Individual Nutrition assessment – an example chart note

What is health care? What is included in an individualized health care appointment?

The answer varies with the type of specialist you are seeing – and what they are allowed to do within their facilities’, or the individual’s insurance plans protocols.

My nutrition counseling experience was in prenatal/early childhood, and residential (nursing home) facilities.

Chart notes would be written for high risk clients when working in either role. Occasionally the nutrition assessment and recommendations note would be sent to the physician directly if very high risk.

As a preventive health focused prenatal/early childhood counselor, or for residential facility chart review (nutrition assessments of all nursing home residents considered high risk nutritionally, occasionally would include an in person visit with the resident to visually observe and ask further questions about their health and diet symptoms.

Patients typically do not see a chart note. They might be given the ‘Problem’ and ‘Assessment’ sections as an action list of recommendations on a simpler handout. The medical chart has a Care Plan section where recommendations for a daily change in care might be added – such as adding a high protein snack in the evening.

I would typically spend a half hour to an hour per client and writing a good note might take an additional 15 minutes. Current insurance standards have been set which limit physicians to 15 minutes per patient appointment – and only scheduling/discussing one symptom per appointment. That would make a differential diagnosis fairly impossible.

  • The entirety of a person’s symptoms – and what makes the problems worse, and what seems to improve things – is what provides clues to the underlying issues that may have led to the increased inflammation and/or decreased function.
  • Health is a balance of not too much inflammatory response -> autoimmune or allergies – or too little -> rampant infection and catching every cold.
  • Health is also a balance of enough nutrients and not too many toxins to cope with, whether from air, water, food, or touch, or from internal production of stress chemicals caused by emotional or physical stress.

Autoimmune issues are particularly challenging because many odd symptoms can occur, and more than one type of autoimmune antibody may be involved – not just one ‘autoimmune disease’ – several. Low vitamin D makes autoimmune issues more likely to occur, and low magnesium can make low vitamin D more likely – even with supplements of vitamin D.

Low magnesium also increases inflammation symptoms, pain, and anxiety, depression or anger and irritability.

A physician might look at my example note (below) and think: ‘but this is not my field‘ — exactly — please refer to the specialist – a registered dietitian or clinically trained nutritionist. Caution, there are many ‘nutrition certification’ programs online which are not equivalent to a college education, internship, and the equivalent of a lawyer’s Board Exam.

The client gave permission to share the write-up for educational purposes or maybe to help someone. Patients know that pain hurts, and that health is better. Too often I hear from physicians something like ~ ‘we don’t know what is causing this, … so the patient will probably die‘ – but it is regarding symptoms that likely involve nutrient deficiency.

Even sick patients need to eat or be fed and their nutrient needs are likely increased, or decreased, due to the illness, for a few specific nutrients affecting or being used in excess by the underlying issue. Telling a patient there is no hope is providing a nocebo – a negative expectation. Saying “I don’t know,” – when that is the true situation – would at least not be setting up a roadblock for the patient to seek further information or a second opinion.

If in reading my example chart note*, as a physician, you think, ‘but this is not my field‘ — exactly — you are correct – but it is the patient’s whole health that matters, not just symptoms that may be temporarily controllable by medications.

SOAPE note

The SOAPE chart note* below, is an extended version compared to what would be likely to be written in a patient chart. SOAPE note: Subjective, what the client said; Objective, what the clinician observed; Assessment; what the clinician believes may be underlying issues; Problem/Plan, recommendations being made by the clinician; Evaluation – an opinion statement about the likelihood of positive change, based on the overall attitude or motivation the client is presenting and social factors that may impact the client positively or negatively.

I included extra information that might be in a report to the client, with the education they might need to understand the reasoning for the recommendation, or how to proceed. Complex strategies can take several weeks of a class like setting possibly with cooking and tasting demonstrations. My web pages and posts try to provide self care guidance so a motivated learner could just try things and see if they help.

I added some additional info links for the version in this post, to pages or posts that provide some next step guidance, Gluten Free diet? what is that? The products on the market are not ideal suppliers of nutrients in my personal and professional opinion and learning how to bake gluten free can be healthier and less expensive for the nutrient value. My websites are my file cabinet of patient handouts, some of it.

While working as a public health nutrition counselor I did occasionally write a very thorough note for someone with a complicated case, and send it to the client’s physician on their or their child’s behalf.

Nutrient deficiencies can lead to death (niacin/pellagra example) – and can turn around dramatically very shortly after the nutrients and any cofactors are provided (nutrients are a team – refeed gradually and in balance).

Sometimes nutrition care is a life or death situation. Continue the nutrient deficiencies and deterioration can be rapid, and death can be the result. Niacin deficiency, pellagra, has a nickname for symptoms – the four D’s: “Pellagra defines systemic disease as resulting from a marked cellular deficiency of niacin. It is characterized by 4 “D’s”: diarrhea, dermatitis, dementia, and death.” (1) If there is severe lower leg rash and edema – suspect a B vitamin deficiency.


Nutrition assessment

Subjective:

  1. CoV like symptoms, mild, ~ early outbreak mid 2020, left a new problem, 2. swollen throat, reflux like pain/not quite reflux though, flair up of CoV symptoms again later when family had it 2021, again not too bad. 
  2. Swollen throat symptoms – has had labs showing autoimmune thyroid condition.
  3. Thyroid symptoms had improved a year or so earlier after stopping use of wheat/gluten and dairy. Recently started using ginger tea for the throat problem and it sooths. Hasn’t used long term, recent addition. 
  4. Reading about eosinophilic esophagitis did not sound like the problem. 
  5. Reading about histamine/MCAS symptoms did sound like it might be a problem. Tomato/salsa particularly, chicken causes congestion. Likes to drink orange juice.

Objective:

  1. Pale complection, may suggest magnesium deficiency/low vitamin D, low level anemia of chronic inflammation possibly.
  2. Throat visibly enlarged in pattern of enlarged thyroid gland 

Assessment: 

  1. CoV, even with mild symptoms, may have increased autoimmune antibodies, or created new types. Pale complection may suggest magnesium deficiency/low vitamin D, low level anemia of chronic inflammation possibly.
  2. Enlarged thyroid gland would be likely to cause difficulty swallowing at times, particularly if a food flair of the underlying autoimmune antibody sensitivity. (The thyroid gland presses inwards also and can narrow the throat significantly – *personal experience from also being an autoimmune thyroid patient, swallowing a large supplement can be very painful, and may feel stuck even.)
    1. Eosinophilic esophagitis might also be adding to swallowing symptoms if early stages, wouldn’t be causing as severe reflux symptoms as a more advanced case which is more likely to be what is described in articles about the problem. Food sensitivities are the most frequent cause and include gluten, dairy, eggs, and other common food sensitivity foods.
  3. Autoimmune thyroiditis can be a gluten molecular mimicry problem – the thyroid hormone chemically is similar to the gluten molecule. 
  4. Autoimmune antibodies to other food chemicals might also flair up an underlying autoimmune overactive eosinophile problem, white blood cells. Ginger contains a chemical similar to albumin and an egg sensitivity might be triggered by a sudden increase in use of ginger – or chicken – or eggs, or any animal product containing albumin. *also learned from personal experience – this can be a significant problem – I developed sensitivity to eggs and gradually realized I needed to exclude all sources of albumin or my symptoms would flair up again (non healing rash, not quite eczema – more wounds, lack of skin regrowth).
    1. An apparent ‘wheat/gluten’ sensitivity might be an albumin sensitivity, see one of my early posts with the information about plant albumin in wheat and ginger: Wheat is rich in albumin – so are ginger and egg whites.
  5. Histamine sensitivity seems a problem worth working on by decreasing trigger foods. Orange juice could be an additive problem food. The total load is part of the problem but even small amounts can set off the allergy cells that increase inflammatory cytokines and pain/inflammation signals – swollen, itchy, sore throat, dry eyes, but it can also effect mood when a more severe problem – extreme anxiety and fear, or out of control, hyper-excitable.

Problem:

  1. Elevated iron and symptoms of anemia of chronic inflammation may be a lingering CoV effect or of autoimmune conditions – it can be common to have several types of autoimmune antibodies also, and there has been cases of LongCovid where autoimmune antibodies were found. The spike lodges in a receptor and antibodies are made against the receptor, instead of against spike.. 
    1. Iron chelators may help mitigate chronic inflammation damage, restore energy level if that is a problem. The quercetin is one, continue regularly, opposite the niacin protocol if following that., or eat more of the good plant sources of a few, EGCG, pomegranate peel, green tea, oregano, olive leaf extract, there are many see the Iron chelator section of this Resources & Iron Chelators list
    2. Epsom salt soaks for a topical source of magnesium, help immune function, energy level, fluid balance. Continue if already using or start 1-3 times a week.
    3. Sunshine or Full spectrum light 20-30 minutes per day and or a moderate dose vitamin D3 ~ 600-1000 IU. 
    4. Avoid glyphosate residue. Consider supplementing with DMG, dimethylglycine, bulk powder, 1/2 spoonful once or twice a day in water or with a little juice and water. (too much juice is not really good for us).
  2. Thyroid problems in the modern world are likely related to excess fluoride and bromide and too little iodine. Cautiously increasing iodine and 200 mcg selenium may be helpful. Higher dose for one month can help the body to dump fluoride, bromide and chloride. When there is a lack of iodine the body will build molecules with the other halides, but then the thyroid hormone or other chemical won’t work right. Lab tests may show ‘normal’ levels of thyroid hormone but symptoms of hypothyroidism may still be present.
    1. In autoimmune conditions, when possible, it is essential to identify the trigger foods and strictly avoid them. It can take 6 months for antibodies to fade away, at which point symptoms should improve, but memory B cells still exist so even little tastes of the problem foods can set off a new 6 month batch of autoimmune antibodies that will attack the thyroid gland, or esophagus, or wherever else the problem point is located. 
    2. In this case eggs/chicken/ animal products/ ginger/ albumin /*hemp kernels too then/, may be part of the problem foods – 
    3. Elimination type diets that start with the least risky foods and gradually reintroduce things one at a time can be the best way to individualize what is the problem for you the individual. 
  3. Gluten was definitely identified as a part of the thyroid problem by removing, it already had helped to stop that. Dairy has a variety of allergens, and also would have albumin. Removing food triggers strictly, can help a swollen thyroid gland reduce in size – versus get more swollen when trigger foods are eaten.
    1. Gluten free baking recipes and tips for converting recipes: effectivecare.info – G8. Cookies & Bean Soup. -> and it mentions that increasing corn or corn flour instead, is not ideal either. Corn or gluten can increase zonulin which also increases leaky membranes in the gut or blood brain barrier, and more open membranes can increase risk of allergens entering undigested from the diet. See: What is Zonulin? (2)
    2. A quick mix recipe that can be used for pancakes or muffins, a post: Pancakes in a Jiffy – Quick Bread Mix.
  4. Eosinophilic esophagitis may be related to food sensitivities, so as food elimination is attempted it would also be helpful to pay attention to the swallowing symptoms to see if change occurs other than the swollen pressure feeling of the enlarged thyroid gland.
    1. Research shows a strong connection between food allergies and eosinophilic esophagitis (EOE). These six foods are most commonly associated with this allergic response: dairy, wheat, soy, eggs, nuts, and seafood/shellfish. Unfortunately, there is no accurate test to identify food allergies* connected with EOE.” (3
    2. *The food sensitivity is not the same type as tested for people who get hives to peanut butter or eggs or are allergic to bee stings. It is food sensitivity that activates white blood cells though, called eosinophils. 
    3. During normal function eosinophils fight parasites for us. So …. Maybe they are doing something in ‘autoimmune disease’ that involves their normal function too fighting an unidentified parasite – or they are responding to chemicals of the six foods listed above in an allergy-like way. 
    4. Asthma and allergies involve increased eosinophil activity, which can lead to inflammation symptoms and tissue damage: “Eosinophils can consume foreign substances. For example, they fight substances related to parasitic infection that have been flagged for destruction by your immune system. Regulating inflammation. Eosinophils help promote inflammation, which plays a beneficial role in isolating and controlling a disease site.” […] “…eosinophils play a key role in the symptoms of asthma and allergies, such as hay fever. Other immune system disorders also can contribute to ongoing (chronic) inflammation.” (4
  5. Eliminating common histamine problem foods may help anxiety and inflammatory symptoms. Orange juice, tomatoes, fermented foods, or older leftovers, cranberries, others, it is a lengthy list but can make a huge difference *personal issue for me also.
    1. More info on page MCAS/Histamine, jenniferdepew.com: MCAS/HIstamine.
    2. Summary of foods to avoid, or a few helpful in an over-reaction: Histamine Food Lists. it is a document (6)

Evaluation:

Client seems motivated and capable of making positive changes for improving health, cheerful and confident amid a complex set of problems, and has support of family.


So does my disclaimer make more sense now?

  • Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

My professional and personal expectations of individualized health care guidance does not include a 15 minute appointment limited to discussing one symptom. In seeking a health care provider I recommend searching for ‘functional health’ or possibly holistic but that is less precisely used than ‘functional’. The orthomolecular approach is also whole body and restoring function oriented.

*am I taking clients? I am working in that direction but I am still in initial stages of having a system set up.


Change is easiest by just practicing the desired habit and the more often it is remembered, practiced, then the more that brain pathway will be strengthened and the old one is gradually deactivated, becomes harder for the nerve cells to fire instead of being an automatic habit like happens without even thinking consciously – to change that ingrained of a habit takes substituting a new pattern rather than trying to ‘attack’ with ‘will power’. Work with nature and it will work with you. Attack and it tends to have an undesired ripple effect.

Pain hurts, health is better.

We all die, the question is quality of life while living – and enjoying that life while living.

Namaste – the soul in me, sees the soul in you.

We are all children, under the care of Mother Nature and Father Sun.

Where there is light there is life, and there is hope.

Reference List

  1. Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. 2004 Jan;43(1):1-5. doi: 10.1111/j.1365-4632.2004.01959.x. PMID: 14693013. https://pubmed.ncbi.nlm.nih.gov/14693013/
  2. What is Zonulin? https://www.creative-diagnostics.com/blog/index.php/what-is-zonulin/
  3. 6 Food Elimination Eosinophilic Esophagitis, oregonclinic.com, https://www.oregonclinic.com/6-Food-Elimination-Eosinophilic-Esophagitis-EOE 
  4. Eosinophilia, symptoms, mayoclinic.com, https://www.mayoclinic.org/symptoms/eosinophilia/basics/causes/sym-20050752

Documents, Posts & Pages

  1. Wheat is rich in albumin – so are ginger and egg whites, post transcendingsquare.com
  2. Resources & Iron Chelators list, document https://docs.google.com/document/d/1XiwJBPoFUnUTQKcRAW_8NMriQMt8b31zjeTY4zV0wJo/edit?usp=sharing
  3. effectivecare.info – G8. Cookies & Bean Soup, webpage
  4. Pancakes in a Jiffy – Quick Bread Mix. post transcendingsquare.com
  5. MCAS/Histamine. webpage, jenniferdepew.com
  6. Histamine Food Lists. document, https://docs.google.com/document/d/17iz9lsJyGqIUUjF0p-totXp4R2GhgRi2Na4gYueisTM/edit?usp=sharing

Integrity and health

Integrity – has a two part definition – 1) regarding personal characteristic the aspect of honesty and having values – 2) regarding the physical state of wholeness, the person or substance or nation is complete and undivided.

Currently there is too much division in many areas between groups of people with different beliefs. Race,  religion, science, whatever the difference there is something in common, we share one planet. Infertility is increasing in humans and in many other species. Loss of insects causes a ripple effect up the food chain as plants are not pollinated and other species don’t have adequate food either from the loss of plants or the loss of insects. Infertility treatments are a costly procedure that is becoming common enough that some governments with nationalized health insurance have to decide about paying, which then leads to a question of who deserves the treatments and how many times. Five million dollars is the cost of fertility treatments in some areas of the world and there is no guarantee that it will work. How many treatments to attempt?

My own field of work experience could be described as a fertility expert – not an infertility expert who helps people conceive, instead a counselor who helped people who already had conceived have the healthiest pregnancy possible, or counseled about preparing for a healthy pregnancy for their next child. Something I heard frequently enough to stand out in my memory was something like, “I wasn’t trying to get pregnant, I had just worked really hard to get healthier and had lost weight and was exercising and now here I am pregnant.” Tragedy for many is not being able to conceive even with a variety of interventions. (information and statistics about infertility, cdc.gov) Focusing on health first was what seemed a successful method from a retrospective point of view. Tragedy did visit some, who was likely to miscarry? Not typically those who had achieved health first. The last post suggests also that adequate iodine and thyroid function may be part of the answer.

Self respect – confidence and faith in your own abilities and value.

How can I help you,” was recommended as a valuable question to ask for leadership or business. It is helpful in many roles. People don’t want to feel coerced or manipulated and are more likely to accept or participate with plans that they have had a part in making. The flaw in overly depending on the strategy is when people don’t know what they don’t know – if they don’t know about the possibility or value in something new than how can they ask for help with it? Horseless carriages and electric light-bulbs are two inventions that people were initially skeptical about trying. Elevators initially had elevator operators to push the buttons, in part to help people feel safer about riding in the new-fangled contraption, in part because the doors were not automated. A few elevator operators still work in higher price buildings, it adds a level of security as well as a prestige service. (The Benefits of an Elevator Operator).

If I felt that I could help and didn’t I wouldn’t feel good about myself however I can only help within my ability to help and continue to take care of myself. Mothers learn that being sick is no vacation from motherhood.

My goal with writing online and trying a few different website formats is for the purpose of trying to share self care information with those who seek it out. The preventative education prenatal/early childhood program in which was very effective and to me seemed even better than the care I had received from my health insurance covered medical care. Preventative health education takes time that typical medical appointments don’t have to spare. Providing self directed educational resources online can allow adult learners to access the information that they are interested in as they need it, as they develop the interest in seeking it out – answering their own question of “How can I help myself?

The Science of Self-Care: How climate researchers are coping with the U.N. report, Eric Holthaus @EricHolthausgrist.org.

Sea-level rise and flooding is one thing, people get wet, immigrate, and create huge problems. Loss of biodiversity means the human species as a whole is threatened to disappear. No joke. This is not discussed enough in the media.” – Eric Rignot @erignotgrist.org.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Iodine and Hydrogen Ions

To make a complex topic simple – iodine is a metallic element that can be electrically active and it helps stabilize water and hydrogen ions in a electrically active form. The combination of iodine and water in ionic form can create changes in protein structure more rapidly than regular enzymatic chemical reactions. The combination can effect DNA and mitochondria which helps explain why iodine is so important to infant development and energy levels throughout life.

Iodine is known as the mineral used in the thyroid hormone which is essential for energy metabolism but it is also essential for mitochondria which produce energy within every cell.

For more details: Tensegrity #6: Hydrogen Bonding Networks in Water, by Dr. Jack Kruse, a neurosurgeon, jackkruse.com.

Iodine & Proton Tunneling in Tadpole Development:

  • Providing iodine allows normal development of frog tadpoles even when they are missing normal pituitary or thyroid gland function which typically would disrupt the loss of their tail and growth of legs. (Accelerated Metamorphosis of Frog Tadpoles by Injections of Extract of Anterior Lobe Pituitary Gland and the Administration of Iodinepdf)
  • A video with a simple explanation of proton tunneling (positive hydrogen ions are a single positive proton, the negative electron likely remains with the oxygen atom of a water molecule), and the role proton tunneling may help a tadpole change into a four legged frog is available in a video: How do tadpoles change into frogs: The secrets of quantum physics. Spark.
  • Early stages of human development is somewhat similar to the changes seen in a frog tadpole. Between weeks four to seven of human fetal development the fertilized egg changes from a sphere shaped ball of cells into a tadpole type shape and then eventually into more of a human infant shape. (fetal development)
  • Early miscarriages in human pregnancy may be more of a risk if the woman is low in iodine levels. (Iodine status in women after early miscarriages in the Czech Republic, endocrine-abstracts.org)
  • Apathy, depression, slightly or significantly reduced cognitive skills, feeling cold in normal room temperatures, constipation, and sparse hair growth may all be symptoms of iodine deficiency in addition to increased risk for miscarriage in early pregnancy.  Food sources and symptoms of deficiency for iodine and selenium are available here: Iodine & Thyroid, effectivecare.info)

Humans need iodine, we are water based creatures, 60-70% water, and it is electrically stabilized and made more chemically efficient by iodine. We grow rapidly during infancy and childhood however we continue to perform rapid electrical reactions in all of our mitochondria in all of our cells, every day of our lives. Loss of mitochondria function has been linked to many chronic illnesses and with aging.

We need iodine because the water within our brain cells and other cells need iodine and the hydrogen ion rich plasma of our mitochondria need iodine.  Quantum proton tunneling saves energy, – it is how the sun works too.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Links on heart disease, calcium and iodine

Whether nutrient deficiencies or other metabolic imbalance is the cause is not clear or it may be a response to oxidative stress, however levels of the trace nutrients magnesium, selenium, zinc, and vitamin D3 were found to be low and the level of calcium elevated in myocardium, a type of muscle tissue in the heart. (1)

The short story – adequate nutrition is needed to support pregnancy and lactation (breast feeding) – longer duration breast feeding (6-12 months or more) is associated with less heart disease (2) and breast cancer (3risk. Increased amounts of iodine is needed for pregnancy and lactation (4) and low iodine and low selenium may be involved in breast cancer risk. (5)

A high protein diet, especially one high in dairy products is associated with more heart disease risk. (6) Background information – a high protein diet creates more work for the kidneys in order to excrete the extra nitrogen from protein that was converted into energy (ketones) (7(29) instead of being used to build muscle or other proteins.

Magnesium may help protect against calcification in heart disease in two important ways. It is needed for the kidneys to be able to excrete excess calcium. It also acts as a calcium channel blocker by providing electrical power from inside of cells or organ tissue in order to help keep excess calcium from entering the soft tissue and blood vessels through the membrane calcium channels. Medications used for hypertension include several calcium channel blockers.

Potassium is also important to protect against calcification of blood vessels by preventing increased calcium entry into the cell. The mineral is also important for preventing high blood pressure/hypertension – in addition to excess sodium/salt, too little potassium can be a problem. See excerpt with the link. (29)

Five to nine servings of vegetables or fruits per day is the recommendation for a healthy balanced diet (five) or potentially cancer preventing diet (nine). They are a good source of potassium and magnesium in addition to other trace nutrients.

Cholesterol plaque formation (atherosclerotic plaques) along vessel membrane walls may be simply acting as a coating to prevent the electrically active calcium ions from entering cells or doing other damage by plastering it in place, like plaster or spackle on dry wall. Calcium and magnesium levels in normal health are very carefully controlled by the kidneys. Lack of potassium and excess sodium may also affect the kidneys ability to excrete excess calcium.

The current understanding of atherosclerosis does not describe the role of magnesium in this way – current description: (8) and (9).

The role of potassium, magnesium and calcium in hypertension is available here: (10) and (29).

Magnesium has been found to help reduce vascular calcification (atherosclerotic plaques in blood vessels) in animal based research, (11) {and I believe in a few human research studies too but I have to find the links again. See Table 7 for a list of symptoms common to magnesium deficiency, hypertension and myocardial infarction are included: (14)} Magnesium may also help reduce prostate cancer risk or progression, (15), and low magnesium levels may be an underlying factor in the formation of cancer tumors, (18); and depression (16) can be a symptom of magnesium deficiency (14) and frequently co-occurs with other diagnoses. (17)

The short story – excess calcium may increase heart disease risk while adequate iodine, selenium, magnesium, potassium and vitamin D are all important for a healthy pregnancy, ability to lactate for a longer duration and reduce the risk of heart disease and breast cancer.

Addition, miscarriage history and history of having more than four pregnancies/four children has been associated with increased risk of heart disease for the mothers. (12) Increased losses of iodine and magnesium stores from the bones may be an underlying factor.  Premature infants born to multiparous women (women who had previous pregnancies) are more likely to have low Thyroid Stimulating Factor – which is associated with hypothyroidism which can simply be due to low iodine levels during the pregnancy. (13)

The long story is in the links below;

except for references about magnesium, potassium and vitamin D for pregnancy and breast feeding but they are also important for pregnancy and lactation. The baby may not thrive or may be fussier if the breast milk is low in essential nutrients or it may be difficult to maintain an adequate supply if the woman is malnourished.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. Thanks.

  1. Karl T. Weber, William B. Weglicki, Robert U. Simpson, Macro- and micronutrient dyshomeostasis in the adverse structural remodelling of myocardium, Cardiovasc Res. 2009 Feb 15; 81(3): 500–508. https://www.ncbi.nlm.nih.gov/pubmed/18835843 (1)
  2. Katherine Lindemann, Mothers who breastfeed may be less likely to suffer from heart disease and stroke later in life, an interview with Sanne A. E. Peters, University of Oxford, Research Fellow in Epidemiology, June 21, 2017, researchgate.net blog post,   https://www.researchgate.net/blog/post/breastfeeding-may-have-long-term-health-benefits-for-mothers-too  Benefits were seen/measured with six months increments in breastfeeding duration, with a large group of Chinese mothers, “Mothers who had breastfed their babies had a nine percent lower risk of heart disease and an eight percent lower risk of stroke.” (2)
  3. Loren Lipworth, L. Reness Bailey, Dimitrios Trichopoulos,

    History of Breast-Feeding in Relation to Breast Cancer Risk: a Review of the Epidemiologic Literature, JNCI: Journal of the National Cancer Institute, Volume 92, Issue 4, 16 February 2000, Pages 302–312, https://academic.oup.com/jnci/article/92/4/302/2624708 “Overall, the evidence with respect to “ever” breast-feeding remains inconclusive, with results indicating either no association or a rather weak protective effect against breast cancer. […] It appears that the protective effect, if any, of long-term breast-feeding is stronger among, or confined to, premenopausal women. It has been hypothesized that an apparently protective effect of breast-feeding may be due to elevated breast cancer risk among women who discontinue breast-feeding or who take medication to suppress lactation; however, the evidence is limited and should be interpreted with caution” (3)

  4. Angela M. Leung, MD, MSc, Elizabeth N. Pearce, MD, MSc,* and Lewis E. Braverman, MD, Iodine Nutrition in Pregnancy an Lactation, Endocrinol Metab Clin North Am. 2011 Dec; 40(4): 765–777. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266621/  Iodine needs are increased during pregnancy and lactation and in iodine replete geographic areas breast milk levels seemed adequate for the infant’s needs. 250-290 micrograms is estimated to be needed compared to the RDA of 150 micrograms. That level did not seem adequate in geographically low area of New Zealand: ” In a recent study, the iodine needs for breastfed infants in iodine-deficient New Zealand remained inadequate even when their mothers were supplemented with 150 μg/d of iodine during the first 6 postpartum months.” (4)
  5. Peter PA Smyth, The Thyroid, Iodine and Breast CancerBreast Cancer Res. 2003; 5(5): 235–238.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314438/ Autoimmune thyroid disease and goiter is more common in patients with breast cancer. Iodine and selenium may be protective against both conditions, a review of literature rather than a study. (5)
  6. Heart Risk of High Protein Diets, June 4, 2018, The Hippocrtic Post,  https://www.hippocraticpost.com/ageing/heart-risk-of-high-protein-diets/?utm_source=website&utm_medium=webpush&utm_campaign=notifications The group of men with the highest intake of protein in percentage of total calories had increased risk of heart disease, except for protein from fish or eggs. “When they compared men who ate the most protein to those who ate the least, they found their risk of heart failure was:33 percent higher for all sources of protein;
    43 percent higher for animal protein;
    49 percent higher for dairy protein;
    17 percent higher for plant protein.” (6)
  7. Sherwin RS, Hendler RG, Felig P.,  Effect of Ketone Infusions on Amino Acid and Nitrogen Metabolism in ManJ Clin Invest. 1975 Jun;55(6):1382-90.
       https://www.ncbi.nlm.nih.gov/pubmed/1133179 (7)
  8. Isabella AlbaneseKashif KhanBianca BarrattHamood Al‐KindiAdel Schwertani, Atherosclerotic Calcification: Wnt is the Hint, Basic Science for Clinicians, February 8, 2018 Journal of the American Heart Association,  http://jaha.ahajournals.org/content/7/4/e007356 (8)
  9. The Cardiovascular System in Disease, Diseases of the Vessels, Chapter 6, Ch006-M3430.indd 4/19/2007, http://booksite.elsevier.com/samplechapters/9780723434306/9780723434306.pdf (9)
  10. Mark C. Houston MD, MS, Karen J. Harper MS, PharmD,  Potassium, Magnesium, and Calcium: Their Role in Both the Cause and Treatment of Hypertension, JCH, Vol 10, Issue 7, pp 3-11, July 2008,  https://onlinelibrary.wiley.com/doi/full/10.1111/j.1751-7176.2008.08575.x (10)
  11. Fatih Kircelli, Mirjam E. Peter, Ebru Sevinc Ok, Fatma Gul Celenk, Mumtaz Yilmaz, Sonja Steppan, Gulay Asci, Ercan Ok, Jutta Passlick-Deetjen, Magnesium reduces calcification in bovine vascular smooth muscle cells
    in a dose-dependent manner, Nephrol Dial Transplant (2012) 27: 514–521, https://watermark.silverchair.com/gfr321.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAZ0wggGZBgkqhkiG9w0BBwagggGKMIIBhgIBADCCAX8GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMbSRHWigPf17i-jCnAgEQgIIBUIkKsm3S-WvD5qd-tNiIBBwsoiqBg-FrbTXdm2oS2q2AdX0wuviR-rsM-hi6IMVKWwMEinUYTbh7DopBg7SWLxBIi4bHXaQft3IHdQqhDKr_RiB69uxkVRwW_2aHFGYjR0FzhUSfhDrmVLweVHZRTIYDVbrSkgaVgLnFq4YHvxohG08oMbAeF4C26XL026jpA7J1xbOodHz_o5MUvoQgVcxwhrIFuu7ysxD_B7bjJehfrw6SLjkrm3Q43jrsS3vS37v_hIig_lTQyFCPe5L6UhFwlQvH1mwPIKPNituSvoob5OxY5odMFjtcXNg0Wz2tqLajbKP_Cg4Rt1X0c67CLvTGMkos_d7QLKbxwiFibtfpcrPJlIfbPPEIjd4jKRI2MWFePBaQTQLnUOoC934JHOp4abLCC5jRaOAgHykzJhZPOpvgmvrgj-jJmZBtfdgW9g (11)
  12. Kashmira Gander, Having More Kids Linked to Heart Disease Risk in Mothers, According to New Study, June 4, 2018, newsweek.com, http://www.newsweek.com/kids-linked-heart-disease-risk-mothers-according-new-study-956066 (12)
  13. Kelli K Ryckman, M.S., PhD, Cassandra N Spracklen, M.S., John M Dagle, M.D., PhD., Jeffrey C Murray, M.D.Maternal Factors and Complications of Preterm Birth Associated with Neonatal Thyroid Stimulating Hormone, J Pediatr Endocrinol Metab. 2014 Sep; 27(0): 929–938. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260397/ “Maternal and neonatal thyroid levels are tightly correlated and hypothyroidism …. Multiparous women had infants with lower TSH levels (P=8×10−4) compared to …” (13)

  14. R. Swaminathan, Magnesium Metabolism and Its Disorders, Clin Biochem Rev. 2003 May; 24(2): 47–66.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1855626/ (14)
  15. Oseni, Saheed & Quiroz, Elsa & Kumi-Diaka, Jim. (2016). Chemopreventive Effects of Magnesium Chloride Supplementation on Hormone Independent Prostate Cancer Cells. Functional Foods in Health and Disease. 6. 1-15.  https://www.researchgate.net/publication/291164181_Chemopreventive_Effects_of_Magnesium_Chloride_Supplementation_on_Hormone_Independent_Prostate_Cancer_Cells (15)

  16. Eby GA, Eby KL, Rapid recovery from major depression using magnesium treatment.Med Hypotheses. 2006;67(2):362-70. Epub 2006 Mar 20. https://www.ncbi.nlm.nih.gov/pubmed/16542786 (16

  17. Hee-Ju Kang, Seon-Young Kim, Kyung-Yeol Bae, Sung-Wan Kim, Il-Seon Shin, Jin-Sang Yoon, and Jae-Min Kim, Comorbidity of Depression with Physical Disorders: Research ad Clinical ImplicationsChonnam Med J. 2015 Apr; 51(1): 8–18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406996/ (17)
  18. : Castiglioni S, Maier JAM. Magnesium and cancer: a dangerous liason. Magnes Res 2011; 24(3): S92-S100 doi:10.1684/mrh.2011.0285   http://www.mgwater.com/Magnesium%20and%20Cancer.pdf (18)
  19.  Pharmacology of Cardiac Potassium Channels, Cardiovascular Research, Volume 62, Issue 1, 1 April 2004, Pages 9–33, Oxford Academic – see Table 4, https://academic.oup.com/cardiovascres/article/62/1/9/373105 (19)
  20. Lakshman Goonetilleke, John Quayle, TREK-1 K+ Channels in the Cardiovascular System: Their Significance and Potential as a Therapeutic Target, Cardiovascular Therapeutics 30 (2012) e23–e29  https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1755-5922.2010.00227.x (20)
  21. University of Pittsburgh: Cardiovascular system during the postpartum state in women with a history of preeclampsia, Chapter 2: Cardiovascular System,  pp 190-191, Advances in Physiology Research and Application: 2012 Edition, Scholarly EditionsDec 26, 2012, ebook, https://books.google.com/books?id=3SyvNMZLBU0C&pg=PA190&lpg=PA190&dq=TREK+1+preeclampsia&source=bl&ots=2SzKQHcFJ0&sig=fGwDeK6cMIkUXhtwPDNKqio1zIQ&hl=en&sa=X&ved=0ahUKEwirhN_h6-XbAhUSbq0KHWDZCS0Q6AEIUjAF#v=onepage&q=TREK%201%20preeclampsia&f=false (21)
  22. Ma R, Seifi M, Papanikolaou M, Brown JF, Swinny JD, Lewis A.TREK-1 Channel Expression in Smooth Muscle as a Target for Regulating Murine Intestinal Contractility: Therapeutic Implications for Motility Disorders.  Front Physiol. 2018 Mar 6;9:157, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845753/ (22)
  23. Antidepressant Drugs Suppress Activity of Potassium Channels, Lawrence Berkeley National Laboratory, Feb. 8, 2011, psypost.org,  https://www.psypost.org/2011/02/antidepressant-ssri-potassium-channel-4068 (23)
  24. Nicholas J. Talley, SSRIs in IBS: Sensing a dash of disappointment. Clinical Gastroenterology and Hepatology, May 2003, Volume 1, Issue 3, Pages 155–159.  https://www.cghjournal.org/article/S1542-3565(03)70030-5/fulltext (24)
  25. Tülay Özkan Seyhan, Olgaç Bezen, Mukadder Orhan Sungur, İbrahim Kalelioğlu, Meltem Karadeniz, and Kemalettin Koltka,

    Magnesium Therapy in Pre-eclampsia Prolongs Analgesia Following Spinal Anaesthesia with Fentanyl and Bupivacaine: An Observational Study., Balkan Med J. 2014 Jun; 31(2): 143–148.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115934/ Exerimental group needed less fluid replacement and waited longer before requesting additional pain killing medication than the women with normal (no preeclampsia) deliveries. (25)

  26. Ramanathan J, Vaddadi AK, Arheart KL. Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: a preliminary report. Reg Anesth Pain Med. 2001 Jan-Feb;26(1):46-51. https://www.ncbi.nlm.nih.gov/pubmed/11172511 (26)
  27. KCNK2 potassium two pore domain channel subfamily K member 2 [ Homo sapiens (human) ], Gene ID: 3776, updated on 23-May-2018,   https://www.ncbi.nlm.nih.gov/gene/3776 (27)

     

  28. Tayyba Y Ali, Fiona Broughton Pipkin, and Raheela N Khan, The Effect of pH and Ion Channel Modulators on Human Placental Arteries. PLoS One. 2014; 9(12): e114405. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260857/  “In vessels isolated from placentae of women with pre-eclampsia (n = 6), pH responses were attenuated.” (28) *attenuated means a weakened response, less responsive to the stimulus.
  29. Qi Qian, Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology, Nutrients 2018, 10(6), 778; Open Access, http://www.mdpi.com/2072-6643/10/6/778/htm “Recently, Sun et al. [53] demonstrated a causal role for dietary K+ in the regulation of osteogenic differentiation and calcification of vascular smooth muscle cells, both in vitro and in atherosclerotic animal models. Specifically, lower levels of extracellular fluid K+ induce vascular smooth muscle cell osteogenic transformation by elevating intracellular calcium. The latter activates CREB (cyclic AMP response element-binding protein) leading to an enhanced expression of osteogenic markers, e.g., RUNX-2, and simultaneously reduced smooth muscle cell markers, e.g., α-actin. Remarkably, even a slight serum K+ reduction (mean K+ level, 3.70 ± 0.21 mEq/L) in mice can trigger significant vessel calcification associated with elevated pulse-wave velocity, a reliable indicator of aortic stiffness. On the contrary, when K+ levels are raised to ~4.73 mEq/L by dietary modification, signs of osteogenic differentiation were abrogated, and vascular calcification prevented. Consistent with the notion of K+ being protective to vasculature, a high ratio of urine Na+/K+ excretion (indicative of high Na and low K+ intake) has recently been linked to the genesis of HTN [54].?” (29)
  30.  Robert Vink, Mihai Nechifor, editors, Magnesium in the Central Nervous System, University of Adelaide Press, 2011, adelaide.edu.au, free ebook pdf, https://www.adelaide.edu.au/press/titles/magnesium/magnesium-ebook.pdf  See page 20 re TRPM7 channels and different effects of oxidative stress on calcium versus magnesium being allowed through the ion channel. Magnesium helps survival while calcium can increase risk to the cell.  other notes about the book:   https://twitter.com/deNutrients/status/1012685811001806849?s=19