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Science for Better Nutrition
Breast Feeding - The Gold Standard
Talk to me! Breast Feeding - A 3D Experience
Workshop Report, Orissa, 30th-31st, July 2}fi.
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Panel Discussion: Talk to Me! Breast Feeding
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The panel discussion on Talk to Me ! Breast
Feeding A 3D Experience, focused on
communication as a strategic tool connecting
various layers, levels, sectors and stakeholders to
improve the status of breast feeding rates in the
country. Dr. Shanta Ghatak, Director - Bhoruka
Public welfare Trust moderated the panel
discussion which had representation of health
care experts from varied fields like public health,
scientific, regulatory, medicine, govt., NGOs
etc.
The panel members included - Dr. Shubhamay Dutta Chowdhury, DHS, West Bengal, Dr.
Soumendra Nath Banerjee, DME, West Bengal, Dr. Kashinath Nath Nayak, DHS, Orissa, Dr.
DK Raman, ADHS, Bihar, Dr. P Borah, State Programme Manager, Assam, Dr. Madhumita
Dobe, Director-AIIPH, Dr. Biplab Nandi, EX-Senior FAO, UN and Dr. Sanjeev Ganguly,
Medical Director, Nestl6 Nutrition-South Asia.
Panel Dr'scussion
General Question: This year's theme "Talk to me! Breastfeeding - a 3D Experience" is aimed at
promoting not only breastfeeding support but also communication at various levels and between
various sectors. How do you think this could be achieved and what are the communication
strategies which would help in realizing this objective?
Dr. Subhamay Dutta Chowdhury: The focus must be on integrating the various ava ilable
resources since creating newer ones will not help when the govt. has already rolled out good
impactful initiatives to promote breast feeding in the country. We simply must align and thru, a
co-ordinated strategy should develop communication tools on effectively piomoting and
supporting breast feeding. This will be achieved if all concerned stakeholders come togeGr and
focus on communicating the benefits of early initiation of breast feeding and its later health-
nutritional outcome. We must start early with our school going children and concomitantly move
towards educating the care givers. Also, support to the mother must come from home,
community and the society atlarge. To achieve this we must do our bit to educate the influential
sections of the society especially when it comes to advising the mother for or against breast
feeding.
Dr. Soumendra Nath Banerjee: If we look at the existing health care system in the country
there are the primary, secondary and tertiary health sefups. To ensure proper orientation and
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Science for Better Nutri-tion
promotion of breast feeding, baby friendly clinics must be setup in these health setups which
must remain fully functional. This would not only enable creating awareness which is so very
essential for propagating the importance of breast feeding. Also, in every health centre we must
have breast feeding counselors to impart training to the health care providers to effectively
communicate on Breast Feeding. This is one way which might help in strengthening
communication strategy on breast feeding.
Question 1: When we look at breastfeeding support, we tend to see it in two-dimensions: time
(from pre-pregnancy to weaning) and place (the home, community, health care system, etc). But
neither has much impact without a THIRD dimension - communication! The question is how do
you do that in a country like India and perhaps in Orissa?
Dr. Kashinath Nayak Before I come to the question let us look at certain figures on Breast
Feeding in its relation to Orissa - Breastfeeding in one hour is only 30Yo and exclusive breast
feeding till 6 months is 60% which means early initiation of breast feeding still remains a huge
issue and a challenge for us. Now, coming to the question when we look at breast feeding we
tend to see it terms of only time and place but do pay much importance to communication which
is an overarching strategy connecting both time and space. To ensure that communication starts
early we must focus during the adolescent phase and ensure that the right information and
messages must reach out to all the beneficiaries including mothers, health care providers and
policy makers. To support with the arduous task of building communication strategy we must
focus in the 3 areas - (a) Build partnerships involving the Govt. (b) Enable Capacity Building
and (c) Knowledge Sharing. If we could do this, I am sure we will see marked improvements in
the breast feeding rates in Orissa and the country as a whole.
Question 2: The 3rd dimension - communication includes cross-generation, cross-sector, cross-
gender, and cross-culture communication and encourages the sharing of knowledge and
experience, thus enabling wider outreach. How do you create this communication network and
wider outreach? And who do you think would be the major players to drive this intervention
strategy? What do we need to know and what are the Communication Actions for Breast Feeding
and Right Feeding Practices?
Dr. Madhumita Dobe: These are a number of questions put together which might seem like a
tall order but essentially summarizes - what we must do about it and what we are here for today.
For years together we have been talking about breast feeding on how we can promote, support
and protect breast feeding. Now, it may be a good time for us to reflect and see what we have
done 'right' and what we have done 'not-so-right', which will provide a necessary backdrop for
us to move forward in right earnest. We could categorize our communication strategy as -
Communication to Promote, Communication to Support and Communication to Protect. Mass
media is an extremely potent tool when we talk of promoting and supporting breast feeding, it
must be done in a more techno-sawy and market friendly manner to have that outreach which
we expect. Media will be a very important stakeholder in this crusade to protect and promote
breast feeding. I do not agree that only knowledge will help with promotion and protection of
breast feeding. However, having worked with health behavior for so long I can safely say - What
the mind does know, the heart in hand cannot always do because there are other supports
required to make the environment conducive for promoting and supporting breast feeding. This
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is where good maternity facilities and communication on appropriate maternal nutrition should
begin, communication in work places, communication in schools and communication in other
sectors come in a big way both from the provider and the consumer end as well. Now to do that
interpersonal skills are extremely important e.g. doctor or mrse counseling the patient,
employing trained lactation counselors in special clinics, support in work places etc. This is very
labor intensive and very resource intensive which we need to think about if we were to move
forward. May be here we need to focus in areas which would give tangible results and this is
indeed a tall order. On the other hand raising consumer demand is more doable and this requires
the Community participation. In the past wherever we have witnessed significant results
Community has played a key role since they bought in the idea and participated more actively
which has lead to community policing, mother support groups, peer support groups which have
far more outreach, is affordable and acceptable. Next in order is to have strong policies which
would support some of the wonderful plans we have since policy making is also a form of
communication and advocacy for the policy is equally important else everything would faII apart.
This would mean impressing upon the policy makers and program managers on what is right and
wrong and also guiding them on the correct strategies. Now as we talk of initiation of breast
feeding we also need to involve the private parties as this would mean policy alignment,
transparency and accountability in operation. We have also seen that numerous opportunities are
lost during immtnization, anti-natal or post natal check-ups. This corresponds to time and place
and I believe we must have those checks in place which essentially is intensif,iing
communication efforts in time and places available to us wherever there is an opportunity to
communicate.
When we talk of cross-sector, cross-gender, and cross-culture communication - we need to
involve and bank on the young generation and treat breast feeding as a social nofin. To further
build the communication intensity on breast feeding we would need to include both the
organized and un-organized sector since it is here that things often go wrong. Simply promotion
of breast of breast feeding will not help; we need to create good support mechanisms, strong
policies and good communication strategies to promote and support breast feeding.
Question 3: Bihar Govt today has initiated a lot of projects on promoting Breast Feeding and
appropriate Infant Feeding practices and there has been marked improvements in accessibility to
proper health services and better health outcomes. Could you share with us some of the policies
and work happening in this area? Also, how do you think Bihar as a state will be able to achieve
the child survival goals (MDG l&4)?
Dr. DK Raman: Bihar Govt. has initiated a number of projects to reduce infant mortality and
improve child survival goals as per the MDGs within which breast feeding is an extremely strong
focus area. We have rolled out pilot projects thru' which we have identified three districts to run
the 'Mamta Project'. The Mamta workers come from the same village within a radius of 3 km
and are posted at hospitals and sub-divisional health centres to take care of the mothers and their
new borns. The Mamta workers are trained midwives to support the mother from the beginning
of pregnancy till discharge with counseling of mothers on breast feeding following which the
Asha workers visit the mothers thereby promoting access to improved healthcare at household
level. Also, with the help of UNICEF, Bihar Govt. has developed a health module to train the
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health workers and doctors on breast,feeding.and-appropriate
i1fr* feeding practices. This aparta.number of initiatives were undertaken by"the G;;.;:g. 2010 was declaied as the year of the'New Born" deploying around 609 ambulances with'ulfrn. medical iu.ititi"r, free care for themother and child upto 45 days after delivery, aeaicateJaoctor in.urr.rr.urtr, facility to monitorthe infant being fed mother's milk within tt
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trt rr"rt ut* a.rirr..ylir. inrrit iorrul delivery inthe state has also gone up by 42%. These initiatives uno ,rr. strong commitment of the Govt.
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Question 4: Every year, two million Indian children die before their fifth birthday, most of themfrom preventable causes' Global evidence rrro*, trrut in. developing countries, optimaibreastfeeding is the most important child survirrui int"*ention and^ thJ earlier the baby isbreastfed' within the first trour oruirttr,
lhe !9tt_e1.
ilil these efforts, the results have not beenas per expectation' Sir, you have served with unitea'Nations and have a global perspective onthis' could you share with us the strategies
tha] qy h;lp in.improving breast feeding rates andappropriate feeding practices in the country? cun *. think or ro"oo security before foodaccessibility since this apparently is a serious irru. ut tt. moment?
Dr' Biplab Nandi: At the onset, let.me.tak. thi, opportunity in thanking Nestl6 NutritionInstitute and the organizers or ine. workshgn--r"-r ii"tiaing us with a platform and theopportunity to talk, express and most importantly communicate. Now, coming to the question letme assure you that optimal breast feeding is-the biggert .ttutt.nge not only in India but across theglobe notably in the developing and the unaer devlTopeJcountries. Having worked very closelywith a number of health tutt gtoups in variour .outirri., it is most ...tui-n irrut only strategieswill not help, infact we must dEvelop communication strategies to ensure better execution of theexisting strategies' For this to happen communication must be specific,
"*t"rtoul,
simple andinteresting' The communication strategy must not only be educative but entertainmentbased"'this is what I call 'Edutainment'.-fhere are;;";; ways to do this one of which is thru,media (print and electronic), comic strips, p"r,.i."-p"igr with interesting themes, soft toys etc.I am sure we will
T93Tv interesting ways of commun-icating these messages to the mother onBreast Feeding. I will turrhir touch on"thi, iuring 6;;;;*ration.
Now' coming to second.part of the question-let me say that the first food security comes frommother's breast milk which essentially is the first immJnJation for the child. Thus when we talkof food security it is part of food accessibility una trr.r. *. dimensions to ii which requires abroader understanding! For the more than 80"0 ;ilil;';*ply
-who_
do not get enough regular,healthy food, ill health and a shorter life expectancyL.i."irists. ctrii6,ln,?rrd
"rp""ially
veryyoung children' who suffer from food
ry..*ify; *iii f. r.r, developed than children of thesame age who have had sufficient food. They wiil'mori rit.rv be shorter arJ-*"igt less, and beless able physically. and intellectually, because of poor nutrition. In short rooa security means -
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Question 5: India was on the first countries to-recognize the merits of primary Health careApproach (PHC)' In 2005, the Government of India-had launched the National Rural HealthMission (NRHM)' It reaffirms the political *il,"I.i.".Jpublic health fund allocation to 2-3%

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Science for Better Nutrition
of GDP from existing allocation of 0.9%o of GDP. The NRHM programme aims to bring down
the MMR and IMR through the various schemes - Asha, JSY, mother and child tracking, MMU
and EM|.I etc and is seen as an enabling financing mechanism for strengthening state health
systems and health sector reform. How far have you been able to achieve the goals and What
needs to be done moving ahead?
I)r. Prem Nath Borah: In our state following the initiation of NRHM 2005-06 policies, we are
trying to address the most vital health care indicators like MMR, IMR and TFR in the state with
support from the dtate govt. In so far as MMR ratio goes this indicator is of extreme importance
to us, as in 2001-09 MMR was around 39011 lakh live birth according to registrar general of
India. However with certain interventions the Govt. has been able to address the high MMR rates
in the state. There were many reasons for high MMR rates, one of which was delay in decision
making and low percentage of institutional deliveries. Thus the Govt. thru' a strategy of micro-
birth planning and anti natal screening have managed to bring down the MMR rates. The Govt.
of Assam has launched schemes like Mamoni during the anti-natal period for mothers who are
payed Rs. 1000 during the first check followed with payment of Rs. 500/- in the 2nd and 3rd
checkups. The mothers are also given the 'Mamoni Booklet' which provides complete
information during pregnancy with highlights on the Do's and Don'ts for better pregnancy
outcomes. Also, to bolster institutional deliveries which earlier had been a grave concern for the
government,'Marrrata' scheme had been introduced to reinforce proper care for the mother and
child. The 'MamataKit' is given to mothers who are present in the hospital for 48 hours or more
after delivery. The Mamata kit contains blankets, napkins, new born care kits etc immediately
after delivery. Also, in order to improve IMR each institution will have a stabilizing unit which
will enable stabilizing the newborn post which the child will be moved to a Sick Newborn Care
Unit for advanced medical and nutrition care.
Question 6: The communication initiative to promote breastfeeding will depend much on which
pre-emergency partnerships you have established, for instance with healthcare providers,
community groups, community health workers, maternity caregivers, school and youth groups,
government agencies and other relevant stakeholders including Civil Society Organizations. Do
you agree with this and could you please share some light on the work happening in this area in
the state of West Bengal?
Dr" Shubhamay Dutta Choudhury: This is a priority area for us in the state of West Bengal
and there are various stakeholders like the maternity care givers, civil society organizations and
others who would have to take responsibility and play an important role in promoting breast
feeding in the state. The proportion of institutional delivery in West Bengal has registered an
increase from 56.3%o in 2004 (NSSO-200 4) to 60.2 in 2009 , 7 lo/o in 2010-ll whereas 28Yo of all
births in India occur in institutions as on 2003. So, the health care providers attached to institutes
are extremely important when it comes to interacting with the mothers and so they must be
empowered and equipped with appropriate knowledge in this area. With proper knowledge the
health care providers can than guide the important stakeholders and mothers by imparting
training and education on good maternal and child practices. Though, we have made good
progress yet more needs to be done in this area since just imparting knowledge is not enough.
Organizations Nestl6 Nutrition Institute too could play a major role and should bring out posters,
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educational materials and inputs pertaining to breast feeding. This will enable expanding access
and. increasing awareness. Further expansion will inclid" ,t
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of facilities forinstitutional deliveries. Emergency obstetric and child care Services (Emoc) has been giventhe highest priority in most of the health policies and programmes. Schemes like JananiSurskshya Yojana have been launched to imirove institutional deliveries and thereby reduce
maternal and infant mortality.
Question 7: This refers to an article published by American Academy of pediatrics on April 12,2010 - Multiple studies have revealed inadequacies in breastfeeding education during residency,and results of recent studies have confirmed that attitudes of health ivorkers toward breastfeeding
are deteriorating' The sfudy showed that aresidency curriculum improved physician knowledge,practice pattems, and confidence in providing breastfeeding care and was associated withincreased breastfeeding rates in patients. oo you think in India and west Bengal in particular
there is an urgent need of a targeted breastfeeiing curriculum for residents in pediatrics, familymedicine, and obstetrics and gynecology? could we have a private & Govt partnership in thisareato roll out a residency curriculum?
Dr' soumendra Nath Banerjee: There are two parts in the question - one is on the curriculumand the second part is with regards to the private-govt. partnership. on the first part let me saythat breast feeding education is already undertakeriat the undergraduate and post graduate level,so the focus point is not on having sufficient knowledge or the curriculum not in existence! Infact the worry is that of all the knowledge we tturr. .Fi".tive implementation of the strategies
remains a major challenge and concem. Strategies and plans can be drawn, but this will not meanmuch till the point we-all
ltart working with a single -irra.a approach to i-prorr" the scenario.This will come through effective corlmunication it all levels, developing simple messages andunderstanding the underlying issues or challenges. Also, to achieve better results the states could1o91-r at starting a Tor (training of th-. traine-rs) progr* for nurses, pcr, :.rrrror doctors andpublic health workers which will enable translaiion oT tn. knowledge into aition. we must ridourselves of the preconceived notions and prejudices held against brJast f."Ai"g. vrvtfo;r;;;shattered and a one point agenda of prombtion, protection and supporting breast feeding mustbegin!
Now, coming to the second point of having public and private partnership - we know that govt.alone will not be able to ensure widespiead change iitt th"i" is effective participation andinvolvement of all concerned stakeholders. Private-iublic partnership is thus welcome and, itmust be seen as a key enabler towards- improving breast_ feeding and appropriate feedingpractices in the country. The partnership howlver nleds to be of an academic nature whereinsharing of knowledge and expertise *.rrib. encouraged.
Question 8l How do you think Nestl6 Nutrition Institute could help in supporting breast feeding
and promote breast milk as the optimal form of infant nutrition? Do you see specific areas forNestl6 Nutrition Instifute to work with legislators and policymak.r. o1 ways to increase breast
feeding rates in the special supplemental nutrition p.ogru- for women, inf#s and children?
Dr- Sanjeev Ganguly: When we see
involve, this gives us a huge amount
around and look at the stakeholders we have been able to
of satisfaction since we had been facilitators in bringing
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people working in the policy side, health care, academicians, scientists etc in a workshop of this
kind. This is one area we see a huge amount of scope and potential moving forward we would
like to further strengthen the scientific engagement to build knowledge and capacity!
On the other hand,.ItrNI is spreading and disseminating scientific information, and we have doing
a lot of activities to promote and encourage breast feeding in the recent past and will continue
doing so in the future as well. Also, as Dr. Banerjee was mentioning, we need to actively
participate in TOT and targeted programs with the Govt. and Policy Makers which will help
reach out to a wider section of the society. If there is a think tank, we would be very happy to
participate , partner in that provided the information provided is scientific and credible! This apart
we would like to play a role in strengthening the communication strategies to improve breast
feeding and ensure better matemal and child outcomes.
Also, we must pay attention to the kind of messaging that is done and ensure the source whether
it is the doctor, nurse, dietetician, asha worker, care giver etc. focus on the same message. Media
can also be a very important source to spread the communication messages to promote, support
and protect breast feeding. And we should make the best use of the media in spreading the right
message. Moving forward, all stakeholders must sit together, brain storm, discuss and ensure that
all are aligned and speak the same language so that no conflicting messages are given
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Nutrition and fnfestion
It is clear that suboptimal nutritional status
anorexia and reduced diatary intake may lead
i.e. adult onset of fetal disease if looked from
born as malnourished.
Dr. shanta Ghatak is the Director, Bhoruka public welfare Trust,
India.
Nutrition is an exact science. Its glossary, its principles and practice
needs the perfection as required in rocket science. For example, effect
of under nutrition and its spectrum is qualitatively different from that
of malnutrition. Both are different termi with different implications. In
white Hall studies re,garding Inequalities in Health understanding
basic aspects of nutrition, access to it and its utilization followed i
social gradient and were one of the important factors of morbidity.
Nutrition plays a predominant role right from the beginning during
any infectious process. zinc supplementation from ttre ueginning iimany types of infection comes under evidence based medicine. Same applies for folate and Vit.
A and Vit C. The negative energy balance is the ultimate consequence-of malnutrition. Among
many things it leads to up-regulation of hepatic ALA synthurJ l, as a result of the loss ofcarbohydrate repression of this rate controlling enzyrne for heme synthesis in the liver.
Treatment is repletion, using haematin as substrate.
In a recently conducted study where 1004 patients with AIDS were treated with ART and where
virologic response rate of 76% (with a response defined as <400 copies or rrrv RNAs per
milliliter) was comparable to that of 68% of a Baltimore clinic despiti high rates of poverty,
malnutrition and tuberculosis in populations of African origin. The most important treatment
limiting factor was anemia. In pediatric population there *a, no significant difference in between
children with or without tuberculosis.. The-most important outcome of this study was the
evidence that malnutrition was a critical factor in lnfection progression in ,..o*". poo,
countries. In that cohort low base line body weight was an iniep-endent predictor of death.
Therefore a daily multivitamin supplement to all the patients on ART was provided along with a
monthly stock of rice, beans and vegetable oil to the most undernourished patient.
Following are the major concern of nutrition and infection -
The critical event that by which infections lead to malnutrition and malnutrition interferes
with host defcnses have been the subject of intense study in past 20 years.
Infection not only increases nutritional requirements but also simultaneously reduce
dietary intake are now being defined.
resultitg from recuffitg infection with associated
to impaired host defense. Berkeley's hypothesis:
an Indtan context says basically Indian people are
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infectious agents, prJgression of chronic infection such as HIV and transcriptional regulations of
inflammatory genes that may determine the outcome of sepsis'
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Specific Nutrients and their Role in Immunity
Fat Soluble Vitamins - Ao Do E and K
Vitamin A:
WHO estimates 100 - 140 million children are vitamin A deficient. Implementation of WHO
recommended program of Vitamin A supplementation for all at risk people primarily children
and women ofinita bearing age residing in developing nations has been one of the great WHO
success stories.
Policy on Micronutrient Vitamin A
Regular consumption of dark green leaff vegetables or yellow fruits and vegetables
prevent Vitamin A deficiencY
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Bleast feeding protects against Vitamin A deficiency colostrum rich in Vitamin A
Oral prophylactic dose of Vitamin A
o One dose of 100,000IU to Infants (6-11 months)
o Six months dose of 200,000 IU to Children 1-5 years of age
Treatment of Vitamin A deficient cases
o Single oral dose of 200,000 IU of vitamin A immediately at diagnosis
o Foilow up dose of 200,000 IU, one four weeks later
Therapeutically after some viral illnesses (measles). Epidemiologic studies suggest more than
half of the well nourished measles victims in developed countries will have low serum Vit A
levels despite adequate body stores. Brief high dose of Vitamin A supplementation has been
shown in several trials to reduce morbidity and mortality in measles.
-Although
there is little
debate regarding the effrcacy of vitamin A in populations at high risk for Vit A deficiency, some
have questioned whether Vit A therapy offers any advantage in developed countries where
retinol deficiency is uncommon. The rarity of rubella infection in the developed world suggests
this debate will not be over soon. Similar trials in RSV have provided mixed results. Sonte
demonstrates benefit. Excess produces toxicity. Acute toxic manifestations : headache vomiting
stupor and papillaedema. Chronic toxicity is associated with weight loss, nausea, vomiting,
dryness of the mucosa of the lips, bone and joint pain, hyperostosis and hepatomegaly wiih
parenchymal damage and fibrosis.
Additionally in 1990s, 2 large trials evaluating the role of Beta-Carotene in lung cancer
prevention observed an increased risk of lung cancer in subjects receiving b carotene. There is
further need study the role, of retinoids in human health, immunity before widespread
supplementation with retinoid precursors can be recommended in well nourished populations.
Vitamin E:
Vitamin E plays a role in termination of free radical generated lipid peroxidation chain reactions
particularly in cellular and sub cellular membranes that are rich in polyunsaturated lipids. Vit E
activity is complemented by selenium which as a constituent of glutathion. p"roiidase also
metabolizes peroxides before they cause membrane damage. Vit E supplementati,on has multiple
immunogenic effects , including enhanced T cell proliferation perhaps mediated by suppression
of PGE2 production and enhancing delayed hypersensitivity responsis. Clinical effects of Vit p
supplementation have primarily been studied in the elderly.
Vitamin C:
Most powerful biologic reductant available to cells and provides reducing equivalents for a
number of biochemical reactions involving iron and copper. As a reducing agent ascorbic acid
plays a crucial role as an enzymatic co factor and anti oxidant in a numbir of physiologically
important processes including fatty acid transport, collagen synthesis and neurotransmitter
formation. Vitarnin C plays a role in prostaglandin metabolism and may attenuate the
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inflammatory response and sepsis syndrome. Scurvy (the principal feature of which is impaired
collagen synthesis with signs of increasing capiIlary fragility, bleeding gums, delayed wound
-
healing and impaired bone formation) and an immunomodulatory role with increased resistance
to viral illness and some anti carcinogenic effects perhaps vis reducing T cell apoptosis.
Human trials demonstrate increases in lympho proliferative capacity and phagocytic functions of
peripheral blood neutrophils and a decrease in serum levels of lipid peroxides and cortisol with
Vit C supplementation.
Extreme high doses to be avoided as suppression of T cell proliferation and adhesion and
reduced neutrophil phagocytosis of Candida Albicans has been seen with very high levels of
consumption.
Trace Minerals
Zin*;
Zinc is critical for cell membrane structure, 300 enrymes associated with carbohydrate and
Energy metabolism, protein synthesis and degradation, nucleic acid synthesis, heme
biosynthesis, and COz transport. Deficiency occurs in starvation, PEM, Malabsorption
syndromes, immune-compromised during pregnancy, alcoholism, kidney disease, burns,
inflammatory bowel disease, and HIV.
Selenium:
Seleno proteins (35) critical for redox regulation of key enzyrnes, transcription factors and
receptors. Selenium also acts as an antioxidant with additional immune properties, cancer
prevention. Deficiency is rare and limited to certain regions in China. Supplementation of 200
mu g per day has considerable immune enhancing effect but mega dose therapy may be
associated with reduced immunity.
Iron:
Iron is the most common trace element deficiency worldwide affecting2D-SD% of world's pop
Effects are seen in multiple systems including immune systems. Many immune abnormalities
associated with iron deficiency appear to be reversible with iron replacement but this has been
difficult to demonstrate in human studies.
Fatty Acidsr
3 major groups of dietary fatty acids, oleic, linoleic, linolenic serve as precursors for the
biosynthesis of poly unsaturated fatty acids (PUFAs)
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