Advanced OB-GYN News

Omega-6’s vs Omega-3’s

By Joseph Hazan,M.D., FACOG

Linoleic acid (LA) which is an omega-6

fatty acid and Alpha-Linolenic acid

LnA) which is an omega-3 fatty acid are

both needed in the diet since neither

can be produced by the body.

That is why they are called essential fatty

acids.

On the other hand EPA , DHA and AA

can be produced by the body and

they are nonessential fatty acids.

DHA and EPA wich was covered earlier

this week are long chain

polyunsaturated fatty acids (LC-PUFAs)

The input of omega-6 fatty acids are important

in inflammation, clotting,

cell communication and delivery.

Omega-3 ‘s are useful in counter- balancing

the effects of omega-6’s.

The effect of DHA and EPA is to prevent

prematurity and increase fetal birth

weight.

That is why many women who have

premature delivery have a deficiency

of omega-3’s and increased levels of the

omega-6’s, namely the omega-6

AA (arachidonic acid) and DPA

(docosapentaenoic acid).

Also women with PIH (pregnancy

induced hypertension) have low levels

of omega-3’s.

Preeclampsia risk is also higher if the levels

of omega-3’s are low.

These levels must be increased prior to pregnancy

to provide benefits.

A 15% increase of the ratio of omega-3’s

versus omega-6’s was found to cut

the risk of preeclampsia by 46%.

The supplementation needs to begin prior

to conception in order to be effective against

preeclampsia, PIH (pregnancy

induced hypertension) and IUGR

(intrauterine growth restriction).

When infants have adequate DHA

intake prior to birth, they then have lower

risk of type 1 diabetes, better endocrine,

immunity and heart function later

in life.

Also maternal dietary DHA while

breastfeeding confers improved retinal

and brain development to the infants.

Best sources of DHA are deep ocean

fish that feed on specific algae called

Schizotryum that are found in the deep

ocean.

These algea are also grown

in large containers and used to enrich foods.

Salmon and sardines are good

sources. Fish oil, flaxseed oil and walnut oil

are rich in omega-3’s.

Daily recommended values (DRVs) are

at least 300 mg of DHA and EPA

daily during pregnancy, 20mg per kg for t

erm infants and 40 mg per kg

for preterm infants.

REFERENCES

1) Williams MA, Zingheim RW, King IB,

Zebelman AM. Omega-3 fatty acids in

maternal erythrocytes and risk of

preeclampsia. Epidemiol. 1995;232-237.

2) Carlson Sr, Workman SH, and Tolley EA.

Effect of long-chain n-3 fatty

acid supplementation on visual acuity and

growth of preterm infants with

and withourt bronchopulmonary dysplasia.

Amer J Clin Nutr. 1996;63:687-

607.

HAPPY NEW YEAR

HAPPY AND HEALTHY NEW YEAR TO ALL!

DHA and EPA

By Joseph Hazan,M.D., FACOG

According to recent research, nutrition

during pregnancy should include

the Omega-3 fatty acids DHA and EPA.

These are important to help the

development of the fetus, prevent

prematurity and improve brain

development.

Most diets are deficient in these nutrients.

Fish oil is a good source

and the supplementation of DHA

(docosahexaenoic acid) and EPA

eicosapentaenoic acid) will supply these

Omega-3 fatty acids.

The problem with most diets is the high

content of Omega-6 which

is found in fried and fast foods, milk and meats).

The Omega-6 fatty

acids, namely Linoleic acid (LA) is converted

into Arachidonic Acid (AA)

which in turn cause constriction of vessels,

activation of platelets and clot

formation and inflammation.

This is not beneficial to circulation.

On the other hand the Omega-3’s help do

the opposite and are beneficial.

It is known that if the mother is deficient in Omega-3’s,

the baby tends to be premature.

The vital role of Omega-3’s is attested by the

fact that Omega-3’s help

attain full birth weight, reduce prematurity,

enhance maternal milk

quality, improve the development of

fetal brain and eyes.

Additionally Omega-3 ‘s help relax the

uterine smooth muscle cells and vessels during

pregnancy. For the mother and adults the

Omega-3’s help prevent heart

disease.

To provide adequate intake it is recommended

that adults have at least

2 servings of fish every week.

DHA and EPA intake should be 300 mg

of each daily.

REFERENCES

1) Hornstra G. Essential fatty acids in

mothers and their neonates. Am J

Clin Nutr. 2000;71:1262S-12629S.

2)Mc Gregor JA, Allen, KGD, Harris, MA,et al.

The omega-3 story:

Nutritional prevention of preterm birth

and other adverse pregnancy

outcomes. Obstet Gyn Survey, 2001;

56:S!-S13.

OMEGA-3

By Joseph Hazan,M.D.,FACOG

OMEGA-3

Preterm birth is an ongoing problem in the US. Babies who are born too

early weigh less than five pounds and between 1980 and 2000 the number

of low birth weight infants has increased by 11.8%. The number of very

low-birth weight infants who weigh less than three pounds have increased

even more, by 24.3%.

Prevention of Prematurity

To prevent the prematurity problem several strategies have been

under development. One of these have to do with improved nutrition

of the mother. According to the SNSIG, a group tasked with nutritional

guidelines during pregnancy, increased intake of Omega-3 fatty acids is

currently recommended. Daily intake of 300mg EFA (essential fatty acids) is

recommended. Omega -3 fatty acids include the following

and more coverage will be provided to this issue in the next few days:

LNA – Alpha Linoleic acid

EPA- eicosapentaenoic acid

DHA-docosahexaenoic acid

The Obesity Epidemic and Metabolic Syndrome

By Joseph Hazan, M.D., FACOG

The problem of obesity has now reached

epidemic proportions in the US

and is the single greatest healthcare problem

and the most expensive in

its effects.

The Metabolic Syndrome which is a

consequence of the obesity epidemic

is alarming with increased insulin resistance,

hypertension, blood profile

that is prone to clots, low- level of vessel i

nflammatory response which

causes thrombosis, atherosclerotic

cardiovascular and cerebrovascular

disease.

This results in higher rates of type 2 diabetes,

hypertension, heart attacks,

stroke, venous thromboembolism

(impaired and blocked blood flow),

nonalcoholic steatohepatitis, cirrhosis,

liver failure, sleep apnea, gout,

depression, decline in mental and

psychologic function, cancer and early

death.

Metabolic Syndrome is most common

among the over 50 group with

more than half of women in this age

group now being effected.

Especially among the Native Americans and

Mexican Americans it is very high

(about 70%).

The rate is steadily increasing among other

ethnic groups and since 1988 the prevalence

has increased by 150%.

It is associated with decreased physical activity,

high carbohydrate intake,

smoking and low socioeconomic status.

Lifestyle modification, diet and exercise is

needed to change this trend.

HDL, Triglycerides, Fasting Blood Glucose,

Blood Pressure, Obesity

are all related and addressing the obesity

problem is key to dealing with

the Metabolic Syndrome.

Weight Loss is the key to helping reduce all of

the related health problems.

ROBOTIC SURGERY

By Joseph Hazan,M.D., FACOG

Microinvasive and robotic surgery

provide improved precision and shorter

recovery.

The da Vinci Surgical System was introduced

in 1999 by Intuitive Surgical

and has gain wider acceptance.

The surgeon sits at a console and robotic arms

are used to produce the

finer movements that are required for

dissection, suturing and knot tying.

The precision achieved is due to the

magnified three-dimensional view

and reduction of hand movements to half

or one third of the original.

Instruments of the robotic system

bend at the tip to provide the wrist

motions.

This system allows surgery for very obese

patients especially those with endometrial cancer.

Obesity is a major risk factor for any

surgical procedure.

Obesity also predisposes to uterine cancer due to

the estrogens produced by the fatty tissues.

These estrogens are responsible in the

development and growth of endometrial cancer.

This, coupled with the fact that obesity and

metabolic syndrome is now

the greatest health problem faced in the US,

makes the robotic approach

ideally suited.

Healthy Foods

By Joseph Hazan, M.D., FACOG

The following foods are listed in

alphabetical order and have beneficial

effects on your health:

APPLES contain antioxidants that

help prevent free radical damage.

They help protect your lungs by

providing quercetin.

Also by eating two apples daily the

acetylcholine in the brain is boosted.

This neurotransmitter is important in

memory function.

BANANAS help fight off H. pylori which

cause stomach ulcers.

BARLEY helps lower LDL cholesterol

and triglycerides.

BLACK TEA helps prevent skin cancer

by providing polyphenols.

BLUBERRIES help decrease the risk

of colorectal cancer by one third.

This benefit is due to the antioxidants

called anthocyanins.

BROCCOLI helps prevent osteoporosis

because it contains vitamin K.

Eating three ounces of broccoli daily

provides this benefit.

BROWN RICE helps protect your lungs

from asthma because it has

Selenium which lowers free radicals.

CAULIFLOWER helps prevent breast

cancer by providing sulforaphane.

Best served steamed.

CARROTS help protect the skin against

free radical damage by providing

beta-carotene.

They also help protect the eyes from cataracts.

A cup of carrot juice daily can provide this

benefit.

CHINOOK SALMON helps prevent Alzheimer’s

by providing niacin.

CITRUS helps prevent skin cancer by providing

d-Limonene.

COLLARD GREENS help protect from macular

degeneration and cataracts.

Aim for two servings of collard greens and

spinach daily.

Best served cooked.

GRAPES help prevent heart disease by

providing antioxidant polyphenols.

OLIVE OIL please see the entry here

two days ago.

ORANGES help prevent osteoarthritis

by providing vitamin C.

PEARS help protect the lungs by providing

quercetin.

PINTO BEANS help lower LDL cholesterol

by providing beta-glucan.

POPCORN helps prevent diverticulosis

and diverticulitis by providing

fiber.

TOMATO helps protect the skin and breast

by providing lycopene which is

an antioxidant.

TUNA helps protect the skin by providing

selenium which is an antioxidant.

WALNUTS help protect the retina against

macular degeneration by

providing omega-3.

Mediterranean Diet

By Joseph Hazan,M.D.,FACOG

Mediterranean diet confers health

benefits which are being studied.

For instance Olive oil contains

polyphenols that are shown to lower

blood clot risks by decreasing the

stickiness of platelets.

These polyphenols also act as

anti-inflammatory.

The Mediterranean diet which

contains extra virgin olive oil and

omega-3 fatty acids from fish

confer anti-cancer, anti-heart disease,

anti-diabetes, anti-osteopenic

and anti-arthritic benefits.

The metabolic pathways for this

protection are attributed to substances

like tyrosol, hydrotyrosol, hydrotyrosol

acetate, oleuropein.

REFERENCES

1) Int J Molecular Med 2008 Oct;22(4):433-9

2) Int J Cancer. 2008 Feb 1;122(3):499-500.

3) Eur J Cancer Prevention 2009 Feb;18(1):33-9.

4) Intl J Oncology 2009 Jan;34(1):43-51.

5) Current Opinion Pharmacology 2009 Aug;

9(4):405-10.

6) Surg 2009Jun;7(3):174-80.

7) J Nutritional Biochemistry 2009 July17.

Healthy Nutrition and Olive Oil

By Joseph Hazan,M.D., FACOG

Healthy Nutrition is based on research done

to help promote health.

We will start with the health benefits of olive oil.

A study published this year showed that olive oil

polyphenols and omega 3 fatty acids in fish will

help reduce atherosclerosis between 54% and 61%.

Olive oil increases the HDL (beneficial) cholesterol

and lowers LDL and triglyceride levels.

The mechanism and other benefits of olive oils will

be covered tomorrow.

REFERENCES

1) Nutrit Review 2009 May;67 Suppl 1: s126-9

2) Nutrition 2009 May;25(5):548-54

Abnormal Uterine Bleeding

By Joseph Hazan,M.D.,FACOG

This includes heavy bleeding and

irregular periods.

Spotting, cycles that are closer than

three weeks apart can occur.

Prior to menopause or following menopause

abnormal bleeding can be a problem.

Some of the causes are:

Smoking

Obesity

Chlamydia infection

Pregnancy

Incorrect use of birth control pills

Fibroids

Polyps

Malignancy

Endometriosis

Adenomyosis

Clotting factor deficiencies

Thyroid dysfunction

Kidney disease

Hormonal factors

Treatment depends on the identified

cause of abnormal bleeding.

Most commonly medical management is effective.

In some situations D & C (dilatation and curettage)

or polyp removal is needed.

Endometrial Ablation, Myomectomy, Uterine Artery

Embolization and Hysterectomy are some of the

surgical procedures.

Advanced OB-GYN News

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Omega-6’s vs Omega-3’s

HAPPY NEW YEAR

DHA and EPA

OMEGA-3

The Obesity Epidemic and Metabolic Syndrome

ROBOTIC SURGERY

Healthy Foods

Mediterranean Diet

Healthy Nutrition and Olive Oil

Abnormal Uterine Bleeding

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