power point causes of birth defects
TRANSCRIPT
BIRTH DEFECTSBIRTH DEFECTS
CHEMICAL, PHYSICAL CHEMICAL, PHYSICAL
AND AND
BIOLOGICAL CAUSESBIOLOGICAL CAUSES
Dr Ezzeddin El- DensharyDr Ezzeddin El- Denshary Prof. of Pharmacology & Toxicology Prof. of Pharmacology & Toxicology
Faculty of Pharmacy, Cairo University Faculty of Pharmacy, Cairo University
BIRTH DEFECTSBIRTH DEFECTS
CHEMICAL, PHYSICAL CHEMICAL, PHYSICAL
AND AND
BIOLOGICAL CAUSESBIOLOGICAL CAUSES
Dr Ezzeddin El- DensharyDr Ezzeddin El- Denshary Prof. of Pharmacology & Toxicology Prof. of Pharmacology & Toxicology
Faculty of Pharmacy, Cairo University Faculty of Pharmacy, Cairo University
History of congenital malformationsHistory of congenital malformationsHistory of congenital malformationsHistory of congenital malformations
In 1928In 1928
Exposure to therapeutic radiation and microcephalyExposure to therapeutic radiation and microcephaly
In 1933In 1933
Vitamin A deficiency and anophthalmiaVitamin A deficiency and anophthalmia
In 1941In 1941 Rubella viral infection → cataracts, cardiac Rubella viral infection → cataracts, cardiac
defects, deafness, mental retardation.defects, deafness, mental retardation. Toxoplasma infection → hydrocephaly, vision Toxoplasma infection → hydrocephaly, vision
disturbances.disturbances.
In 1944In 1944 Birth defects due to nutritional deficiencies.Birth defects due to nutritional deficiencies.
In 1928In 1928
Exposure to therapeutic radiation and microcephalyExposure to therapeutic radiation and microcephaly
In 1933In 1933
Vitamin A deficiency and anophthalmiaVitamin A deficiency and anophthalmia
In 1941In 1941 Rubella viral infection → cataracts, cardiac Rubella viral infection → cataracts, cardiac
defects, deafness, mental retardation.defects, deafness, mental retardation. Toxoplasma infection → hydrocephaly, vision Toxoplasma infection → hydrocephaly, vision
disturbances.disturbances.
In 1944In 1944 Birth defects due to nutritional deficiencies.Birth defects due to nutritional deficiencies.
During late 1950s and early 1960s During late 1950s and early 1960s
Thalidomide disasterThalidomide disaster
Babies born with Babies born with : Phocomelia, amelia, CNS, : Phocomelia, amelia, CNS, ocular, respiratory, CV, GI and genitourinary ocular, respiratory, CV, GI and genitourinary anomaliesanomalies
Neurological symptoms Neurological symptoms : Epilepsy, autism, : Epilepsy, autism, learning disorders.learning disorders.
During late 1950s and early 1960s During late 1950s and early 1960s
Thalidomide disasterThalidomide disaster
Babies born with Babies born with : Phocomelia, amelia, CNS, : Phocomelia, amelia, CNS, ocular, respiratory, CV, GI and genitourinary ocular, respiratory, CV, GI and genitourinary anomaliesanomalies
Neurological symptoms Neurological symptoms : Epilepsy, autism, : Epilepsy, autism, learning disorders.learning disorders.
Birth defects caused by genetic and Birth defects caused by genetic and chromosomal abnormalitieschromosomal abnormalities
Birth defects caused by genetic and Birth defects caused by genetic and chromosomal abnormalitieschromosomal abnormalities
GeneticGenetic
Damage in DNA by: atomic explosion, X-ray, Damage in DNA by: atomic explosion, X-ray, radioactive materials, carcinogens, drugs.radioactive materials, carcinogens, drugs.
AchondroplasiaAchondroplasia is an example characterized by is an example characterized by dwarfism, macrocephaly, kyphosis, protrusion of dwarfism, macrocephaly, kyphosis, protrusion of the abdomen, polydactyly.the abdomen, polydactyly.
GeneticGenetic
Damage in DNA by: atomic explosion, X-ray, Damage in DNA by: atomic explosion, X-ray, radioactive materials, carcinogens, drugs.radioactive materials, carcinogens, drugs.
AchondroplasiaAchondroplasia is an example characterized by is an example characterized by dwarfism, macrocephaly, kyphosis, protrusion of dwarfism, macrocephaly, kyphosis, protrusion of the abdomen, polydactyly.the abdomen, polydactyly.
Chromosomal numberChromosomal numberAutosomal Autosomal Down’s syndromeDown’s syndrome (trisomy 21): mental (trisomy 21): mental
retardation, deformity, high susceptibility to retardation, deformity, high susceptibility to infection, genetic heart disease, acute leukemia, infection, genetic heart disease, acute leukemia, death in childhood.death in childhood.
Genosomal Genosomal Turner’s diseaseTurner’s disease ( XO), characterized by short ( XO), characterized by short
stature, deformity, web neck, immature ovaries, stature, deformity, web neck, immature ovaries, menstrual disturbance, infertility.menstrual disturbance, infertility.
Klinefelter’s syndromeKlinefelter’s syndrome ( XXY) ( XXY)
Features include: sterility, small testes, Features include: sterility, small testes, impotence, oligospermia, abnormal high length, impotence, oligospermia, abnormal high length, decreased intelligence ( or mental retardation).decreased intelligence ( or mental retardation).
Chromosomal numberChromosomal numberAutosomal Autosomal Down’s syndromeDown’s syndrome (trisomy 21): mental (trisomy 21): mental
retardation, deformity, high susceptibility to retardation, deformity, high susceptibility to infection, genetic heart disease, acute leukemia, infection, genetic heart disease, acute leukemia, death in childhood.death in childhood.
Genosomal Genosomal Turner’s diseaseTurner’s disease ( XO), characterized by short ( XO), characterized by short
stature, deformity, web neck, immature ovaries, stature, deformity, web neck, immature ovaries, menstrual disturbance, infertility.menstrual disturbance, infertility.
Klinefelter’s syndromeKlinefelter’s syndrome ( XXY) ( XXY)
Features include: sterility, small testes, Features include: sterility, small testes, impotence, oligospermia, abnormal high length, impotence, oligospermia, abnormal high length, decreased intelligence ( or mental retardation).decreased intelligence ( or mental retardation).
Chromosomal structureChromosomal structure
Breaking or loosing a part of the chromosomeBreaking or loosing a part of the chromosome
Chromosomal number may be normalChromosomal number may be normal
Cri-du-chatCri-du-chat is an example characterized by is an example characterized by
mental retardation, deformity, mewing of a cat. mental retardation, deformity, mewing of a cat.
Agents causing chromosomal abnormalitiesAgents causing chromosomal abnormalities
Atomic explosion, fallout, radioactive materials, Atomic explosion, fallout, radioactive materials,
LSD, heavy smoking, viruses.LSD, heavy smoking, viruses.
Chromosomal structureChromosomal structure
Breaking or loosing a part of the chromosomeBreaking or loosing a part of the chromosome
Chromosomal number may be normalChromosomal number may be normal
Cri-du-chatCri-du-chat is an example characterized by is an example characterized by
mental retardation, deformity, mewing of a cat. mental retardation, deformity, mewing of a cat.
Agents causing chromosomal abnormalitiesAgents causing chromosomal abnormalities
Atomic explosion, fallout, radioactive materials, Atomic explosion, fallout, radioactive materials,
LSD, heavy smoking, viruses.LSD, heavy smoking, viruses.
Drug-induced multiple and specific Drug-induced multiple and specific malformations or toxicitymalformations or toxicity
Drug-induced multiple and specific Drug-induced multiple and specific malformations or toxicitymalformations or toxicity
Multiple malformations Multiple malformations AntiepilepticsAntiepileptics
e.g. carbamazepinee.g. carbamazepine
phenobarbitonephenobarbitone
phenytoin phenytoin
valproic acidvalproic acid
antimetabolites antimetabolites
e.g. methotrexatee.g. methotrexate
Multiple malformations Multiple malformations AntiepilepticsAntiepileptics
e.g. carbamazepinee.g. carbamazepine
phenobarbitonephenobarbitone
phenytoin phenytoin
valproic acidvalproic acid
antimetabolites antimetabolites
e.g. methotrexatee.g. methotrexate
Specific Specific malformations or toxicitymalformations or toxicitySpecific Specific malformations or toxicitymalformations or toxicityDrug Toxicity or malformations
ACE inhibitors Anuria
Androgens Musclinization
Aspirin, indomethacin, diclofenac Pulmonary hypertension, inhibition of uterine contractility ( due to inhibition of
PG synthesis) which prolongs pregnancy and labour ( when given in last trimester)
Benzodiazepine Floppy infant syndrome (muscle flaccidity and weak sucking).
Withdrawal symptoms ( tremors, convulsions in neonatal period)
Carbamazepine Spina bifida
Cocaine CNS, intestinal and kidney damage
Warfarin Coumarin syndrome ( fetal bleeding and CNS abnormalities )
DES Vaginal dysplasia, neoplasms
Iodine ( overdose) Reversible hypothyroidism
Valproic acid Spina bifida
Drug Toxicity or malformations
Misoprostol Reduction defects of extremities
Lithium Ebstein’s syndrome( congenital heart malformations)
Retinoids, vitamin A ( in excess) Ear, CNS, CV and skeletal disorders
Tetracyclines Tooth discoloration, bone malformation
Thalidomide Amelia, phocomelia, autism
Recreational drugs causing birth Recreational drugs causing birth defects defects
Recreational drugs causing birth Recreational drugs causing birth defects defects
AlcoholAlcohol
Effect of ethanol or acetaldehyde → FAS Effect of ethanol or acetaldehyde → FAS
(↓ birth weight and body (↓ birth weight and body
length, microcephaly, neurological disorders, length, microcephaly, neurological disorders,
developmental delay, intellectual impairment). developmental delay, intellectual impairment).
Regular small amounts → ↓ neoborn length.Regular small amounts → ↓ neoborn length.
AlcoholAlcohol
Effect of ethanol or acetaldehyde → FAS Effect of ethanol or acetaldehyde → FAS
(↓ birth weight and body (↓ birth weight and body
length, microcephaly, neurological disorders, length, microcephaly, neurological disorders,
developmental delay, intellectual impairment). developmental delay, intellectual impairment).
Regular small amounts → ↓ neoborn length.Regular small amounts → ↓ neoborn length.
Caffeine and other xanthinesCaffeine and other xanthines
Caffeine, theobromine, theophylline → ↑ fetal Caffeine, theobromine, theophylline → ↑ fetal activity and heart rate.activity and heart rate.
150mg of caffeine daily → spontaneous 150mg of caffeine daily → spontaneous absorption and intrauterine growth restriction.absorption and intrauterine growth restriction.
Theophylline → changes in breutting movements, Theophylline → changes in breutting movements, heart rate, jitterness and cyanoses.heart rate, jitterness and cyanoses.
Caffeine and other xanthinesCaffeine and other xanthines
Caffeine, theobromine, theophylline → ↑ fetal Caffeine, theobromine, theophylline → ↑ fetal activity and heart rate.activity and heart rate.
150mg of caffeine daily → spontaneous 150mg of caffeine daily → spontaneous absorption and intrauterine growth restriction.absorption and intrauterine growth restriction.
Theophylline → changes in breutting movements, Theophylline → changes in breutting movements, heart rate, jitterness and cyanoses.heart rate, jitterness and cyanoses.
SmokingSmoking
Nicotine, cadmium, organochlorine insecticides, Nicotine, cadmium, organochlorine insecticides, PCBs, carcinogens ( e.g. benzo-α-pyrene) in serum PCBs, carcinogens ( e.g. benzo-α-pyrene) in serum of the newborns of smoking mothers.of the newborns of smoking mothers.
Smoking → spontaneous abortion, placental Smoking → spontaneous abortion, placental function disturbances ( perinatal mortalities),↓birth function disturbances ( perinatal mortalities),↓birth weight, SIDS.weight, SIDS.
Hyperkinetic babies, cleft lip and palate.Hyperkinetic babies, cleft lip and palate.
Childhood brain tumors, leukemia and lymphoma.Childhood brain tumors, leukemia and lymphoma.
SmokingSmoking
Nicotine, cadmium, organochlorine insecticides, Nicotine, cadmium, organochlorine insecticides, PCBs, carcinogens ( e.g. benzo-α-pyrene) in serum PCBs, carcinogens ( e.g. benzo-α-pyrene) in serum of the newborns of smoking mothers.of the newborns of smoking mothers.
Smoking → spontaneous abortion, placental Smoking → spontaneous abortion, placental function disturbances ( perinatal mortalities),↓birth function disturbances ( perinatal mortalities),↓birth weight, SIDS.weight, SIDS.
Hyperkinetic babies, cleft lip and palate.Hyperkinetic babies, cleft lip and palate.
Childhood brain tumors, leukemia and lymphoma.Childhood brain tumors, leukemia and lymphoma.
OpiatesOpiates
Danger of withdrawal symptomsDanger of withdrawal symptoms Respiratory distressRespiratory distress HyperirritabilityHyperirritability TremorTremor DiarrheaDiarrhea VomitingVomiting Sleep disturbances Sleep disturbances Seizures ( may Seizures ( may → death) → death)
OpiatesOpiates
Danger of withdrawal symptomsDanger of withdrawal symptoms Respiratory distressRespiratory distress HyperirritabilityHyperirritability TremorTremor DiarrheaDiarrhea VomitingVomiting Sleep disturbances Sleep disturbances Seizures ( may Seizures ( may → death) → death)
Cocaine and amphetaminesCocaine and amphetaminesCocaine and amphetaminesCocaine and amphetamines
CocaineCocaine Newborn symptoms: sleep disturbances, Newborn symptoms: sleep disturbances, SIDS, SIDS,
later behavioral deviations.later behavioral deviations.
Amphetamine & ecstasyAmphetamine & ecstasy Developmental anomalies and learning Developmental anomalies and learning
difficulties at school.difficulties at school.
CocaineCocaine Newborn symptoms: sleep disturbances, Newborn symptoms: sleep disturbances, SIDS, SIDS,
later behavioral deviations.later behavioral deviations.
Amphetamine & ecstasyAmphetamine & ecstasy Developmental anomalies and learning Developmental anomalies and learning
difficulties at school.difficulties at school.
CannabisCannabis
Perinatal morbidity, speech and thought Perinatal morbidity, speech and thought capabilities are affected at age of 4 years if capabilities are affected at age of 4 years if mothers consume cannabis regularly.mothers consume cannabis regularly.
CannabisCannabis
Perinatal morbidity, speech and thought Perinatal morbidity, speech and thought capabilities are affected at age of 4 years if capabilities are affected at age of 4 years if mothers consume cannabis regularly.mothers consume cannabis regularly.
Birth defects caused by herb useBirth defects caused by herb useBirth defects caused by herb useBirth defects caused by herb use Herbs stimulate uterine muscle and cause pregnancy loss Herbs stimulate uterine muscle and cause pregnancy loss
e.g. e.g. nettle rootnettle root, , ephedraephedra..
Herbs causing fetal harm e.g. Herbs causing fetal harm e.g. comfreycomfrey, , mandrake, coffee, mandrake, coffee, oil of wintergreen.oil of wintergreen.
Laxative stimulating the uterus and may cause premature Laxative stimulating the uterus and may cause premature labor e.g. labor e.g. cascara, sennacascara, senna..
Herbs with hormonal actions causing fetal adverse effects Herbs with hormonal actions causing fetal adverse effects e.g. e.g. licorice, ginseng, saw palmettolicorice, ginseng, saw palmetto..
Other herbsOther herbs
FenugreekFenugreek ( uterine cramps) ( uterine cramps)
SageSage ( fetal adverse effects) ( fetal adverse effects)
Recreational herbs Recreational herbs (mentioned before).(mentioned before).
Herbs stimulate uterine muscle and cause pregnancy loss Herbs stimulate uterine muscle and cause pregnancy loss e.g. e.g. nettle rootnettle root, , ephedraephedra..
Herbs causing fetal harm e.g. Herbs causing fetal harm e.g. comfreycomfrey, , mandrake, coffee, mandrake, coffee, oil of wintergreen.oil of wintergreen.
Laxative stimulating the uterus and may cause premature Laxative stimulating the uterus and may cause premature labor e.g. labor e.g. cascara, sennacascara, senna..
Herbs with hormonal actions causing fetal adverse effects Herbs with hormonal actions causing fetal adverse effects e.g. e.g. licorice, ginseng, saw palmettolicorice, ginseng, saw palmetto..
Other herbsOther herbs
FenugreekFenugreek ( uterine cramps) ( uterine cramps)
SageSage ( fetal adverse effects) ( fetal adverse effects)
Recreational herbs Recreational herbs (mentioned before).(mentioned before).
Birth defects caused by Birth defects caused by environmental Pollutantsenvironmental Pollutants
Birth defects caused by Birth defects caused byenvironmental Pollutantsenvironmental Pollutants
COCOSources:Sources: car exhaust, coal heaters, tobacco car exhaust, coal heaters, tobacco
and cannabis smoking. and cannabis smoking.
Causing:Causing: spontaneous abortion, placental spontaneous abortion, placental changes, premature labor, malformations, changes, premature labor, malformations, growth retardation, perinatal mortality, growth retardation, perinatal mortality, stillbirths, neonatal death.stillbirths, neonatal death.
COCOSources:Sources: car exhaust, coal heaters, tobacco car exhaust, coal heaters, tobacco
and cannabis smoking. and cannabis smoking.
Causing:Causing: spontaneous abortion, placental spontaneous abortion, placental changes, premature labor, malformations, changes, premature labor, malformations, growth retardation, perinatal mortality, growth retardation, perinatal mortality, stillbirths, neonatal death.stillbirths, neonatal death.
Mercury Mercury Sources:Sources: fish contaminated with methyl mercury, fish contaminated with methyl mercury,
wheat and seeds for which mercurial antifungals wheat and seeds for which mercurial antifungals used as preservatives.used as preservatives.
Causing:Causing: fetal CNS damage, mental retardation, fetal CNS damage, mental retardation, malformations, stillbirths, spontaneous abortion malformations, stillbirths, spontaneous abortion (Minamata disease). (Minamata disease).
Mercury Mercury Sources:Sources: fish contaminated with methyl mercury, fish contaminated with methyl mercury,
wheat and seeds for which mercurial antifungals wheat and seeds for which mercurial antifungals used as preservatives.used as preservatives.
Causing:Causing: fetal CNS damage, mental retardation, fetal CNS damage, mental retardation, malformations, stillbirths, spontaneous abortion malformations, stillbirths, spontaneous abortion (Minamata disease). (Minamata disease).
CadmiumCadmium
Sources:Sources: industrial exposure, tobacco industrial exposure, tobacco smoke, shelfish, kidney.smoke, shelfish, kidney.
Causing:Causing: placental disturbances, fetal zinc placental disturbances, fetal zinc deficiency and malformations.deficiency and malformations.
CadmiumCadmium
Sources:Sources: industrial exposure, tobacco industrial exposure, tobacco smoke, shelfish, kidney.smoke, shelfish, kidney.
Causing:Causing: placental disturbances, fetal zinc placental disturbances, fetal zinc deficiency and malformations.deficiency and malformations.
LeadLead
Sources:Sources: car exhaust, industrial waste car exhaust, industrial waste products.products.
Causing:Causing: increased rates of miscarriage increased rates of miscarriage and stillbirth, minor anomalies, premature and stillbirth, minor anomalies, premature delivery, decreased birth weight, low IQ delivery, decreased birth weight, low IQ scores in offsprings.scores in offsprings.
LeadLead
Sources:Sources: car exhaust, industrial waste car exhaust, industrial waste products.products.
Causing:Causing: increased rates of miscarriage increased rates of miscarriage and stillbirth, minor anomalies, premature and stillbirth, minor anomalies, premature delivery, decreased birth weight, low IQ delivery, decreased birth weight, low IQ scores in offsprings.scores in offsprings.
RadiationRadiation
Sources:Sources: plants, animals, milk, and water plants, animals, milk, and water contaminated with radioactive materials (fallout contaminated with radioactive materials (fallout of of Hiroshima and NagazakiHiroshima and Nagazaki bombs), exposure to bombs), exposure to X-ray, use of radioactive drugs.X-ray, use of radioactive drugs.
Causing: Causing: growth and mental retardations, growth and mental retardations, leukemia, cancer, bone marrow diseases and leukemia, cancer, bone marrow diseases and immunological disorders. immunological disorders.
RadiationRadiation
Sources:Sources: plants, animals, milk, and water plants, animals, milk, and water contaminated with radioactive materials (fallout contaminated with radioactive materials (fallout of of Hiroshima and NagazakiHiroshima and Nagazaki bombs), exposure to bombs), exposure to X-ray, use of radioactive drugs.X-ray, use of radioactive drugs.
Causing: Causing: growth and mental retardations, growth and mental retardations, leukemia, cancer, bone marrow diseases and leukemia, cancer, bone marrow diseases and immunological disorders. immunological disorders.
Maternal and paternal factors Maternal and paternal factors causing birth defectscausing birth defects
Maternal and paternal factors Maternal and paternal factors causing birth defectscausing birth defects
Maternal factorsMaternal factorsInfectious diseasesInfectious diseasesViral infectionsViral infections RubellaRubella (deafness, cataracts, blindess, (deafness, cataracts, blindess,
retinopathy, glaucoma, cardiac defects, retinopathy, glaucoma, cardiac defects, microcephaly, mental retardation). microcephaly, mental retardation).
Smallpox, chickenpox, poliomyelitis and Smallpox, chickenpox, poliomyelitis and hepatitis viruseshepatitis viruses (abortion, stillbirth). (abortion, stillbirth).
Maternal factorsMaternal factorsInfectious diseasesInfectious diseasesViral infectionsViral infections RubellaRubella (deafness, cataracts, blindess, (deafness, cataracts, blindess,
retinopathy, glaucoma, cardiac defects, retinopathy, glaucoma, cardiac defects, microcephaly, mental retardation). microcephaly, mental retardation).
Smallpox, chickenpox, poliomyelitis and Smallpox, chickenpox, poliomyelitis and hepatitis viruseshepatitis viruses (abortion, stillbirth). (abortion, stillbirth).
Bacterial infectionsBacterial infections
TBTB (loss of weight, splenomegaly, hepatomegaly, (loss of weight, splenomegaly, hepatomegaly, neonatal death).neonatal death).
SyhilisSyhilis (hydrocephalus, tooth malformation, CNS (hydrocephalus, tooth malformation, CNS disturbances, deafness, skin diseases, disturbances, deafness, skin diseases, hepatomegaly, splenomegaly,mental retardation.hepatomegaly, splenomegaly,mental retardation.
GonorrheaGonorrhea (eye diseases and blindness in (eye diseases and blindness in neonates).neonates).
Bacterial infectionsBacterial infections
TBTB (loss of weight, splenomegaly, hepatomegaly, (loss of weight, splenomegaly, hepatomegaly, neonatal death).neonatal death).
SyhilisSyhilis (hydrocephalus, tooth malformation, CNS (hydrocephalus, tooth malformation, CNS disturbances, deafness, skin diseases, disturbances, deafness, skin diseases, hepatomegaly, splenomegaly,mental retardation.hepatomegaly, splenomegaly,mental retardation.
GonorrheaGonorrhea (eye diseases and blindness in (eye diseases and blindness in neonates).neonates).
Protozoal infectionsProtozoal infections Toxoplasma : from cat fecesToxoplasma : from cat feces
↓↓ BlindnessBlindness
MicrocephalyMicrocephaly HydrocephalusHydrocephalus CNS damageCNS damage
Mental retardationMental retardation HepatomegalyHepatomegaly SplenomegalySplenomegaly
Protozoal infectionsProtozoal infections Toxoplasma : from cat fecesToxoplasma : from cat feces
↓↓ BlindnessBlindness
MicrocephalyMicrocephaly HydrocephalusHydrocephalus CNS damageCNS damage
Mental retardationMental retardation HepatomegalyHepatomegaly SplenomegalySplenomegaly
Non- Infectious diseasesNon- Infectious diseases
HypertensionHypertension (pre-eclampsia, eclampsia, toxemia (pre-eclampsia, eclampsia, toxemia of pregnancy, severe hypertension, placental of pregnancy, severe hypertension, placental dysfunction, perinatal and maternal death). dysfunction, perinatal and maternal death).
Diabetes mellitusDiabetes mellitus ( malformations and free ( malformations and free radicals, importance of antioxidant use)radicals, importance of antioxidant use)
HyperthermiaHyperthermia ( caused by fevers, sauna → ( caused by fevers, sauna → structural and functional defects e.g. CNS structural and functional defects e.g. CNS disturbances). disturbances).
Non- Infectious diseasesNon- Infectious diseases
HypertensionHypertension (pre-eclampsia, eclampsia, toxemia (pre-eclampsia, eclampsia, toxemia of pregnancy, severe hypertension, placental of pregnancy, severe hypertension, placental dysfunction, perinatal and maternal death). dysfunction, perinatal and maternal death).
Diabetes mellitusDiabetes mellitus ( malformations and free ( malformations and free radicals, importance of antioxidant use)radicals, importance of antioxidant use)
HyperthermiaHyperthermia ( caused by fevers, sauna → ( caused by fevers, sauna → structural and functional defects e.g. CNS structural and functional defects e.g. CNS disturbances). disturbances).
Nutritional deficiencies & vitamin Nutritional deficiencies & vitamin overdosagesoverdosages
Nutritional deficiencies Nutritional deficiencies predispose to schizophrenia, predispose to schizophrenia, fertility disorders, diabetes, and CV diseases.fertility disorders, diabetes, and CV diseases.
Vitamin AVitamin A deficiency (visual disturbances). deficiency (visual disturbances).
Vitamin A Vitamin A > 25000 IU daily → teratogenesis.> 25000 IU daily → teratogenesis.
Vitamin D Vitamin D deficiency (reduced ossification).deficiency (reduced ossification).
Folic acid and zinc Folic acid and zinc deficiency (spinal bifida) Ca, Fe, K and deficiency (spinal bifida) Ca, Fe, K and iodine deficiencies (malformations).iodine deficiencies (malformations).
Nutritional deficiencies & vitamin Nutritional deficiencies & vitamin overdosagesoverdosages
Nutritional deficiencies Nutritional deficiencies predispose to schizophrenia, predispose to schizophrenia, fertility disorders, diabetes, and CV diseases.fertility disorders, diabetes, and CV diseases.
Vitamin AVitamin A deficiency (visual disturbances). deficiency (visual disturbances).
Vitamin A Vitamin A > 25000 IU daily → teratogenesis.> 25000 IU daily → teratogenesis.
Vitamin D Vitamin D deficiency (reduced ossification).deficiency (reduced ossification).
Folic acid and zinc Folic acid and zinc deficiency (spinal bifida) Ca, Fe, K and deficiency (spinal bifida) Ca, Fe, K and iodine deficiencies (malformations).iodine deficiencies (malformations).
Maternal stressMaternal stress
Low birth weight and malformationsLow birth weight and malformations
Maternal stressMaternal stress
Low birth weight and malformationsLow birth weight and malformations
Paternal factorsPaternal factors
Cytostalics (e.g. cyclophosphamide), lead, Cytostalics (e.g. cyclophosphamide), lead, radiotherapy → damage of sperm genes, radiotherapy → damage of sperm genes, impairment of spermatogenesis or maturation of impairment of spermatogenesis or maturation of sperms → fertility disturbances, malformations.sperms → fertility disturbances, malformations.
Anti-androgenic & estrogenic chemicalsAnti-androgenic & estrogenic chemicals
-PCBs, dioxin, phthalates ( fertility disturbances)-PCBs, dioxin, phthalates ( fertility disturbances)
-Pesticides, heavy metals, organic solvents, -Pesticides, heavy metals, organic solvents, radiation, smoking (spontaneous abortion, fetal radiation, smoking (spontaneous abortion, fetal development abnormalities, childhood cancer).development abnormalities, childhood cancer).
Paternal factorsPaternal factors
Cytostalics (e.g. cyclophosphamide), lead, Cytostalics (e.g. cyclophosphamide), lead, radiotherapy → damage of sperm genes, radiotherapy → damage of sperm genes, impairment of spermatogenesis or maturation of impairment of spermatogenesis or maturation of sperms → fertility disturbances, malformations.sperms → fertility disturbances, malformations.
Anti-androgenic & estrogenic chemicalsAnti-androgenic & estrogenic chemicals
-PCBs, dioxin, phthalates ( fertility disturbances)-PCBs, dioxin, phthalates ( fertility disturbances)
-Pesticides, heavy metals, organic solvents, -Pesticides, heavy metals, organic solvents, radiation, smoking (spontaneous abortion, fetal radiation, smoking (spontaneous abortion, fetal development abnormalities, childhood cancer).development abnormalities, childhood cancer).
Preventive measures of Preventive measures of teratogenesisteratogenesis
Preventive measures of Preventive measures of teratogenesisteratogenesis
1. Vaccination e.g. against rubella.1. Vaccination e.g. against rubella.
2. Avoidance of smoking, alcohol & abused drugs.2. Avoidance of smoking, alcohol & abused drugs.
3. Reproductive toxicants not approved or approved with 3. Reproductive toxicants not approved or approved with labelling or restriction.labelling or restriction.
4. Secondary measures e.g. abortion. 4. Secondary measures e.g. abortion.
5. Tertiary measures e.g. taking diet low in phenylalanine in 5. Tertiary measures e.g. taking diet low in phenylalanine in patients with phenylketonuria ( to prevent mental patients with phenylketonuria ( to prevent mental retardation).retardation).
6. Avoidance of harmful drugs during pregnancy, before 6. Avoidance of harmful drugs during pregnancy, before pregnancy, and better during the entire fertile period.pregnancy, and better during the entire fertile period.
1. Vaccination e.g. against rubella.1. Vaccination e.g. against rubella.
2. Avoidance of smoking, alcohol & abused drugs.2. Avoidance of smoking, alcohol & abused drugs.
3. Reproductive toxicants not approved or approved with 3. Reproductive toxicants not approved or approved with labelling or restriction.labelling or restriction.
4. Secondary measures e.g. abortion. 4. Secondary measures e.g. abortion.
5. Tertiary measures e.g. taking diet low in phenylalanine in 5. Tertiary measures e.g. taking diet low in phenylalanine in patients with phenylketonuria ( to prevent mental patients with phenylketonuria ( to prevent mental retardation).retardation).
6. Avoidance of harmful drugs during pregnancy, before 6. Avoidance of harmful drugs during pregnancy, before pregnancy, and better during the entire fertile period.pregnancy, and better during the entire fertile period.
Teratology Information CentersTeratology Information CentersTeratology Information CentersTeratology Information Centers
Provide health professionals and patients with Provide health professionals and patients with information relating to pertinent situation illness information relating to pertinent situation illness and chemical exposure of the individual involved.and chemical exposure of the individual involved.
Assessment of drug use in pregnancy and Assessment of drug use in pregnancy and lactation.lactation.
Researches concerning exposure of pregnant Researches concerning exposure of pregnant women to chemicals and medicines, maternal and women to chemicals and medicines, maternal and paternal diseases, and occupational conditions.paternal diseases, and occupational conditions.
Provide health professionals and patients with Provide health professionals and patients with information relating to pertinent situation illness information relating to pertinent situation illness and chemical exposure of the individual involved.and chemical exposure of the individual involved.
Assessment of drug use in pregnancy and Assessment of drug use in pregnancy and lactation.lactation.
Researches concerning exposure of pregnant Researches concerning exposure of pregnant women to chemicals and medicines, maternal and women to chemicals and medicines, maternal and paternal diseases, and occupational conditions.paternal diseases, and occupational conditions.
DRUG AND CHEMICAL RISK DURING DRUG AND CHEMICAL RISK DURING LACTATIONLACTATION
DRUG AND CHEMICAL RISK DURING DRUG AND CHEMICAL RISK DURING LACTATIONLACTATION
Factors Affecting drug excretionFactors Affecting drug excretion in milk in milk
Factors Affecting drug excretionFactors Affecting drug excretion in milk in milk
1. 1. Molecular weight ( MW)Molecular weight ( MW)
The low the MWThe low the MW, , the more amounts excreted.the more amounts excreted.
High MW drugs e.g. insulin, heparin not excreted.High MW drugs e.g. insulin, heparin not excreted.
2. 2. Degree of ionizationDegree of ionization
Nonionizable drugs at blood pH traverse to the milk.Nonionizable drugs at blood pH traverse to the milk.
3. 3. Protein binding in bloodProtein binding in blood
The more the bound, the less excreted. The more the bound, the less excreted.
4. 4. Lipid solubilityLipid solubility
Drugs or chemicals very highly soluble in lipid readily Drugs or chemicals very highly soluble in lipid readily cross.cross.
5. 5. Specific uptake by mammary tissue Specific uptake by mammary tissue
Certain compounds actively taken up by mammary tissue.Certain compounds actively taken up by mammary tissue.
1. 1. Molecular weight ( MW)Molecular weight ( MW)
The low the MWThe low the MW, , the more amounts excreted.the more amounts excreted.
High MW drugs e.g. insulin, heparin not excreted.High MW drugs e.g. insulin, heparin not excreted.
2. 2. Degree of ionizationDegree of ionization
Nonionizable drugs at blood pH traverse to the milk.Nonionizable drugs at blood pH traverse to the milk.
3. 3. Protein binding in bloodProtein binding in blood
The more the bound, the less excreted. The more the bound, the less excreted.
4. 4. Lipid solubilityLipid solubility
Drugs or chemicals very highly soluble in lipid readily Drugs or chemicals very highly soluble in lipid readily cross.cross.
5. 5. Specific uptake by mammary tissue Specific uptake by mammary tissue
Certain compounds actively taken up by mammary tissue.Certain compounds actively taken up by mammary tissue.
Anticoagulants and NSAIDsAnticoagulants and NSAIDs in breast milk in breast milk
Anticoagulants and NSAIDsAnticoagulants and NSAIDs in breast milk in breast milk
AnticoagulantsAnticoagulants HeparinsHeparins including low molecular-weight heparins (e.g. including low molecular-weight heparins (e.g.
enoxaparinenoxaparin))
Not detected or found in low concentrations → no harm to Not detected or found in low concentrations → no harm to the baby.the baby.
Oral anticoagulants ( e.g. Oral anticoagulants ( e.g. phenindionephenindione)) High concentrations in milk → hemorrhage in infants High concentrations in milk → hemorrhage in infants
(vitamin K deficiency). (vitamin K deficiency).
WarfarinWarfarin
Appears safe.Appears safe.
AnticoagulantsAnticoagulants HeparinsHeparins including low molecular-weight heparins (e.g. including low molecular-weight heparins (e.g.
enoxaparinenoxaparin))
Not detected or found in low concentrations → no harm to Not detected or found in low concentrations → no harm to the baby.the baby.
Oral anticoagulants ( e.g. Oral anticoagulants ( e.g. phenindionephenindione)) High concentrations in milk → hemorrhage in infants High concentrations in milk → hemorrhage in infants
(vitamin K deficiency). (vitamin K deficiency).
WarfarinWarfarin
Appears safe.Appears safe.
NSAIDsNSAIDs
SalicylatesSalicylatesOccasional doses are safeOccasional doses are safeRegular use → hypoprothromobinemiaRegular use → hypoprothromobinemia
IndomethacinIndomethacinMay cause convulsions May cause convulsions APAP and ibuprofenAPAP and ibuprofenSafe during lactation.Safe during lactation.
NSAIDsNSAIDs
SalicylatesSalicylatesOccasional doses are safeOccasional doses are safeRegular use → hypoprothromobinemiaRegular use → hypoprothromobinemia
IndomethacinIndomethacinMay cause convulsions May cause convulsions APAP and ibuprofenAPAP and ibuprofenSafe during lactation.Safe during lactation.
Antimicrobial agentsAntimicrobial agents in breast milk in breast milk
Antimicrobial agentsAntimicrobial agentsin breast milk in breast milk
ChloramphenicolChloramphenicol Causes refusal of food and vomiting by the baby.Causes refusal of food and vomiting by the baby.
Co-trimoxazole and sulphonamidesCo-trimoxazole and sulphonamides Excreted in the milk → kernicterus Excreted in the milk → kernicterus
TetracyclinesTetracyclines Symptoms in infants have never been reported.Symptoms in infants have never been reported.
Penicillin derivatives and cephalosporinsPenicillin derivatives and cephalosporins No adverse effects (except allergy to the No adverse effects (except allergy to the
antibiotic).antibiotic).
ChloramphenicolChloramphenicol Causes refusal of food and vomiting by the baby.Causes refusal of food and vomiting by the baby.
Co-trimoxazole and sulphonamidesCo-trimoxazole and sulphonamides Excreted in the milk → kernicterus Excreted in the milk → kernicterus
TetracyclinesTetracyclines Symptoms in infants have never been reported.Symptoms in infants have never been reported.
Penicillin derivatives and cephalosporinsPenicillin derivatives and cephalosporins No adverse effects (except allergy to the No adverse effects (except allergy to the
antibiotic).antibiotic).
CNS acting drugs CNS acting drugs in breast milkin breast milk
CNS acting drugs CNS acting drugs in breast milkin breast milk
CNS depressantsCNS depressants AntiepilepticAntiepileptic Phenobarbital excreted and → drowsinessPhenobarbital excreted and → drowsiness
Diazepam and its metabolite excreted and → Diazepam and its metabolite excreted and → lethargy and weight loss.lethargy and weight loss.
Carbamazepine, phenytoin and valproic acid are Carbamazepine, phenytoin and valproic acid are compatible with breastfeeding.compatible with breastfeeding.
Lithium excreted and → CV and CNSLithium excreted and → CV and CNS
CNS depressantsCNS depressants AntiepilepticAntiepileptic Phenobarbital excreted and → drowsinessPhenobarbital excreted and → drowsiness
Diazepam and its metabolite excreted and → Diazepam and its metabolite excreted and → lethargy and weight loss.lethargy and weight loss.
Carbamazepine, phenytoin and valproic acid are Carbamazepine, phenytoin and valproic acid are compatible with breastfeeding.compatible with breastfeeding.
Lithium excreted and → CV and CNSLithium excreted and → CV and CNS
CNS stimulantsCNS stimulants
Excessive amounts of coffee, tea, cola or caffeine Excessive amounts of coffee, tea, cola or caffeine → irritability and sleeplessness.→ irritability and sleeplessness.
Excessive amounts of chocolate (containing Excessive amounts of chocolate (containing theobromine) → irritability, poor sleep pattern, theobromine) → irritability, poor sleep pattern, diarrhea.diarrhea.
Theophylline is compatible with breastfeeding. Theophylline is compatible with breastfeeding. Rapidly absorbed preparations used with Rapidly absorbed preparations used with precaution (may cause irritability).precaution (may cause irritability).
CNS stimulantsCNS stimulants
Excessive amounts of coffee, tea, cola or caffeine Excessive amounts of coffee, tea, cola or caffeine → irritability and sleeplessness.→ irritability and sleeplessness.
Excessive amounts of chocolate (containing Excessive amounts of chocolate (containing theobromine) → irritability, poor sleep pattern, theobromine) → irritability, poor sleep pattern, diarrhea.diarrhea.
Theophylline is compatible with breastfeeding. Theophylline is compatible with breastfeeding. Rapidly absorbed preparations used with Rapidly absorbed preparations used with precaution (may cause irritability).precaution (may cause irritability).
Sex hormones, corticosteroids, and Sex hormones, corticosteroids, and opiates in breast milkopiates in breast milk
Sex hormones, corticosteroids, and Sex hormones, corticosteroids, and opiates in breast milkopiates in breast milk
Sex hormonesSex hormones AndrogensAndrogens Musculinization in the female infant.Musculinization in the female infant. Precocious puberty in the male infant.Precocious puberty in the male infant. Suppress lactation ( in high doses).Suppress lactation ( in high doses).
EstrogensEstrogens Decrease the quantity and quality of milk.Decrease the quantity and quality of milk.
ProgesteroneProgesterone Causes adverse effects on infants.Causes adverse effects on infants.
Sex hormonesSex hormones AndrogensAndrogens Musculinization in the female infant.Musculinization in the female infant. Precocious puberty in the male infant.Precocious puberty in the male infant. Suppress lactation ( in high doses).Suppress lactation ( in high doses).
EstrogensEstrogens Decrease the quantity and quality of milk.Decrease the quantity and quality of milk.
ProgesteroneProgesterone Causes adverse effects on infants.Causes adverse effects on infants.
CorticosteroidsCorticosteroids Maternal dose of prednisolone (> 400 mg daily) → Maternal dose of prednisolone (> 400 mg daily) →
adrenocortical disturbances in infants.adrenocortical disturbances in infants.
OpiatesOpiates If the nursing mother is dependent on morphine If the nursing mother is dependent on morphine
→ withdrawal symptoms in infants.→ withdrawal symptoms in infants. If the mother takes methadone → sedation in If the mother takes methadone → sedation in
infants.infants.
CorticosteroidsCorticosteroids Maternal dose of prednisolone (> 400 mg daily) → Maternal dose of prednisolone (> 400 mg daily) →
adrenocortical disturbances in infants.adrenocortical disturbances in infants.
OpiatesOpiates If the nursing mother is dependent on morphine If the nursing mother is dependent on morphine
→ withdrawal symptoms in infants.→ withdrawal symptoms in infants. If the mother takes methadone → sedation in If the mother takes methadone → sedation in
infants.infants.
Medications that affect lactationMedications that affect lactationMedications that affect lactationMedications that affect lactation
Medications enhance milk productionMedications enhance milk production Phenothiazines, haloperidol, alpha-methyl dopa, growth Phenothiazines, haloperidol, alpha-methyl dopa, growth
hormone, domperidone, metoclopramide.hormone, domperidone, metoclopramide.
Medications reduce milk productionMedications reduce milk production Amphetamines, estrogen, Amphetamines, estrogen, methylergometrine, methylergometrine,
bromocriptine, and pergolide are antiprolactins and can bromocriptine, and pergolide are antiprolactins and can reduce milk production.reduce milk production.
Herbal galactogogues & antigalactogensHerbal galactogogues & antigalactogens GalactogoguesGalactogogues Fenugreek, fennel, alfalfa.Fenugreek, fennel, alfalfa. AntigalactogensAntigalactogens Peppermint, sage, parsley.Peppermint, sage, parsley.
Medications enhance milk productionMedications enhance milk production Phenothiazines, haloperidol, alpha-methyl dopa, growth Phenothiazines, haloperidol, alpha-methyl dopa, growth
hormone, domperidone, metoclopramide.hormone, domperidone, metoclopramide.
Medications reduce milk productionMedications reduce milk production Amphetamines, estrogen, Amphetamines, estrogen, methylergometrine, methylergometrine,
bromocriptine, and pergolide are antiprolactins and can bromocriptine, and pergolide are antiprolactins and can reduce milk production.reduce milk production.
Herbal galactogogues & antigalactogensHerbal galactogogues & antigalactogens GalactogoguesGalactogogues Fenugreek, fennel, alfalfa.Fenugreek, fennel, alfalfa. AntigalactogensAntigalactogens Peppermint, sage, parsley.Peppermint, sage, parsley.
Environmental contaminants in Environmental contaminants in breast milkbreast milk
Environmental contaminants in Environmental contaminants in breast milkbreast milk
MycotoxinsMycotoxins Aflatoxin BAflatoxin B1, 1, and its metabolite aflatoxin Mand its metabolite aflatoxin M11 are are
excreted in milk → hepatotoxicity.excreted in milk → hepatotoxicity.
Organic compounds Organic compounds DDT, hexachlorobenzene, PCBs and dioxin DDT, hexachlorobenzene, PCBs and dioxin
excreted in milk. excreted in milk.
Hexachlorobenzene → Hexachlorobenzene → Turkish porphyriaTurkish porphyria (skin (skin rash, weight loss, death).rash, weight loss, death).
PCBs → PCBs → Yasho diseaseYasho disease (muscular hypotonia, (muscular hypotonia, hyperexcitability, apathy).hyperexcitability, apathy).
MycotoxinsMycotoxins Aflatoxin BAflatoxin B1, 1, and its metabolite aflatoxin Mand its metabolite aflatoxin M11 are are
excreted in milk → hepatotoxicity.excreted in milk → hepatotoxicity.
Organic compounds Organic compounds DDT, hexachlorobenzene, PCBs and dioxin DDT, hexachlorobenzene, PCBs and dioxin
excreted in milk. excreted in milk.
Hexachlorobenzene → Hexachlorobenzene → Turkish porphyriaTurkish porphyria (skin (skin rash, weight loss, death).rash, weight loss, death).
PCBs → PCBs → Yasho diseaseYasho disease (muscular hypotonia, (muscular hypotonia, hyperexcitability, apathy).hyperexcitability, apathy).
Inorganic chemicalsInorganic chemicals
MercuryMercury Neurological disorders Neurological disorders
CadmiumCadmium Toxic effects have not been described.Toxic effects have not been described.
Inorganic chemicalsInorganic chemicals
MercuryMercury Neurological disorders Neurological disorders
CadmiumCadmium Toxic effects have not been described.Toxic effects have not been described.
INFORMATION FOR DIETARY INFORMATION FOR DIETARY MANAGEMENT OF DIABETES MANAGEMENT OF DIABETES
MELLITUSMELLITUS
INFORMATION FOR DIETARY INFORMATION FOR DIETARY MANAGEMENT OF DIABETES MANAGEMENT OF DIABETES
MELLITUSMELLITUS
Patient EducationPatient EducationPatient EducationPatient Education
Exer
cise
Diet
Composition of diabetic dietsComposition of diabetic dietsComposition of diabetic dietsComposition of diabetic diets
Diet % of total calories
1 .Carbohydrates Avoid high glycemic index
(Glucose, sucrose, lactose, fructose).Use low glycemic index
(Bread, rise, potatoes, corn and beans).
50-60
2 .FatRestrict food rich in saturated fatty acids (milk, cream, butter, fatty cheese, cooking fats and chocolate).Restrict food with high cholesterol ( brain, egg yolk, liver and kidney)Use vegetable oils, fish, and fish oil.
20-30
3 .ProteinRestricted meatUse fish and poultry
15
4. FiberWhole meal flour, skin of vegetables & fruits, high bran food, gaur, gum, pectin.
Ample amounts
Characteristics of diabetic food Characteristics of diabetic food Characteristics of diabetic food Characteristics of diabetic food
CarbohydratesCarbohydrates Avoid high-glycemic index carbohydrates.Avoid high-glycemic index carbohydrates. Use low--glycemic index carbohydrates.Use low--glycemic index carbohydrates.
FatsFats Avoid food in saturated fatty acids ( animal fats) Avoid food in saturated fatty acids ( animal fats)
and food with high cholesterol content e.g. brain , and food with high cholesterol content e.g. brain , egg yolk, liver, kidney.egg yolk, liver, kidney.
Foods rich in saturated fatty acids include milk, Foods rich in saturated fatty acids include milk, cream, butter, cheese, biscuits, pastry, cooking cream, butter, cheese, biscuits, pastry, cooking fat, chocolate, hard margarine.fat, chocolate, hard margarine.
Use foods containing polyunsaturated fatty acids Use foods containing polyunsaturated fatty acids e.g. vegetable oils, fish oil and oily fish.e.g. vegetable oils, fish oil and oily fish.
CarbohydratesCarbohydrates Avoid high-glycemic index carbohydrates.Avoid high-glycemic index carbohydrates. Use low--glycemic index carbohydrates.Use low--glycemic index carbohydrates.
FatsFats Avoid food in saturated fatty acids ( animal fats) Avoid food in saturated fatty acids ( animal fats)
and food with high cholesterol content e.g. brain , and food with high cholesterol content e.g. brain , egg yolk, liver, kidney.egg yolk, liver, kidney.
Foods rich in saturated fatty acids include milk, Foods rich in saturated fatty acids include milk, cream, butter, cheese, biscuits, pastry, cooking cream, butter, cheese, biscuits, pastry, cooking fat, chocolate, hard margarine.fat, chocolate, hard margarine.
Use foods containing polyunsaturated fatty acids Use foods containing polyunsaturated fatty acids e.g. vegetable oils, fish oil and oily fish.e.g. vegetable oils, fish oil and oily fish.
ProteinProtein Got from fish and poultry rather than from red meat.Got from fish and poultry rather than from red meat. Other sources: dried beans and peas, cereals, grains, egg Other sources: dried beans and peas, cereals, grains, egg
white, skimmed milk, cottage cheese. white, skimmed milk, cottage cheese. Low-protein diet to decrease progression of kidney Low-protein diet to decrease progression of kidney
disease.disease.
Reduction of protein intake in elderly patientsReduction of protein intake in elderly patientsDietary fiberDietary fiber
Taking ample amount of insoluble and soluble fibersTaking ample amount of insoluble and soluble fibers
Insoluble fiber inInsoluble fiber in Wheat bran, bran flakes, whole wheat bread Wheat bran, bran flakes, whole wheat bread
Soluble fibersSoluble fibers, , when dissolved in water → ↓ glucose when dissolved in water → ↓ glucose absorption and blood glucose levels after meals. Also absorption and blood glucose levels after meals. Also useful in treating certain hyperlipidemia.useful in treating certain hyperlipidemia.
ProteinProtein Got from fish and poultry rather than from red meat.Got from fish and poultry rather than from red meat. Other sources: dried beans and peas, cereals, grains, egg Other sources: dried beans and peas, cereals, grains, egg
white, skimmed milk, cottage cheese. white, skimmed milk, cottage cheese. Low-protein diet to decrease progression of kidney Low-protein diet to decrease progression of kidney
disease.disease.
Reduction of protein intake in elderly patientsReduction of protein intake in elderly patientsDietary fiberDietary fiber
Taking ample amount of insoluble and soluble fibersTaking ample amount of insoluble and soluble fibers
Insoluble fiber inInsoluble fiber in Wheat bran, bran flakes, whole wheat bread Wheat bran, bran flakes, whole wheat bread
Soluble fibersSoluble fibers, , when dissolved in water → ↓ glucose when dissolved in water → ↓ glucose absorption and blood glucose levels after meals. Also absorption and blood glucose levels after meals. Also useful in treating certain hyperlipidemia.useful in treating certain hyperlipidemia.
Micronutrients and diabetic Micronutrients and diabetic managementmanagement
Micronutrients and diabetic Micronutrients and diabetic managementmanagement
To enhance the action of insulin and help control To enhance the action of insulin and help control blood glucose. blood glucose.
To enhance the action of insulin and help control To enhance the action of insulin and help control blood glucose. blood glucose.
Nutrient Recommended daily dose Comments
Vitamin E 800 mg; begin with 100 mg/day and gradually increase dose
Can enhance insulin sensitivity and reduce needs for oral hypo-glycemics and / or insulin.Reduces platelet aggregation and risk of thrombosis.
Chromium 200-400mg chromium
As a component of GTF, helps control blood glucose and decrease need for insulin or hypoglycemic drugs. Can be taken together with 5-10 g brewer’s yeast.
Nutrient Recommended daily dose
Comments
Vitamin C 1-2 g. can be taken as a complex with bioflavonoids
Can help regulate blood glucose,
strengthen small blood vessels, and reduce
risk of early heart disease.
Niacin 100 mg Used in combination with chromium
supplementation daily to improve diabetic
control.
Nicotinamide 1-3 g; begin with 500 mg / day and increase
dose gradually
Long-term administration can
benefit insulin secretion by diabetics
Biotin Pyridoxine-α-
ketoglutarate9-16 mg daily
Biotin and Pyridoxine improve the glycemic
response
To prevent mineral deficiencies which impair To prevent mineral deficiencies which impair glucose toleranceglucose tolerance
To prevent mineral deficiencies which impair To prevent mineral deficiencies which impair glucose toleranceglucose tolerance
Nutrient Recommended daily dose Comments
Magnesium 400-600 mg daily
Magnesium deficiency is common in diabetes
supplements may help control blood glucose and protect
against C.V. diseases.
Calcium 1 g daily
If enough calcium is provided in the diet, supplemental calcium
is available in tablets containing calcium carbonate or calcium citrate. Calcium is essential to
prevent osteoporosis.
Zinc220 mg daily
Deficiency of zinc due to urinary losses impairs the
ability to control blood glucose.
To prevent or minimize diabetic neuropathyTo prevent or minimize diabetic neuropathyTo prevent or minimize diabetic neuropathyTo prevent or minimize diabetic neuropathy
Nutrient Recommended daily dose Comments
Acetyl-L-carnitine 1-3 g daily Supplements are beneficial in treating neuropathy
alpha-lipoic acid 0.6- 1.2 g daily An antioxidant which is useful in treating
neuropathy.
Primerose oil ( containing gamma linoleic
acid ( GLA)2-4 g evening
primerose oil dailyBeneficial in treatment of
neuropathy
Sodium selenite 100 µg daily An antioxidant
Vitamin B-complex
High potency supplement containing at least 50 mg thiamine ( vitamin B1) and
vitamin B6
Beneficial in treatment of neuropathy
To inhibit platelet hyperaggreabilityTo inhibit platelet hyperaggreability To inhibit platelet hyperaggreabilityTo inhibit platelet hyperaggreability
Nutrient Recommended daily dose Comments
Taurine 500 mg tds Decreasing thrombosis risk
Vitamin E 1200-1600 IU daily Decreasing thrombosis risk
To decrease albuminuriaTo decrease albuminuria
To decrease albuminuriaTo decrease albuminuria
Nutrient Recommended
daily doseComments
Vitamin C+
Vitamin E
1250 mg +
680 IU daily
Beneficial to reduce albumin
excretion ( micro-& macro-
albuminuria)
Herbs and diabetes mellitusHerbs and diabetes mellitusHerbs and diabetes mellitusHerbs and diabetes mellitus
American gensing improves postprandial glycemiaAmerican gensing improves postprandial glycemia
Garlic and onions stimulate insulin production Garlic and onions stimulate insulin production
Guar gum and aloe vera slow glucose absorption.Guar gum and aloe vera slow glucose absorption.
Among herbs modifying blood glucose levels: dandelion, Among herbs modifying blood glucose levels: dandelion,
cinnamon, fenugreek, green and black teas, nutmeg, cinnamon, fenugreek, green and black teas, nutmeg,
cloves, mushrooms, and brewer’s yeast.cloves, mushrooms, and brewer’s yeast.
American gensing improves postprandial glycemiaAmerican gensing improves postprandial glycemia
Garlic and onions stimulate insulin production Garlic and onions stimulate insulin production
Guar gum and aloe vera slow glucose absorption.Guar gum and aloe vera slow glucose absorption.
Among herbs modifying blood glucose levels: dandelion, Among herbs modifying blood glucose levels: dandelion,
cinnamon, fenugreek, green and black teas, nutmeg, cinnamon, fenugreek, green and black teas, nutmeg,
cloves, mushrooms, and brewer’s yeast.cloves, mushrooms, and brewer’s yeast.
Thank YouThank YouThank YouThank You