group you were in if you were guzzling 3 large goblets of wine while the pregnant woman next to you only had a shot glass full. Also, you couldn't simply tell the women to go home and drink one glass of wine 2 days a week. One woman's glass might be 3 ounces, while another woman might consume 7 ounces. All of these rigid study criteria would be designed to eliminate statistical biases that might influence the results of the study.

And that's only the beginning! As I alluded to before, in an ideal study, a participant would be followed across time as her fetus develops and grows (both in the womb and once he or she was out in the world). Because some effects of alcohol exposure are not readily apparent (see my discussion of Fetal Alcohol Spectrum Disorders below), participants' children would need to be followed into adolescence. Even then, the study would need to be repeated with other types of pregnant women (of different weights, backgrounds, etc) to figure out whether and how much other factors impact the influence of prenatal alcohol exposure on the development of the fetus and child.

I hope you can see where I am going with this...not only would this research be time consuming and difficult, but ethics boards (that review studies for potential ethical violations before allowing them to go forward) simply would not allow a researcher to proceed. Subjecting a group of pregnant women to this type of research simply to find out whether their children are harmed won't fly. The researchers proposing the study could not argue that the potential benefits of alcohol outweigh the potential risks. Obviously, alcohol is not designed to treat or cure diseases.

So, the best we can do to is rely on less precise studies that are available. And, the studies we have clearly indicate that alcohol easily passes through the placenta and is a teratogen, or potentially harmful substance. In other words, alcohol can harm cell growth. A single binge at a critical period in the growth of the fetus, and repetitive bouts of drinking can cause problems.
So, I disagree with Dr. Moritz. There have been studies conducted. However, I do agree that the type of studies that would allow us to provide guidelines about the exact amount (and timing) of alcohol consumption have not. So, we can't say that drinking any amount of alcohol during pregnancy "will always" cause problems for the fetus. That is also untrue. We can say, though, that the potential risk of harming a fetus is there. We can also say that whether or not a fetus is damaged by prenatal alcohol exposure depends on several factors, including: how a pregnant woman’s body breaks down alcohol; the mother's weight, and the genetic makeup of the fetus and the mother.

Problematic Point #2:

In the ABC story, Dr. Moritz stated that in his many years of practice as an OB/GYN, he had never seen a case of Fetal Alcohol Syndrome (a collection of symptoms including abnormal facial features, growth deficiency, and central nervous system problems (e.g., impaired learning, memory, attention span, communication, vision, and/or hearing). I assume that he was trying to reassure the public by suggesting that the risk of having a child with FAS if you drink while pregnant is relatively slim. However, I am troubled by what the viewer may have taken from this comment.

Here's the problem with this point: just because Dr. Moritz has not dealt with this medical condition doesn't mean that the risk isn't real or that it doesn't occur. Unfortunately, Dr. Moritz did not go on to explain that FAS is only one end (the severe or most serious end) of the spectrum of disorders that can result from prenatal alcohol use. The whole group of problems, called Fetal Alcohol Spectrum Disorders (FASD) can range from mild to severe and include physical defects as well as cognitive, behavioral, and emotional problems. Some of these problems may not be apparent right away (e.g., infants with some of these disorders don't look any different than other infants at birth). So, even though Dr. Moritz hasn't seen a child with FAS, he might have delivered a baby with one of the other disorders without knowing it.

Labels used to diagnose the range of Fetal Alcohol Spectrum Disorders include FAS; Fetal Alcohol Effects (FAE); Alcohol-related Neurodevelopmental Disorder (ARND); and Alcohol-related Birth Defects (ARBD). The label FAE was commonly used in the past to describe a person with behavioral and cognitive problems who didn't have the physical characteristics to warrant a full-blown FAS diagnosis. This FAE diagnosis was eventually expanded and replaced by the labels ARND and ARBD, again keeping the idea that problems exist, but do not fit all of the criteria for FAS. ARND is used to describe people who have behavioral or cognitive problems, or a combination of both (e.g, learning difficulties, poor school performance and/or poor impulse control) resulting from prenatal alcohol exposure. People with ARBD have problems with the heart, kidneys, or bones; hearing loss; or a combination of these. According to the American Institute of Medicine (IOM), 0.6 to 3 babies born per 1,000 have FAS. The rates of less severe Fetal Alcohol Spectrum Disorders are much higher; ARND occurs in approximately 9 babies per every 1,000 live births.

Again, the research does not suggest that every women who drinks during pregnancy will go on to have a baby with a Fetal Alcohol Spectrum Disorder. Most won't. However, there is no failproof way to predict whether a person is one of the mothers who will drink while pregnant and have a child with FAS, ARND, or ARBD. The only failproof way to prevent this event is to avoid drinking during pregnancy. That's the reasoning behind the American College of Obstetricians and Gynecologists and the March of Dimes' recommendations and also the reason why this information should have been included in the ABC story.

If you would like more information on this issue, here are some resources:

Amerian College of Obstetricians and Gynecologists news release:
Publication from National Institute on Alcohol Abuse and Alcoholism:http://pubs.niaaa.nih.gov/publications/DrinkingPregnancy_HTML/pregnancy.htm
Ebrahim SH, Diekman ST, Decoufle P, Tully M, Floyd RL. Pregnancy-related alcohol use among women in the United States, 1988-95. Prenatal and Neonatal Medicine 1999; 4:39-46.
Kodituwakku PW. Patterns of cognitive-motor development in children with fetal alcohol syndrome from a community in South Africa. Alcoholism: Clinical and Experimental Research. In press.
May PA, Brooke L, Gossage JP, Croxford J, Adnams C, Robinson L, Viljoen D. Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province. American Journal of Public Health 2000; 90(12):1905-1912.

Morse BA, Hutchins E. Reducing complications from alcohol use during pregnancy through screening. Journal of the American Medical Women's Association 2000 Summer; 55(4):225 227.
National Institute on Alcohol Abuse and Alcoholism and Office of Research on Minority Health. Identification of At-Risk Drinking and Intervention with Women of Childbearing Age. A Guide for Primary-Care Providers. NIH Publication No. 99-4368; 1999.

National Institute on Alcohol Abuse and Alcoholism and Office of Research on Minority Health. Identification and Care of Fetal Alcohol-Exposed Children. NIH Publication No. 99-4369; 1999.
National Institute on Alcohol Abuse and Alcoholism and Office of Research on Minority Health. Personal Steps to a Healthy Choice: A Woman's Guide. NIH Publication No. 00-4370; 1999.

I am very interested in hearing your opinions and reactions to this story. Does knowing all of this information help you make a decision? If you are currently pregnant, share your ideas about why you choose to drink or not drink. I would also be interested to hear what doctors are currently telling pregnant women about this issue.
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